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PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SELECT BENEFIT ADMINISTRATORS, INC.(800) 397-0427
SELECT BENEFIT ADMINISTRATORS, INC.
66 FEDERAL CREDIT UNIONAffiliated With: SELECT BENEFIT ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
SELECT BENEFIT ADMINISTRATORS, INC.(800) 397-0427
SELECT BENEFIT ADMINISTRATORS, INC.3001 Westown Pkwy.WEST DES MOINES IA 50266
BUTLER BENEFIT SERVICES(563) 327-2240
CHECK BENEFIT CARDA & D MANAGEMENT CO INCAffiliated With: SISCO/Cottingham & Butler
Fund No:PlanType: Group Health
BUTLER BENEFIT SERVICES(563) 327-2240
BUTLER BENEFIT SERVICESPO Box 3310Davenport IA 52808-3310
THE LOOMIS COMPANY(800) 346-1223
UM NOT APPLICABLEA C HOUSTON LUMBERAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(800) 346-1223
THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011
CHECK BENEFIT CARD CHECK BENEFIT CARDA G ADMINISTRATORSAffiliated With: A G ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
AMERA-NET(517) 631-3469
AMERA-NETA&G/AMERA-NETAffiliated With: AMERA-NET
Fund No:PlanType: Group Health
AMERA-NET(517) 631-3469
AMERA-NET2805 Dallas Pkwy STE 140PLANO TX 75093
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-1• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDABACUS PROJECT MANAGEMENT INC
Affiliated With: ADVANCED BENEFIT SOLUTIONS LLC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
EBMC(614) 766-5800
CHECK BENEFIT CARDABETIC CORPORATIONAffiliated With: EMPLOYEE BENEFIT MANAGEMENT CORP
Fund No:PlanType: Group Health
EBMC(614) 766-5800
EBMC4789 Rings RdDublin OH 43017-1599
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDABRAHAM BALDWIN AGRICULTURAL COLLEGE AIH0057867
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDABRAHAM BALDWIN AGRICULTURAL COLLEGE AIH0057877
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-2• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEABRAHAM BALDWIN AGRICULTURAL COLLEGE UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
ASSURECARE(800) 968-6616
CARELINE(763) 383-4800
ABTREX INDUSTRIESAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823
CHECK BENEFIT CARD CHECK BENEFIT CARDACADEMY OF ART COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
PREFERRED CARE, INC.(215) 639-6208
PREFERRED CARE, INC.ACCESSAffiliated With: PREFERRED CARE
Fund No:PlanType: Group Health
PREFERRED CARE, INC.(215) 639-6208
PREFERRED CARE, INC.6 Neshaminy Interplex #205TREVOSE PA 19053
NHBC(888) 621-7900
CHECK BENEFIT CARDACCESS ADMINISTRATORS , INCAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-3• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Accident Fund Insurance Company of America(517) 367-1771
Accident Fund Insurance Company of America(517) 367-1771
Accident Fund Insurance Company of America
Affiliated With: ACCIDENT FUND OF AMERICA
Fund No:PlanType: Workers' Compensation
Accident Fund Insurance Company of America(517) 367-1771
Accident Fund Insurance Company of America232 S Capitol AveLansing MI 48901-7990
American Administrative Group(800) 877-7474
First Health(800) 346-3220
ACCO ManagementAffiliated With: American Administrative Group
Fund No:PlanType: Group Health
American Administrative Group(800) 877-7474
American Administrative GroupPO Box 93670LUBBOCK TX 79493-3670
P5 E HEALTH SERVICES, INC.(800) 397-3685
P5 PROVIDER REVIEW(200) 633-1988
ACCOR NORTH AMERICA, INC.Affiliated With: P5 E HEALTH SVCS, INC. (MOTEL 6 & RED ROOF INNS)
Fund No:PlanType: Group Health
P5 E HEALTH SERVICES, INC.(800) 397-3685
P5 E HEALTH SERVICES, INC.2455 E. Parleys Way #300Salt Lake City UT 84109
TALL TREE ADMINISTRATORS(801) 274-8100
CORVEL(801) 269-8723
ACE DISPOSAL COMPANYAffiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
TALL TREE ADMINISTRATORS(801) 274-8100
TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDACE INTERNATIONAL UNIVERSITY OF NORTH TEXAS
Affiliated With: ACADEMIC RISK MANAGEMENT
Term Effective: 8/31/2007Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-4• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERACE USA Integrated
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
GLOBALCARE, INC. GLOBALCARE, INC.ACMGAffiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC. GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
ASSURECARE(800) 422-2026
ASSURECARE(763) 383-4800
ACROM PUBLISHINGAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
CHECK BENEFIT CARD CHECK BENEFIT CARDACS BENEFIT SERVICES INCAffiliated With: NATIONAL HEALTH BENEFITS COUNCIL
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
REWARDS ADMINISTRATION CENTER
HEALTH INTERNATIONAL
ACS HEALTH ADVANTAGE PLAN
Fund No:PlanType: Group Health
HEALTH INTERNATIONAL REWARDS ADMINISTRATION CENTERPO Box 10219SCOTTSDALE AZ 85271
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-5• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD8002779476
CHECK BENEFIT CARDACTARISAffiliated With: CORPORATE BENEFITS SERVICE INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8002779476
CHECK BENEFIT CARD
ASSURECARE(800) 968-6616
CARELINE(763) 383-4800
ADAMS-REMCOAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823
FMH BENEFIT SERVICES INC(800) 990-9058
HCM(800) 990-9058
ADKNOWLEDGE, INCAffiliated With: FMH BENEFIT SERVICES, A DIVISION OF CORESOURCE
Fund No:PlanType: Group Health
FMH BENEFIT SERVICES INC(800) 990-9058
FMH BENEFIT SERVICES INCPO Box 25946OVERLAND PARK KS 66225-5946
MARSH ADVANTAGE AMERICA(800) 426-9786
CHECK BENEFIT CARDADVANCE AMERICA CASH ADVANCE
Affiliated With: MARSH ADVANTAGE AMERICA
Term Effective: 9/30/2007Fund No:PlanType: Group Health
MARSH ADVANTAGE AMERICA(800) 949-5945
MARSH ADVANTAGE AMERICAONE W. THIRD ST #900TULSA OK 74103
EBPA(800) 525-8788
CHECK BENEFIT CARDADVANCE MANUFACTURING COMPANY WRAP JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-6• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
ADVANSTAFFAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
ADVANSTAFF TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
CONTACT EMPLOYER CONTACT EMPLOYERAdvantageAffiliated With: ADVANTAGE
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(800) 293-3131
CONTACT EMPLOYER
Attn:
CHECK BENEFIT CARD CHECK BENEFIT CARDAdvantage Consulting ServicesAffiliated With: ADVANTAGE CONSULTING SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
HEALTH PLAN INC(508) 752-2480
CARE MANAGEMENT SERVICES(866) 325-1550
ADVANTAGE GASES AND TOOLSAffiliated With: HEALTH PLANS, INC.
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INCPO Box 5199WESTBOROUGH MA 01581
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-7• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ADVENTIST HEALTH SYSTEM WEST
CHECK BENEFIT CARDADVENTIST HEALTH SYSTEM / WEST-CORPORATE OFFICE
Affiliated With: ADVENTIST HEALTH SYSTEM/WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002
ADVENTIST RISK MANAGEMENT, INC.(909) 353-6800
CHECK BENEFIT CARDADVENTSOURCEAffiliated With: ADVENTIST RISK MANAGEMENT, INC.
Fund No:PlanType: Group Health
ADVENTIST RISK MANAGEMENT, INC.(909) 353-6800
ADVENTIST RISK MANAGEMENT, INC.11291 Pierce St.RIVERSIDE CA 92515-8007
Advocate Case Management(405) 601-2498
CHECK BENEFIT CARDAdvocate Case ManagementAffiliated With: CompIQ
Fund No:PlanType: Workers' Compensation
Advocate Case Management(405) 601-2498
Advocate Case Management809 S Agnew Ste HOklahoma City OK 73108
PARAGON BENEFITS, INC.(703) 279-9218
AMERICAN HEALTH HOLDINGS(703) 279-9218
AEROTRON AIRPOWERAffiliated With: PARAGON BENEFITS INC
Fund No:PlanType: Group Health
PARAGON BENEFITS, INC.(703) 279-9218
PARAGON BENEFITS, INC.PO Box 12288COLUMBUS GA 31917
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARDAFFILIATED HEALTH CARE INC - DIRECT PEPM BUSINESS
Affiliated With: AFFILIATED HEALTH CARE INC
Fund No:PlanType: Group Health
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-8• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARDAFFILIATED HEALTHCARE INC - TRAVEL PEPM BUSINESS
Affiliated With: AFFILIATED HEALTH CARE INC
Fund No:PlanType: Group Health
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
AG SUPPLYAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
CONSOCIATE, INC. C/O CCN(800) 798-2422
CHECK BENEFIT CARDAGRI-FAB, INC.Affiliated With: CONSOCIATE, INC.
Fund No:PlanType: Group Health
CONSOCIATE, INC. C/O CCN(800) 798-2422
CONSOCIATE, INC. C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARDAHI - LOST HIGHWAYAffiliated With: AFFILIATED HEALTH CARE, INC.
Fund No:PlanType: Group Health
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046
AFFILIATED HEALTHCARE INC(713) 914-3400
CHECK BENEFIT CARDAHI AFFILIATED HEALTHCARE NETWORK
Affiliated With: AFFILIATED HEALTH CARE INC
Fund No:PlanType: Group Health
AFFILIATED HEALTHCARE INC(713) 914-3400
AFFILIATED HEALTHCARE INC2 GREENWAY STE 502HOUSTON TX 77046
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-9• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARDAHI METRO AVIATIONAffiliated With: AFFILIATED HEALTH CARE INC
Fund No:PlanType: Group Health
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046
QUALIFIED BENEFIT SERVICES LLC(800) 853-3234
UM NOT APPLICABLEAIR TERMINAL INCAffiliated With: QUALIFIED BENEFIT SERVICES
Fund No:PlanType: Group Health
QUALIFIED BENEFIT SERVICES LLC(800) 853-3234
QUALIFIED BENEFIT SERVICES LLCPO Box 5000SPRINGVILLE UT 84663
PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777
HINES AND ASSOCIATES(800) 866-0105
AKIMEKA, LLCAffiliated With: PREFERRED BENEFIT ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777
PREFERRED BENEFIT ADMINISTRATORS INCPO Box 916188LONGWOOD FL 32791-6188
MEDICAL CLAIMS SERVICES8882250522
INTRACORP(972) 302-2700
AL TYLER & SONS, INC.Affiliated With: MEDICAL CLAIMS SERVICE, INC.
Fund No:PlanType: Group Health
MEDICAL CLAIMS SERVICES(800) 557-1755
MEDICAL CLAIMS SERVICESONE WALL ST STE 2ARAVENSWOOD WV 26164
HEALTHCOMP(800) 442-7247
HEALTHCOMP(800) 755-7247
ALAMEDA HOSPITALAffiliated With: HEALTHCOMP TPA
Fund No:PlanType: Group Health
HEALTHCOMP(800) 442-7247
HEALTHCOMPPO Box 45018Fresno CA 93718
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-10• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GROUP & PENSION ADMINISTRATORS(800) 827-7223
CHECK BENEFIT CARDAlamo Cement (TRAVEL)Affiliated With: GROUP & PENSION ADMINISTRATORS
*
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
CONTACT EMPLOYER CONTACT EMPLOYERAlaska National
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER CONTACT EMPLOYERAlbanyAffiliated With: New York State Insurance Fund
*
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
ALBANY (STRATTON) VA MEDICAL CENTER
CHECK BENEFIT CARDALBANY (STRATTON) VA MEDICAL CENTER 3520
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
ALBANY (STRATTON) VA MEDICAL CENTER
ALBANY (STRATTON) VA MEDICAL CENTER
113 HOLLAND AVEALBANY NY 12208
Attn: FEE BASIS 136E
MBA OF WYOMING C/O CCN
MBA OF WYOMING C/O CCN
ALBANY COUNTY SCHOOL DISTRICT 1
Affiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING C/O CCN
MBA OF WYOMING C/O CCNPO Box 3000SCOTTSDALE AZ 85271
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-11• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDALBANY STATE UNIV AIH0057887Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDALBANY STATE UNIV AIH0058897Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEALBANY STATE UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
ALBUQUERQUE VAMC CHECK BENEFIT CARDALBUQUERQUE VAMC 3170Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
ALBUQUERQUE VAMC ALBUQUERQUE VAMC
1501 SAN PEDRO SEALBUQUERQUE NM 87108
Attn: FMS-04
CHECK BENEFIT CARD CHECK BENEFIT CARDALEXANDRIA MOULDING INCAffiliated With: MERCER ADMINISTRATION
Term Effective: 8/31/2007Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-12• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EBPA(802) 846-8060
CHECK BENEFIT CARDALICE PECK DAY HEALTH SYSTEMS JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
ULTRABENEFITS INC(866) 858-7223
CHECK BENEFIT CARDALL STAR GASAffiliated With: ULTRABENEFITS, INC.
*
Term Effective: 8/31/2007Fund No:PlanType: Group Health
ULTRABENEFITS INC(508) 438-0007
ULTRABENEFITS INCPO Box 763WESTBOROUGH MA 01581
GROUP & PENSION ADMINISTRATORS(800) 827-7223
HEALTH WATCH(972) 238-7900
ALL TECH INSPECTIONS, INC. TRAVEL
Affiliated With: GROUP & PENSION ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
ALLIED NATIONAL(800) 825-7531
CHECK BENEFIT CARDALLIED NATIONAL INCAffiliated With: ALLIED NATIONAL INC
Fund No:PlanType: Group Health
GLOBALCARE, INC.(800) 825-7531
GLOBALCARE, INC.6875 SHILOH RD EALPHARETTA GA 30005
AFFORDABLE BENEFIT ADMINISTRATORS, INC.
AFFORDABLE BENEFIT ADMINISTRATORS, INC.
ALLTRADE, INC.Affiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC. (ABA)
Fund No:PlanType: Group Health
AFFORDABLE BENEFIT ADMINISTRATORS, INC.
AFFORDABLE BENEFIT ADMINISTRATORS, INC.PO Box 10787BURBANK CA 91510
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-13• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Alpha Review Corporation(630) 305-8108
Alpha Review Corporation(630) 305-8108
Alpha Review CorporationAffiliated With: Alpha Review Corporation
Fund No:PlanType: Workers' Compensation
Alpha Review Corporation(630) 305-8108
Alpha Review Corporation1807 Diehl RdNaperville IL 60563
Alpha Review Corporation(630) 305-8108
Alpha Review Corporation(630) 305-8108
Alpha Review Corporation AutoAffiliated With: Alpha Review Corporation
Fund No:PlanType: Auto
Alpha Review Corporation(630) 305-8108
Alpha Review Corporation1807 Diehl RdNaperville IL 60563
REGIONAL CARE INC(308) 635-2260
HINES ASSOCIATES(308) 635-2260
ALPINE RESOURCES GROUP INCAffiliated With: REGIONAL CARE INC 19254
Fund No:PlanType: Group Health
REGIONAL CARE INC(308) 635-2260
REGIONAL CARE INC905 W 27th StScottsbluff NE 69361
AMERIBEN SOLUTIONS(800) 953-1801
CHECK BENEFIT CARDALSCOAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 953-1801
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
CHECK BENEFIT CARD CHECK BENEFIT CARDALTA BATES SUMMIT MEDICAL CENTER
Affiliated With: BENEFIT AND RISK MANAGEMENT SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-14• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ALTOONA VAMC CHECK BENEFIT CARDALTOONA VAMC 3122Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
ALTOONA VAMC ALTOONA VAMC
2907 PLEASANT VALLEY BLVDALTOONA PA 16602
Attn: FEE BASIS (14F)
EMPLOYEE BENEFIT CONSULTANTS(800) 523-5789
CHECK BENEFIT CARDALTO-SHAAM INCAffiliated With: HEALTH DATA SERVICES
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT CONSULTANTS(800) 523-5789
EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839
PITTMAN & ASSOCIATES, INC.(800) 238-1344
PITTMAN & ASSOCIATES, INC.
ALUSUISSE COMPOSITES, INC.Affiliated With: PITTMAN & ASSOCIATES, INC.
Fund No:PlanType: Group Health
PITTMAN & ASSOCIATES, INC.(800) 238-1344
PITTMAN & ASSOCIATES, INC.PO Box 111047MEMPHIS TN 38111
RBMS, LLC(907) 561-3740
MEDICAL REHABILITATION CONSULTANTS(800) 827-5058
Alutiiq, LLCAffiliated With: RBMS LLC
Fund No:PlanType: Group Health
RBMS, LLC(907) 561-3740
RBMS, LLC510 L STREET, STE 650ANCHORAGE AK 99501
Amalgamated Life Insurance Co. - Clothing Fund(212) 539-5105
Amalgamated Life Insurance Co. - Clothing Fund(800) 332-5426
Amalgamated Clothing FundAffiliated With: Amalgamated Life Insurance Co.
Fund No:PlanType: Group Health
Amalgamated Life Insurance Co. - Clothing Fund(212) 539-5105
For electronic claims submission ID, refer to Benefit Card. Mail all other claims to: Amalgamated Life Insurance Co - Clothing FundPO Box 1449New York NY 10116-1449ECS Payor ID 13550
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-15• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Amalgamated Life Insurance Co. - Cotton Fund(212) 539-5100
Amalgamated Life Insurance Co. - Cotton Fund(800) 332-5426
Amalgamated Cotton FundAffiliated With: Amalgamated Life Insurance Co.
Fund No:PlanType: Group Health
Amalgamated Life Insurance Co. - Cotton Fund(212) 539-5100
For electronic claims submission ID, refer to Benefit Card. Mail all other claims to: Amalgamated Life Insurance Co - Clothing FundPO Box 1451New York NY 10116-1451ECS Payor ID 13550
ALICO(212) 539-5112
ALICO(800) 332-5426
Amalgamated Industrial Service Workers Benefit Fund
Affiliated With: Amalgamated Life Insurance Co.
Fund No:PlanType: Group Health
ALICO(212) 539-5112
For electronic claims submission ID, refer to Benefit Card. Mail all other claims to: ALICOPO Box 1432New York NY 10003ECS Payor ID 13550
Amalgamated Life Insurance Co.(800) 543-4723
Amalgamated Life Insurance Co. - Retail Fund(800) 332-5426
Amalgamated Retail FundAffiliated With: Amalgamated Life Insurance Co.
Fund No:PlanType: Group Health
Amalgamated Life Insurance Co.(800) 543-4723
Amalgamated Life Insurance Co.730 BroadwayNew York NY 10003ECS Payor ID 13550
AMARILLO VAMC CHECK BENEFIT CARDAMARILLO VAMC 3171Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
AMARILLO VAMC AMARILLO VAMC
6010 AMARILLO BLVD WESTAMARILLO TX 79106
Attn: FEE 136
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
AMBECAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-16• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
American Administrative Group Inc.(800) 877-7474
First Health(800) 346-3220
American Administrative Group (AAG)
Affiliated With: American Administrative Group
Fund No:PlanType: Group Health
- Network participation is contingent upon proper member identification. The First Health® Network Logo must be on the benefit card.
American Administrative Group Inc.(800) 877-7474
American Administrative Group Inc.PO Box 34297San Antonio TX 78265ECS Payor ID 37283
CONTACT EMPLOYER CONTACT EMPLOYERAmerican Alternative Insurance Company
Affiliated With: Genex Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
AMERICAN ASPHALT & GRADING COMPANY
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
AMERICAN ASPHALT & GRADING COMPANY TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-17• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDAMERICAN COMMUNITY - JMSAffiliated With: AMERICAN COMMUNITY
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDAMERICAN EDUCATION CENTERSAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
HEALTHSCOPE BENEFITS INC(866) 885-4944
HEALTHSCOPE BENEFITS INC(501) 218-7691
AMERICAN GREETINGSAffiliated With: HEALTHSCOPE BENEFITS, INC
Fund No:PlanType: Group Health
HEALTHSCOPE BENEFITS INC(800) 560-4664
HEALTHSCOPE BENEFITS INC27 CORPORATE HILL DRLITTLE ROCK AR 72205
AMERICAN HEALTHCARE ALLIANCE(800) 870-6252
CHECK BENEFIT CARDAMERICAN HEALTHCARE ALLIANCE
Affiliated With: AMERICAN HEALTHCARE ALLIANCE
Fund No:PlanType: Group Health
AMERICAN HEALTHCARE ALLIANCE(800) 870-6252
AMERICAN HEALTHCARE ALLIANCEPO Box 8530KANSAS CITY MO 64114-0530
AMERICAN HEALTHCARE ALLIANCE(800) 870-6252
CHECK BENEFIT CARDAMERICAN HEALTHCARE ALLIANCE - OUT OF AREA
Affiliated With: AMERICAN HEALTHCARE ALLIANCE 13780
Fund No:PlanType: Group Health
AMERICAN HEALTHCARE ALLIANCE(800) 870-6252
AMERICAN HEALTHCARE ALLIANCEPO Box 8530KANSAS CITY MO 64114-0530
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-18• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
AMO MEDICAL PLAN CHECK BENEFIT CARDAMERICAN MARITIME OFFICERSAffiliated With: AMERICAN HEALTHCARE ALLIANCE
Fund No:PlanType: Group Health
AMO MEDICAL PLAN AMO MEDICAL PLANPO Box 35Dania FL 33004
CHECK BENEFIT CARD CHECK BENEFIT CARDAMERICAN MISSIONARY FELLOWSHIP
Affiliated With: BROKERAGE CONCEPTS BENEFIT CONCEPTS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYERAmerican Red Cross
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CHECK BENEFIT CARD CHECK BENEFIT CARDAmerican Republic Insurance Company
Affiliated With: American Republic Insurance Company
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
INTERNATIONAL MANAGED CARE SERVICES C/O CCN
CHECK BENEFIT CARDAMERICAN SECURITY LIFE INSURANCE COMPANY
Affiliated With: INTERNATIONAL MANAGED CARE SERVICES
Fund No:PlanType: Group Health
INTERNATIONAL MANAGED CARE SERVICES C/O CCN
INTERNATIONAL MANAGED CARE SERVICES C/O CCNPO Box 5190TAMPA FL 33675-5190
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-19• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PREFERRED CARE, INC.(800) 222-3085
CHECK BENEFIT CARDAMERICAN SENTINEL SPORTS & ATHLETIC SERIES 600
Affiliated With: PREFERRED CARE, INC.
Fund No:PlanType: Group Health
PREFERRED CARE, INC.(800) 222-3085
PREFERRED CARE, INC.6 Neshaminy Interplex #205TREVOSE PA 19053
PREFERRED CARE, INC.(800) 222-3085
CHECK BENEFIT CARDAMERICAN SENTINEL SPORTS & ATHLETIC SERIES 800
Affiliated With: PREFERRED CARE, INC.
Fund No:PlanType: Group Health
PREFERRED CARE, INC.(800) 222-3085
SAMBA6 Neshaminy Interplex #205TREVOSE PA 19053
JSL ADMINISTRATORS, INC.(910) 480-3100
DOCTORS DIRECT HEALTHCARE(910) 485-0510
AMERICAN TRUETSCHLERAffiliated With: JSL ADMINISTRATORS INC
Fund No:PlanType: Group Health
JSL ADMINISTRATORS, INC.(910) 480-3100
JSL ADMINISTRATORS, INC.201 HAY STREET, STE 302FAYETTEVILLE NC 28301
JSL ADMINISTRATORS, INC.(910) 480-3100
MEDCOST(800) 443-9178
AMERICAN TRUETZSCHLERAffiliated With: JSL ADMINISTRATORS INC
Fund No:PlanType: Group Health
JSL ADMINISTRATORS, INC.(910) 480-3100
JSL ADMINISTRATORS, INC.201 HAY STREET, STE 302FAYETTEVILLE NC 28301
CHECK BENEFIT CARD CHECK BENEFIT CARDAMERICAN TRUST ADMINISTRATORS
Affiliated With: AMERICAN TRUST ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-20• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
AMERICAN WEST DEVELOPMENTAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Benesight(800) 464-5488
CHECK BENEFIT CARDAmerican Youth HostelsAffiliated With: Benesight
Fund No:PlanType: Group Health
Benesight(407) 661-4242
BenesightPO Box 360Pueblo CO 81002-0360
AMERIHEALTH ADMINISTRATORS C/O CCN
CHECK BENEFIT CARDAMERIHEALTH ADMINISTRATORSAffiliated With: AMERIHEALTH ADMINISTRATORS
Fund No:PlanType: Group Health
AMERIHEALTH ADMINISTRATORS C/O CCN
AMERIHEALTH ADMINISTRATORS C/O CCNPO Box 5190TAMPA FL 33675-5190
WAUSAU BENEFITS, INC.(715) 841-7802
CHECK BENEFIT CARDAMERIMAX FABRICATED PRODUCTS
Affiliated With: WAUSAU BENEFITS INC
Fund No:PlanType: Group Health
WAUSAU BENEFITS, INC.(715) 841-7802
WAUSAU BENEFITS, INC.
PO Box 8046WAUSAU WI 54401-8046
Attn: LeAnn Fichtner
CONTACT EMPLOYER CONTACT EMPLOYERAMERISUREAffiliated With: SOLUTIONS4
Fund No:PlanType: Workers' Compensation
Solutions4(888) 350-1150 Ext 228
Solutions4701 TECHNOLOGY DR STE 201CANONSBURG PA 15317
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-21• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CDN(800) 249-8440
HINES & ASSOCIATES(800) 528-2498
AMERITEC CORP.Affiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
CDN(800) 249-8440
CDNPO Box 10999SCOTTSDALE AZ 85271
CHECK BENEFIT CARD8007867930
CHECK BENEFIT CARDAMERITEL INNS INCAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8007867930
CHECK BENEFIT CARD
T R PAUL INC.7139143400
HINES & ASSOCIATES(727) 530-3444
AMGRAPH PACKAGINGAffiliated With: TR PAUL GROUP SERVICES INC
Fund No:PlanType: Group Health
T R PAUL INC.(800) 678-8161
T R PAUL INC.PO Box 5508NEWTOWN CT 06470
PIONEER MANAGEMENT SYSTEMS(877) 868-9060
CHECK BENEFIT CARDAMHERST COLLEGEAffiliated With: PIONEER MANAGEMENT SYSTEMS
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(877) 868-9060
PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01090
HEALTH PLAN INC(508) 752-2480
CMS(866) 325-1550
AMOSKEAG BEVERAGES, INCAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-22• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FairPay Solutions(972) 715-8000
FairPay Solutions(972) 715-8000
AmTrustAffiliated With: FairPay Solutions
Fund No:PlanType: Workers' Compensation
FairPay Solutions(972) 715-8000
FairPay Solutions
14295 Midway Rd Ste 300Addison TX 75001
Attn: Jon Peebles
CHECK BENEFIT CARD CHECK BENEFIT CARDAMX INTERNATIONAL INCAffiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARDAN DERINGER INC WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
MERITAIN HEALTH(812) 455-1938
CHECK BENEFIT CARDANCHOR INDUSTRIESAffiliated With: MERITIAN HEALTH
Fund No:PlanType: Group Health
MERITAIN HEALTH(812) 455-1938
MERITAIN HEALTH111 SE THIRD ST STE 404EVANSVILLE IN 47708
TRUE CHOICE(800) 251-9665
UM NOT APPLICABLEANGELO STATE UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE(800) 251-9665
TRUE CHOICEPO Box 700307DALLAS TX 75370
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-23• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ANN ARBOR VA MEDICAL CENTER
CHECK BENEFIT CARDANN ARBOR VA MEDICAL CENTER 3152
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
ANN ARBOR VA MEDICAL CENTER
ANN ARBOR VA MEDICAL CENTER
2215 FULLERANN ARBOR MI 48105
Attn: FEE BASIS CHIEF RESOURCE OFFICER (20)
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
ANNIE E CASEY FOUNDATION, THE
Affiliated With: NORTH AMERICAN ADMINISTRATORS - NY
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
APCO EQUIPMENTAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
EVEREST ADMINISTRATORS, INC. C/O CCN
CHECK BENEFIT CARDA-PLUS BENEFITS, INC.Affiliated With: EVEREST ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
EVEREST ADMINISTRATORS, INC. C/O CCN
EVEREST ADMINISTRATORS, INC. C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
GLOBALCARE, INC.8008601111
MedWatch(800) 432-8421
APPALACHIAN BENEFIT ADMINSTRATORS
Affiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC.6783411722
GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-24• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDAPPLETON MCGILL ELECTRIC SWITCH
Affiliated With: MCGILL ELECTRIC SWITCH PRODUCT GROUP
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Applied Underwriters(402) 827-3424
Applied Underwriters(402) 827-3424
Applied UnderwritersAffiliated With: Applied Underwriters
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(800) 293-3131
Applied UnderwritersPO Box 3804Omaha NE 68103
CHECK BENEFIT CARD8007159414
CHECK BENEFIT CARDAQUANTIVE INCAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8007159414
CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYERARAMARK
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
America's TPA(866) 478-6268
CHECK BENEFIT CARDARAZAffiliated With: AMERICAS TPA
Fund No:PlanType: Group Health
America's TPA(866) 478-6268
America's TPAPO Box 398220Bloomington MN 55439
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-25• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)(805) 497-4581
HINES & ASSOCIATES(800) 528-2498
ARC IMPERIAL VALLEYAffiliated With: EMPLOYEE BENEFITS ADMINISTRATION & MGMT (EBA&M)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)(805) 497-4581
CHECK BENEFIT CARD
CHECK BENEFIT CARD CHECK BENEFIT CARDARDENT HEALTH SERVICESAffiliated With: HARRINGTON BENEFIT SERVICES INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
AFFORDABLE BENEFIT ADMINISTRATORS, INC.
AFFORDABLE BENEFIT ADMINISTRATORS, INC.
ARETE ASSOCIATESAffiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC. (ABA)
Fund No:PlanType: Group Health
AFFORDABLE BENEFIT ADMINISTRATORS, INC.
AFFORDABLE BENEFIT ADMINISTRATORS, INC.PO Box 10787BURBANK CA 91510
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDARGOSY UNIVERSITYAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
ARISTOCRATS TRAVEL PLANAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-26• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ECOM PPO ADVISORS, INC(479) 785-6178
CHECK BENEFIT CARDARKANSAS BEST CORPORATIONAffiliated With: ECOM PPO ADVISORS INC
Fund No:PlanType: Group Health
ECOM PPO ADVISORS, INC(479) 785-6178
ECOM PPO ADVISORS, INC
8350 N. CENTRAL EXPWY, STE 600DALLAS TX 75206
Attn: ACCOUNTING
ADMINONE CORPORATION(800) 967-2077
MEDCAREONE CORP(800) 816-1206
ARKANSAS MILL SUPPLY COAffiliated With: ADMINONE CORPORATION
Fund No:PlanType: Group Health
ADMINONE CORPORATION(800) 967-2077
RESOURCEONE ADMINSTRATORS
PO Box 489BUCKEYSTOWN MD 21717
Attn: Mary Shepherd
ARM, LTD.(503) 968-6831
CHECK BENEFIT CARDARM, LTD.Affiliated With: ALTERNATIVE RISK MANAGEMENT LTD NORTHWEST
Fund No:PlanType: Group Health
ARM, LTD.(877) 544-1770
ARM, LTD.10200 S.W. Nimbus Ave. Ste G-5PORTLAND OR 97223
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
ARMFIELD HARRISON & THOMASAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDARMSTRONG ATLANTIC STATE UNIVERSITY AIH0057907
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-27• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDARMSTRONG ATLANTIC STATE UNIVERSITY AIH0057917
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEARMSTRONG ATLANTIC STATE UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
GLOBALCARE, INC.8008601111
Arnett Health Plans(765) 448-7725
ARNETT HEALTH PLANSAffiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC.6783411722
GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
CHECK BENEFIT CARD CHECK BENEFIT CARDArrowpoint Capital Corp.Affiliated With: Royal Indemnity Company
Fund No:PlanType: Workers' Compensation
CHECK BENEFIT CARD CHECK BENEFIT CARD
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDART INSTITUTE OF AMERICAAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-28• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
NORTH AMERICAN ADMINISTRATORS(800) 397-2122
NORTH AMERICAN ADMINISTRATORS(800) 397-2122
ASARCO AZAffiliated With: MARITAIN HEALTH
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS(800) 397-2122
NORTH AMERICAN ADMINISTRATORS
PO Box 853921Richardson TX 75085-3921
Attn: Claims Dept
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
NORTH AMERICAN ADMINISTRATORS(800) 828-6922
ASH BROKERAGEAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
NORTH AMERICAN ADMINISTRATORS-NYPO Box 730AMHERST NY 14226
ASHVILLE VAMC CHECK BENEFIT CARDASHEVILLE VAMC 3134Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
ASHVILLE VAMC ASHVILLE VAMC
1100 TUNNEL RDASHVILLE NC 28805
Attn: FEE BASIS 136
ASSURECARE(800) 968-6616
CARELINE(763) 383-4800
ASHLEYAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823
Mountain States Administrative Services(520) 722-7133
Hines and Associates(847) 214-2780
ASMLAffiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
Mountain States Administrative Services(520) 722-7133
Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-29• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTHSCOPE BENEFITS INC(866) 885-4944
HEALTHSCOPE BENEFITS INC(501) 218-7691
ASMO MANUFACTURINGAffiliated With: HEALTHSCOPE BENEFITS, INC
Fund No:PlanType: Group Health
HEALTHSCOPE BENEFITS INC(800) 560-4664
HEALTHSCOPE BENEFITS INC27 CORPORATE HILL DRLITTLE ROCK AR 72205
GLOBALCARE(888) 285-4864
AEGIS CARE MANAGEMENT(800) 868-1660
ASR TRIALONAffiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(888) 285-4864
GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
CHECK BENEFIT CARDAssemblies of God (AG10000036598)
Affiliated With: International Medical Group, Inc.
Fund No:PlanType: Group Health
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
ASSETS, INCAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650
MED-CERT(800) 356-7126
ASSUMPTION GRAIN COOPERATIVE GRAIN COMPANY
Affiliated With: NORTH AMERICA ADMINISTRATORS LP TENNESSEE
Fund No:PlanType: Group Health
NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650
NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-30• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
KEY BENEFIT ADMINISTRATORS(866) 387-0489
FORTIS BENEFITS INSURANCE COMPANY(866) 387-3407
ASSURANT HEALTH PREFERRED PLAN
Affiliated With: FORTIS BENEFITS INSURANCE COMPANY
Fund No:PlanType: Group Health
KEY BENEFIT ADMINISTRATORS(317) 284-7649
KEY BENEFIT ADMINISTRATORS8330 ALLISON POINT TRAILINDIANAPOLIS IL 46250
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
ASSURECAREAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
ACCOUNT EXECUTIVE(800) 242-4472
GISC OPTIMUM CARE / AMERICAN HEALTH(800) 290-4698
ASSURED SOURCEAffiliated With: GROUP INSURANCE SERVICE CENTER
Fund No:PlanType: Group Health
ACCOUNT EXECUTIVE(800) 242-4472
ACCOUNT EXECUTIVE20 WINTER STPEMBROKE MA 02359
PPC(800) 446-5439
PRIMARY PHYSICIANCARE, INC.7045232758
ASTEN JOHNSONAffiliated With: PRIMARY PHYSICIAN CARE INC
Fund No:PlanType: Group Health
PPC(800) 446-5439
PPCPO Box 11088CHARLOTTE NC 28220
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDATASCADERO UNIFIED SCHOOL DISTRICT
Affiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-31• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GROUP & PENSION ADMINISTRATORS(800) 827-7223
CHECK BENEFIT CARDAtascosa County (TRAVEL)Affiliated With: GROUP & PENSION ADMINISTRATORS
*
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
GROUP & PENSION ADMINISTRATORS INC(800) 827-7223
GPA/HEALTH WATCH(972) 587-1402
ATCO RUBBER PRODUCTS INCAffiliated With: GROUP & PENSION ADMINISTRATORS INC
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS INC(972) 587-2311
GROUP & PENSION ADMINISTRATORS INCPO Box 749075DALLAS TX 75374-9075
CompIQ Corporation(800) 293-3131
CompIQ CorporationAthens AdministratorsAffiliated With: CompIQ
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(800) 293-3131
CompIQ Corporation35 Tesla Way #100Irvine CA 92618
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDATLANTA METRO AIH0057927Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEATLANTA METRO COLLEGE UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-32• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ATLANTA VAMC CHECK BENEFIT CARDATLANTA VAMC 3545Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
ATLANTA VAMC ATLANTA VAMC
1670 CLAIRMONT RDDECATUR GA 30033
Attn: FEE BASIS 508/16
CONTACT EMPLOYER CONTACT EMPLOYERAtlantic Charter Insurance CoAffiliated With: GENEX Services, Inc
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
CHECK BENEFIT CARDATLANTIC UNION COLLEGEAffiliated With: PIONEER MANAGEMENT SERVICES
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090
CORESOURCE(800) 354-5233
UM NOT APPLICABLEATLAS AMERICAAffiliated With: CORESOURCE
Fund No:PlanType: Group Health
CORESOURCE(800) 354-5233
CORESOURCEPO Box 2920CLINTON OH 52733-2920
Attenta(800) 580-1642
Attenta(800) 580-2273
AttentaAffiliated With: Attenta
Fund No:PlanType: Workers' Compensation
Attenta(800) 580-1642
CONTACT EMPLOYER
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-33• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD8005211555
UM NOT APPLICABLEATWOOD MOBILE PRODUCTS INC
Affiliated With: NGS AMERICAN INC
Fund No:PlanType: Group Health
NGS AMERICAN, INC.8005211555
NGS AMERICAN, INC.PO Box 7676DETROIT MI 48080
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDAUBURN UNIVERSITYAffiliated With: UnitedHealthcare StudentResources #11689
Term Effective: 8/31/2007Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
AUGUSTA - EXTERNAL AFFAIRS
CHECK BENEFIT CARDAUGUSTA - EXTERNAL AFFAIRS 3715
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
AUGUSTA - EXTERNAL AFFAIRS
AUGUSTA - EXTERNAL AFFAIRS
950 15TH ST Rm 1D-103AUGUSTA GA 30901
Attn: EXTERNAL AFFAIRS (112E)
AUGUSTA - FEE BASIS CHECK BENEFIT CARDAUGUSTA - FEE BASIS 3542Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
AUGUSTA - FEE BASIS AUGUSTA - FEE BASIS
950 15TH STAUGUSTA GA 30901
Attn: FEE BASIS 116
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDAUGUSTA STATE UNIV AIH0057947
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-34• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDAUGUSTA STATE UNIV AIH0057957
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEAUGUSTA STATE UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
TRUE CHOICE(800) 251-9665
UM NOT APPLICABLEAUSTIN COLLEGEAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE(800) 251-9665
TRUE CHOICEPO Box 700307DALLAS TX 75370
NHBC(888) 621-7900
CHECK BENEFIT CARDAVALON BENEFIT SERVICESAffiliated With: NATIONAL HEALTH BENEFIT CORPORATION NHBC #12717
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
HEALTH NETWORK AMERICA(732) 676-2637
HEALTH NETWORK AMERICA(732) 676-2637
AVALON HEALTHCARE - INSURANCE COMPANY
Affiliated With: HEALTH NETWORK AMERICA
Fund No:PlanType: Group Health
HEALTH NETWORK AMERICA(732) 676-2637
HEALTH NETWORK AMERICA246 INDUSTRIAL WAY WESTEATONTOWN NJ 07724
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-35• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
AVANT-INT'L EMPLOYEE BENEFIT SERVICES/ALPHA AMERIC
AVANT-INT'L EMPLOYEE BENEFIT SERVICES/ALPHA AMERIC
AVANT - INTERNATIONAL EMPLOYEE BENEFIT SERVICES
Affiliated With: AVANT - INTERNATIONAL EMPLOYEE BENEFIT SERVICES
Fund No:PlanType: Group Health
AVANT-INT'L EMPLOYEE BENEFIT SERVICES/ALPHA AMERIC
AVANT-INT'L EMPLOYEE BENEFIT SERVICES/ALPHA AMERIC700 B Smithridge Dr. #104RENO NV 89502
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
AVI RESORT & CASINOAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
ALLIED BENEFIT SYSTEMS, INC3129068080
CHECK BENEFIT CARDAWANA CLUBS INTERNATIONAL, INC
Affiliated With: ALLIED BENEFIT SYSTEMS INC
Fund No:PlanType: Group Health
ALLIED BENEFIT SYSTEMS, INC3129068080
ALLIED BENEFIT SYSTEMS, INC208 S. LASALLE STREETCHICAGO IL 60604
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONS(800) 786-7930
AZUSA PACIFIC UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDBAINBRIDGE COLLEGE AIH0057967
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-36• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEBAINBRIDGE COLLEGE UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
SMITH ADMINISTRATORS(801) 261-5511
SERVICE ADVOCATES(877) 261-5511
BALL ENTERPRISES, INC.Affiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
SMITH ADMINISTRATORS(801) 261-5511
SMITH ADMINISTRATORS428 E WINCHESTER ST, STE 200SALT LAKE CITY UT 84107
PROFESSIONAL BENEFIT ADMINISTRATORS(630) 655-3755
UM NOT APPLICABLEBall HorticulturealAffiliated With: PROFESSIONAL BENEFIT ADMINISTRATORS INC
*
Fund No:PlanType: Group Health
PROFESSIONAL BENEFIT ADMINISTRATORS(630) 655-3755
PROFESSIONAL BENEFIT ADMINISTRATORS900 Jorie Blvd Ste 250Oakbrook IL 60523
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
BALLY TECHNOLOGY - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
CHECK BENEFIT CARD8007867930
CHECK BENEFIT CARDBANK OF COMMERCEAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8007867930
CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-37• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CENBEN USA(614) 797-5204
CHECK BENEFIT CARDBARONA BAND OF MISSION INDIANS
Affiliated With: CENBEN USA INC
Fund No:PlanType: Group Health
CENBEN USA(614) 797-5204
CENBEN USA
4079 Executive PkwyWesterville OH 43081
Attn: Melissa Joseph
AMERIBEN SOLUTIONS(800) 953-1801
AUM(800) 388-3193
BASIC AMERICAN FOODSAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 953-1801
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
CompIQ Corporation(800) 293-3131
CONTACT EMPLOYERBass and BabbAffiliated With: CompIQ
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(800) 293-3131
CompIQ Corporation2 South PointeLake Forest CA 92630
CompIQ Corporation(800) 293-3131
CHECK BENEFIT CARDBass and Babb AutoAffiliated With: CompIQ
Fund No:PlanType: Auto
CompIQ Corporation(800) 293-3131
CompIQ Corporation2 South PointeLake Forest CA 92630
HEALTH NET FEDERAL SERVICES(972) 550-2836
UM NOT APPLICABLEBATAVIA VAMC 4001Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(972) 550-2836
ALBANY (STRATTON) VA MEDICAL CENTER
113 HOLLAND AVEALBANY NY 12208
Attn: FEE BASIS 136E
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-38• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONSOLIDATED HEALTH PLANS(800) 633-7867
UM NOT APPLICABLEBates CollegeAffiliated With: CONSOLIDATED HEALTH PLANS
Fund No:PlanType: Group Health
CONSOLIDATED HEALTH PLANS(800) 633-7867
CONSOLIDATED HEALTH PLANS195 STAFFORD STSPRINGFIELD MA 01104
HEALTH NET FEDERAL SERVICES(972) 550-2836
UM NOT APPLICABLEBATH VAMC 4002Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(972) 550-2836
ALBANY (STRATTON) VA MEDICAL CENTER
113 HOLLAND AVEALBANY NY 12208
Attn: FEE BASIS 136E
BATTLE CREEK VAMC CHECK BENEFIT CARDBATTLE CREET VAMC 3153Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
BATTLE CREEK VAMC BATTLE CREEK VAMC
5500 ARMSTRONG RDBATTLE CREEK MI 49015
Attn: FEE BASIS (136)
SISCO(800) 547-4726
CHECK BENEFIT CARDBAY INDUSTRIES INCAffiliated With: SISCO/Cottingham & Butler
Fund No:PlanType: Group Health
SISCO(800) 547-4726
SISCOPO Box 389DUBUQUE IA 52004-0389
CHECK BENEFIT CARD CHECK BENEFIT CARDBAY MEDICAL CENTERAffiliated With: CADENT ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-39• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PIONEER MANAGEMENT SYSTEMS(413) 534-8658
UM NOT APPLICABLEBay Path CollegeAffiliated With: PIONEER MANAGEMENT SYSTEMS
*
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(413) 534-8658
PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01089
BAY PINES RD CHECK BENEFIT CARDBAY PINES VA MEDICAL CENTER 3144
Affiliated With: HEALTH NET FEDERALSERVICES
Fund No:PlanType: Group Health
BAY PINES RD BAY PINES RD
10000 BAY PINES RDBAY PINES FL 33744
Attn: FEE BASIS 136A
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDBAYLOR UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
ADMINISTRATIVE SOLUTIONS INC(678) 339-0211
CHECK BENEFIT CARDBCLG CORPORATIONAffiliated With: ADMINISTRATIVE SOLUTIONS, INC.
Fund No:PlanType: Group Health
ADMINISTRATIVE SOLUTIONS INC(678) 339-0211
ADMINISTRATIVE SOLUTIONS INCPO Box 2490ALPHARETTA GA 30023
WAUSAU BENEFITS, INC.(715) 841-7802
WAUSAU BENEFITS, INC.(800) 808-4424
BDS MARKETING, INC.Affiliated With: WAUSAU BENEFITS
Fund No:PlanType: Group Health
WAUSAU BENEFITS, INC.(715) 841-7802
WAUSAU BENEFITS, INC.
PO Box 8046WAUSAU WI 54401-8046
Attn: LeAnn Fichtner
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-40• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
BEACH MOLD & TOOLAffiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(800) 832-8212
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
BEACON GROUPAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
Bear Cat Inc.Affiliated With: QVI Risk Solutions Inc
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
ASSURECARE1011 SW EMKAY DR STE 209BEND OR 97702
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
CHECK BENEFIT CARDBECKER COLLEGEAffiliated With: PIONEER MANAGEMENT SERVICES
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
CHECK BENEFIT CARDBECKER COLLEGE - SPORTSAffiliated With: ADMINISTRATIVE CONCEPTS INC
Fund No:PlanType: Group Health
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-41• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
BECKLEY SINGLETON TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
BECKLEY VAMC CHECK BENEFIT CARDBECKLEY VAMC 3547Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
BECKLEY VAMC BECKLEY VAMC200 VETERANS AVEBECKLEY WV 23667
BEDFORD VA MEDICAL CENTER
CHECK BENEFIT CARDBEDFORD VA MEDICAL CENTER 3111
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
BEDFORD VA MEDICAL CENTER
BEDFORD VA MEDICAL CENTER
200 SPRINGS RDBEDFORD MA 01730
Attn: FEE BASIS - (518-136B)
Western Health(605) 719-4600 or (888) 341-1766
Western Health(605) 719-4640 or (800) 229-0892
Behavior ManagementAffiliated With: Rapid City Regional Hospital DBA Western Health
Fund No:PlanType: Group Health
Western Health(605) 719-4600 or (888) 341-1766
Western Health529 Kansas City St Ste 200Rapid City SD 57701
MAKSIN MANAGEMENT CORP(800) 220-1123
UM NOT APPLICABLEBELLARMINE UNIVERSITYAffiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
MAKSIN MANAGEMENT CORP(800) 220-1123
MAKSIN MANAGEMENT CORP2500 McClellan AvePennsauken NJ 08109
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-42• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FISERV HEALTH KANSAS(800) 235-7160
TRUSTMARK LIFE INSURANCE CO.(800) 725-6566
BELMAR INTERNATIONALAffiliated With: FISERV HEALTH - KANSAS
Fund No:PlanType: Group Health
FISERV HEALTH KANSAS(800) 235-7160
FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520
BRMS(888) 326-2555
BRMS(800) 368-0767
BENEFIT AND RISK MANAGEMENT SERVICES WRAP
Affiliated With: BENEFIT AND RISK MANAGEMENT SERVICES
Fund No:PlanType: Group Health
BRMS(888) 326-2555
BRMSPO Box 2650RANCHO CORDOVA CA 98401
NHBC(888) 621-7900
CHECK BENEFIT CARDBENEFIT MANAGEMENT SYSTEMS
Affiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
NHBC(888) 621-7900
CHECK BENEFIT CARDBENEFITSOURCE, INCAffiliated With: NATIONAL HEALTH BENEFIT CORPORATION NHBC #12717
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
GLOBALCARE(888) 285-4864
AEGIS CARE MANAGEMENT(800) 868-1660
BENESYSAffiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(888) 285-4864
GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-43• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Benicorp Insurance Company(317) 290-1205
CHECK BENEFIT CARDBENICORP INSURANCE COMPANY
Affiliated With: BENICORP INSURANCE COMPANY
Fund No:PlanType: Group Health
Benicorp Insurance Company(317) 290-1205
Benicorp Insurance CompanyPO Box 68917Indianapolis IN 46268-0917
Benicorp Insurance Company(800) 837-1205
Individualized Care Management(888) 448-1864
Benicorp Insurance CompanyAffiliated With: Benicorp Insurance Company
Fund No:PlanType: Group Health
-Network participation is contingent upon proper member identification. The First Health® Network Logo must be on the benefit card.
Benicorp Insurance Company(800) 837-1205
Benicorp Insurance CompanyPO Box 68917Indianapolis IN 46268-0917
Benicorp Insurance Company(800) 837-1205
Benicorp Insurance Company(888) 448-1864
Benicorp Travel AccessAffiliated With: Benicorp Insurance Company
Fund No:PlanType: Group Health
Benicorp Insurance Company(800) 837-1205
Benicorp Insurance CompanyPO Box 68917Indianapolis IN 46268-0917
ARM, LTD.(877) 544-1770
HINES & ASSOCIATES(888) 437-9927
BERING SEA ECCOTECH, INCAffiliated With: ALTERNATIVE RISK MANAGEMENT LTD NORTHWEST
Fund No:PlanType: Group Health
ARM, LTD.(877) 544-1770
ARM, LTD.10200 S.W. Nimbus Ave. Ste G-5PORTLAND OR 97223
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-44• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GROUP INSURANCE SERVICE CENTER INC(800) 242-4472
GISC TOTALCARE(800) 242-4472
BERKSHIRE CORPORATIONAffiliated With: GROUP INSURANCE SERVICE CENTER INC
Fund No:PlanType: Group Health
GROUP INSURANCE SERVICE CENTER INC(800) 242-4472
GROUP INSURANCE SERVICE CENTER INC20 INDUSTRIAL PARK DRPEMBROKE MA 02359
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
BERLIN-GORHAM OPERATIONSAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
BEST CHAIRS, INC.Affiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(800) 832-8212
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
BEST LIFE AND HEALTH(800) 433-0088
CHECK BENEFIT CARDBEST LIFE AND HEALTHAffiliated With: BEST LIFE AND HEALTH
Fund No:PlanType: Group Health
BEST LIFE AND HEALTH(800) 433-0088
BEST LIFE AND HEALTHPO Box 19721Irvine CA 92623-9721
Insurers Administrative Corp(800) 964-4948
Med-Valu(800) 522-2161
Best Life and Health Insurance (IAC)Affiliated With: INSURERS ADMINISTRATIVE CORP
Fund No:PlanType: Group Health
Insurers Administrative Corp(800) 964-4948
Insurers Administrative CorpPO Box 828Park Ridge IL 60068-0828
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-45• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Best Life and Health Insurance Company
HEALTH INTERNATIONAL
BEST LIFE AND HEALTH INSURANCE COMPANY
Affiliated With: BEST LIFE AND HEALTH INSURANCE COMPANY
Fund No:PlanType: Group Health
Best Life and Health Insurance Company
Best Life and Health Insurance CompanyPO Box 19721IRVINE CA 92713-9721
PPC(800) 446-5439
PPC(704) 523-2758
BETCO, INCAffiliated With: PRIMARY PHYSICIAN CARE
Fund No:PlanType: Group Health
PPC(800) 446-5439
PPCPO Box 11088CHARLOTTE NC 28220
MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(800) 877-3727
CRITIQUE(800) 666-5551
BH INC. & A & D HACKING INC.Affiliated With: MANAGED BENEFIT ADMINISTRATORS & INSURANCE
Fund No:PlanType: Group Health
MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(800) 877-3727
MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTSPO Box 651109SALT LAKE CITY UT 84165-1109
GALLAGHER BENEFIT ADMINISTRATORS INC
CHECK BENEFIT CARDBIANCHI INTERNATIONALAffiliated With: TRIDENT PLAN ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
MBA OF WYOMING MBA OF WYOMINGBIG HORN COUNTYAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING MOUNTAIN STATES REVIEWPO Box 94WORLAND WY 82401
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-46• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGBIG HORN FEDERALAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGPO Box 98WORLAND WY 82401
BIG SPRING VAMC CHECK BENEFIT CARDBIG SPRINGS VAMC 3172Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
BIG SPRING VAMC BIG SPRING VAMC
300 VETERANS BLVDBIG SPRING TX 79720
Attn: FEE BASIS
GROUP & PENSION ADMINISTRATORS(800) 827-7223
HEALTH WATCH(972) 238-7900
BIG TEX TRAILERS PRIMARYAffiliated With: GROUP & PENSION ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
GROUP & PENSION ADMINISTRATORS(800) 827-7223
HEALTH WATCH(972) 238-7900
BIG TEX TRAILERS TRAVELAffiliated With: GROUP & PENSION ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
CONTACT EMPLOYER CONTACT EMPLOYERBinghamptonAffiliated With: New York State Insurance Fund
*
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-47• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
BINIONSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONS(800) 786-7930
BIOLA UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
BIRMINGHAM VAMC CHECK BENEFIT CARDBIRMINGHAM VAMC 3538Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
BIRMINGHAM VAMC BIRMINGHAM VAMC
700 S 19TH STBIRMINGHAM AL 35233
Attn: FEE BASIS - 136E
CONSOCIATE, INC.(800) 798-2422
NATIONAL HEALTH SERVICES(800) 558-4353
BLACK AND COMPANYAffiliated With: CONSOCIATE INC
Fund No:PlanType: Group Health
CONSOCIATE, INC.(800) 798-2422
CONSOCIATE, INC.PO Box 1068DECATUR IL 62525
Western Health(605) 719-4600 or (888) 341-1766
Western Health(605) 719-4640 or (800) 229-0892
Black Hills Workshop and Training Center Inc
Affiliated With: Rapid City Regional Hospital DBA Western Health
Fund No:PlanType: Group Health
Western Health(605) 719-4600 or (888) 341-1766
Western Health529 Kansas City St Ste 200Rapid City SD 57701
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-48• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CRITIQUE CHECK BENEFIT CARDBLACKFOOT MEDICALAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
CRITIQUE MANAGED BENEFITS ADMINISTRATOR AND INSURANCE CONSULTANTSPO Box 651109SALT LAKE CITY UT 84165-1109
MIDWEST SECURITY ADMINISTRATORS, INC.(800) 542-6642
Q-REVIEW(608) 783-8706
BLACKHAWK CREDIT UNIONAffiliated With: MIDWEST SECURITY ADMINISTRATORS INC.
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS, INC.(800) 542-6642
MIDWEST SECURITY ADMINISTRATORS, INC.2700 MIDWEST DRONALASKA WI 54650
HEALTH PLAN INC5087522480
CMS INC(866) 325-1550
BLUE ROCK INDUSTRIESAffiliated With: HEALTH PLANS, INC.
Fund No:PlanType: Group Health
HEALTH PLAN INC5087522480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
CHECK BENEFIT CARD CHECK BENEFIT CARDBLUEGRASS FAMILY HEALTH
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
AMERIHEALTH ADMINISTRATORS(215) 793-3223
AMERIHEALTH ADMINISTRATORS(215) 793-3223
BOHLIN CYWINSKI JACKSONAffiliated With: AMERIHEALTH ADMINISTRATORS
Fund No:PlanType: Group Health
AMERIHEALTH ADMINISTRATORS(215) 793-3223
AMERIHEALTH ADMINISTRATORS720 BLAIR MILL RD.HORSHAM PA 19044
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-49• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MAKSIN MANAGEMENT CORP(800) 220-1123
UM NOT APPLICABLEBOISE STATE UNIVERSITYAffiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
MAKSIN MANAGEMENT CORP(800) 220-1123
MAKSIN MANAGEMENT CORP2500 McClellan AvePennsauken NJ 08109
BOISE VAMC CHECK BENEFIT CARDBOISE VAMC 3177Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
BOISE VAMC BOISE VAMC
500 W FORT STBOISE ID 83702
Attn: MAS 136
BOLLINGER, INC.(973) 467-8005 Ext 1007
BOLLINGER, INC.BOLLINGER, INC.Affiliated With: BOLLINGER, INC.
Fund No:PlanType: Group Health
BOLLINGER, INC.(973) 467-8005 Ext 1007
BOLLINGER, INC.830 Morris TurnpikeSHORT HILLS NJ 07078
VA BONHAM CHECK BENEFIT CARDBONHAM VA 3168Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
VA BONHAM VA BONHAM
1201 E 9TH STBONHAM TX 75048
Attn: BRENDA MAGNASS
EBPA(802) 846-8060
CHECK BENEFIT CARDBOOTHCREEK SKI HOLDING JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-50• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
BOOTZ MANUFACTORING COAffiliated With: PREFERRED HEALTH PLAN INC 962550088
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(502) 992-4535
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750
PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750
BORDER FOODS COMPANIESAffiliated With: PREFERREDONE ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750
PREFERREDONE ADMINISTRATIVE SERVICESPO Box 59212MINNEAPOLIS MN 55459
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
CHECK BENEFIT CARDBOSTON BAPTIST COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS INC
Fund No:PlanType: Group Health
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706
MEDICAL CLAIMS SERVICES, INC.(888) 225-0522
AMERICAN HEALTH HOLDINGS INC(886) 614-4244
BOSTON HIGASHI SCHOOLAffiliated With: MEDICAL CLAIMS SERVICES, INC.
Fund No:PlanType: Group Health
MEDICAL CLAIMS SERVICES, INC.(888) 225-0522
MEDICAL CLAIMS SERVICES, INC.ONE WALL ST STE 2ARAVENSWOOD WV 26164
HEALTH NET FEDERAL SERVICES(214) 387-3232
CHECK BENEFIT CARDBOSTON VA MEDICAL CENTER 3118
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(214) 387-3232
HEALTH NET FEDERAL SERVICES
150 S HUNTINGTON AVEBOSTON MA 02130
Attn: FEE BASIS 136F
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-51• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GILSBAR(888) 215-9841
MED COM CARE MGT(985) 898-1505
BOTHWELL SAXTON RESTAURANTS, LLC
Affiliated With: GILSBAR INC
Fund No:PlanType: Group Health
GILSBAR(888) 215-9841
GILSBAR2100 COVINGTON CENTRECOVINGTON LA 70433
NHBC(888) 621-7900
CHECK BENEFIT CARDBOULDER ADMINISTRATIVE SERVICES
Affiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC) 12717
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
CHECK BENEFIT CARDBOWDOIN COLLEGEAffiliated With: PIONEER MANAGEMENT SERVICES
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090
Bradley/Dixie Company(866) 360-7926
QUANTUM HEALTH(800) 257-2038
BRADLEY DIXIE COMPANIESAffiliated With: PARAGON BENEFITS, INC.
Fund No:PlanType: Group Health
Bradley/Dixie Company(866) 360-7926
Bradley/Dixie CompanyPO Box 12288COLUMBUS GA 31904
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
BRADY INDUSTRIESAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-52• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
KLAIS & COMPANY INC(800) 331-1096
CHECK BENEFIT CARDBRANDEIS UNIVERSITYAffiliated With: KLAIS & COMPANY
Fund No:PlanType: Group Health
KLAIS & COMPANY INC(800) 331-1096
KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313
HOLDEN & COMPANY C/O CCN
CHECK BENEFIT CARDBRASSELER USAAffiliated With: HOLDEN & COMPANY
Fund No:PlanType: Group Health
HOLDEN & COMPANY C/O CCN
HOLDEN & COMPANY C/O CCNPO Box 5190TAMPA FL 33675-5190
CHECK BENEFIT CARD CHECK BENEFIT CARDBRATTLEBORO MEMORIAL HOSPITAL
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CENBEN USA(614) 797-5204
CHECK BENEFIT CARDBREG, INC.Affiliated With: CENBEN USA INC
Fund No:PlanType: Group Health
CENBEN USA(614) 797-5204
CENBEN USA
4079 Executive PkwyWesterville OH 43081
Attn: Melissa Joseph
Brokerage Concepts, Inc.6104914911
Brokerage Concepts, Inc.(215) 773-3722
BRENNAN TRANSPORTATION SERVICE
Affiliated With: BROKERAGE CONCEPTS BENEFITS CONCEPTS INC
Fund No:PlanType: Group Health
Brokerage Concepts, Inc.6104914911
Brokerage Concepts, Inc.PO Box 61553KING OF PRUSSIA PA 19406
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-53• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
BRENTWOOD VOLVOAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
BREVARD ACHIEVEMENT CENTER
Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
BREWER YACHT YARD GROUPAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
BRIDGES WTC, INC.Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
BRIDGESTONEAffiliated With: ASSURECAREE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-54• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERBroadspire, A Crawford CompanyAffiliated With: Broadspire, A Crawford Company
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER Crawford & Company5620 Glenridge Dr NEAtlanta GA 30342
MUTUAL ASSURANCE ADMINISTRATORS(405) 607-2694
CHECK BENEFIT CARDBRONCO DRILLINGAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
MUTUAL ASSURANCE ADMINISTRATORS(405) 607-2694
MUTUAL ASSURANCE ADMINISTRATORS3121 QUAIL SPRINGS PKWYOKLAHOMA CITY OK 73134
BRONX VA MEDICAL CENTER
CHECK BENEFIT CARDBRONX VA MEDICAL CENTER 3121
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
BRONX VA MEDICAL CENTER
BRONX VA MEDICAL CENTER
130 W KINGSBRIDGE RDBRONX NY 10468
Attn: FEE BASIS 00AM
BROOKLYN VA MEDICAL CENTER
CHECK BENEFIT CARDBROOKLYN VA MEDICAL CENTER 3521
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
BROOKLYN VA MEDICAL CENTER
BROOKLYN VA MEDICAL CENTER
800 POLY PLACEBROOKLYN NY 11209
Attn: FEE BASIS 136
UNDERWRITERS SAFETY & CLAIMS(800) 678-1536
HEALTH SERVICE REVIEW(800) 334-6468
BROTHERS TRADING CO INC AND INVENTORY HANDLERS INC
Affiliated With: UNDERWRITERS SAFETY & CLAIMS
Fund No:PlanType: Group Health
UNDERWRITERS SAFETY & CLAIMS(800) 678-1536
UNDERWRITERS SAFETY & CLAIMSPO Box 23507Louisville KY 40223-0507
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-55• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDBROULIMS SUPERMARKETSAffiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CONSOLIDATED HEALTH PLANS(800) 517-4791
UM NOT APPLICABLEBrown UniversityAffiliated With: CONSOLIDATED HEALTH PLANS
*
Fund No:PlanType: Group Health
CONSOLIDATED HEALTH PLANS(800) 633-7867
CONSOLIDATED HEALTH PLANS195 STAFFORD STSPRINGFIELD MA 01104
CONTACT EMPLOYER CONTACT EMPLOYERBuffaloAffiliated With: New York State Insurance Fund
*
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
BUFFALO CHINAAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
HEALTH NET FEDERAL SERVICES(972) 550-2836
UM NOT APPLICABLEBUFFALO VAMC 4003Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(972) 550-2836
ALBANY (STRATTON) VA MEDICAL CENTER
113 HOLLAND AVEALBANY NY 12208
Attn: FEE BASIS 136E
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-56• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERBuilders Assoc Self Ins
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Builders Insurance Group(678) 309-4000
Builders Insurance Group(678) 309-4172
Builders Insurance Group
Fund No:PlanType: Workers' Compensation
Builders Insurance Group(678) 309-4172
Builders Insurance GroupPO Box 723099Atlanta GA 31139-0099
Bunch & Associates Inc(888) 853-4735
Bunch & Associates Inc(888) 853-4735
Bunch & Associates Inc.Affiliated With: Bunch & Associates Inc.
Fund No:PlanType: Workers' Compensation
Bunch & Associates Inc(888) 853-4735
Bunch & Associates IncPO Box 32045Lakeland FL 33802
NHBC(888) 621-7900
CHECK BENEFIT CARDBUTLER BENEFIT SERVICES INCAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
BUTLER VAMC CHECK BENEFIT CARDBUTLER VAMC 3123Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
BUTLER VAMC BUTLER VAMC
325 NEW CASTLE RDBUTLER PA 16001
Attn: FEE BASIS (70)
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-57• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
C.L. FRATES AND COMPANY(405) 290-5696
C.L. FRATES AND COMPANY(800) 669-1815
C L FRATES AND COMPANYAffiliated With: C L FRATES & COMPANY
Fund No:PlanType: Group Health
C.L. FRATES AND COMPANY(405) 290-5696
C.L. FRATES AND COMPANYPO Box 268967OKLAHOMA CITY OK 73126
DELTA HEALTH SYSTEMS(209) 948-8483 (209) 948-8483 Ext 3327
DELTA HEALTH SYSTEMS
CAJON VALLEY UNION SCHL DIST/ACTIVE EES
Affiliated With: CAJON VALLEY UNION SCHOOL DISTRICT
Fund No:PlanType: Group Health
DELTA HEALTH SYSTEMS(209) 948-8483 (209) 948-8483 Ext 3327
DELTA HEALTH SYSTEMSPO Box 1147STOCKTON CA 95201
EBPA(802) 846-8060
CHECK BENEFIT CARDCALAIS REGIONAL HOSPITAL WRAP JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
EBPA(802) 846-8060
CHECK BENEFIT CARDCALAIS REGIONAL HOSPITAL WRAP VST
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-58• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
J SMITH LANIER & CO(910) 480-3100
CHECK BENEFIT CARDCALDWELL FREIGHT LINESAffiliated With: JSL ADMINISTRATORS INC
Fund No:PlanType: Group Health
J SMITH LANIER & CO(910) 480-3100
J SMITH LANIER & CO201 HAY STREET, STE 302FAYETTEVILLE NC 28301
AMERIBEN SOLUTIONS(800) 654-7900 (800) 786-7930
AMERIBEN SOLUTIONS(800) 786-7930
CALIFORNIA BAPTIST UNIVERSITY
Affiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDCALIFORNIA INSTITUTE OF INTEGRAL STUDIES
Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
CALIFORNIA IRONWORKERS FIELD WELFARE PLAN
CALIFORNIA IRONWORKERS FIELD WELFARE PLAN
CALIFORNIA IRONWORKERS FIELD WELFARE PLAN
Affiliated With: CALIFORNIA IRONWORKERS FIELD WELFARE PLAN
Fund No:PlanType: Group Health
CALIFORNIA IRONWORKERS FIELD WELFARE PLAN
CALIFORNIA IRONWORKERS FIELD WELFARE PLAN131 N. El Molina Ave. #330PASADENA CA 91101
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-59• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SUMMIT AMERICA INSURANCE SERVICES
SUMMIT AMERICA INSURANCE SERVICES
CALIFORNIA LUTHERAN UNIVERSITY
Affiliated With: SUMMIT AMERICA INSURANCE SERVICES
Fund No:PlanType: Group Health
SUMMIT AMERICA INSURANCE SERVICES
SUMMIT AMERICA INSURANCE SERVICES5001 College Blvd., #216LEAWOOD KS 66211
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDCALIFORNIA STATE UNIVERSITY - LOS ANGELES
Affiliated With: UnitedHealthcare StudentResources #11689
Term Effective: 9/30/2007Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
DELTA HEALTH SYSTEMS(800) 807-0820
DELTA TEAM CARE(209) 939-3438
CALIFORNIA STEEL INDUSTRIESAffiliated With: DELTA HEALTH SYSTEMS
Fund No:PlanType: Group Health
DELTA HEALTH SYSTEMS(800) 807-0820
DELTA HEALTH SYSTEMSPO Box 80Stockton CA 95201
GISC, INC(800) 242-4472
GISC TOTALCARE(800) 999-1077
CALISE AND SONSAffiliated With: GROUP INSURANCE SERVICE CENTER
Fund No:PlanType: Group Health
GISC, INC(800) 242-4472
GISC, INC20 WINTER STPEMBROKE MA 02359
TRUSTEED PLANS SERVICE GROUP(800) 426-9786
AMERICAN HEALTH HOLDING(888) 877-7994
CALLISONS INC - PEPMAffiliated With: TRUSTEED PLANS SERVICE CORPORATION
Fund No:PlanType: Group Health
TRUSTEED PLANS SERVICE GROUP(800) 426-9786
TRUSTEED PLANS SERVICE GROUPPO Box 1894TACOMA WA 98401-1894
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-60• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SMITH ADMINISTRATORS(817) 335-2582
SERVICE ADVOCATES(877) 261-5511
CAMBERLEY HOTEL COAffiliated With: SMITH ADMINISTRATORS
Term Effective: 8/31/2007Fund No:PlanType: Group Health
SMITH ADMINISTRATORS(817) 335-2582
SMITH ADMINISTRATORS3800 SANDSHELL DR STE 260FT. WORTH TX 76134
Health Plan Services(800) 681-0056
First Health(800) 639-9157
Cambridge Life Insurance CompanyAffiliated With: First Health Life and Health Insurance Company
Fund No: V5038PlanType: Group Health
Health Plan Services(800) 681-0056
First HealthPO Box 44199Las Vegas NV 89116
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
CAMCO, INC.Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
TRUE CHOICE(800) 251-9665
UM NOT APPLICABLECAMERON UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE(800) 251-9665
TRUE CHOICEPO Box 700307DALLAS TX 75370
Canadian Medical Network Canadian Medical NetworkCANADIAN MEDICAL NETWORKAffiliated With: CANADIAN MEDICAL NETWORK
*
Fund No:PlanType: Group Health
Canadian Medical Network Canadian Medical Network140 Renfrew Dr. Ste 103Ontario, Canada L3R 6B3
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-61• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH NET FEDERAL SERVICES(972) 550-2836
UM NOT APPLICABLECANANDAIGUA VAMC 4004Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(972) 550-2836
ALBANY (STRATTON) VA MEDICAL CENTER
113 HOLLAND AVEALBANY NY 12208
Attn: FEE BASIS 136E
Cannon Cochran Management Services Inc(800) 252-5059
CONTACT EMPLOYERCannon Cochran Management Services, Inc.
Affiliated With: Stratacare
Fund No:PlanType: Workers' Compensation
StrataCare Inc(800) 277-6512
Cannon Cochran Management Services IncTown Centre Bldg 2 East Main St Ste 208Danville IL 61832
ECOM PPO ADVISORS, INC
UM NOT APPLICABLECAPITAL INTERNATIONAL MANAGEMENT
Affiliated With: ECOM PPO ADVISORS INC
Fund No:PlanType: Group Health
ECOM PPO ADVISORS, INC ECOM PPO ADVISORS, INC
8350 N. CENTRAL EXPWY, STE 600DALLAS TX 75206
Attn: ACCOUNTING
FISERV HEALTH INC(800) 826-9781
AVIDYN HEALTH(800) 808-4424
CAPITAL LUMBER COMPANYAffiliated With: WAUSAU BENEFITS INC
Fund No:PlanType: Group Health
FISERV HEALTH INC(800) 826-9781
FISERV HEALTH INCPO Box 450Pueblo CO 81002-0450
MBA OF WYOMING MBA OF WYOMINGCARBON COUNTY HOLDING COAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING MOUNTAIN STATES REVIEWPO Box 94WORLAND WY 82401
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-62• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MCMC LLC(888) 350-1150 Ext 228
MCMC LLC(888) 350-1150 Ext 228
CARESYS AUTOAffiliated With: MCMC LLC
Fund No:PlanType: Auto
MCMC LLC(888) 350-1150 Ext 228
MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317
CareWorks(800) 627-0065
CareWorks(800) 627-0065
CareWorks
Fund No:PlanType: Group Health
CareWorks(800) 627-0065
CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYERCareWorks
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
CARLING TECHNOLOGIES INC.Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
First Health(800) 654-5321
First Health(800) 654-5321
Carlson Restaurants Worldwide - Platinum and Gold
Affiliated With: Carlson Holdings Inc.
Fund No: H8240PlanType: Group Health
The First Health® Network is not used for Behavioral Health services.
First Health(800) 654-5321
First HealthPO Box 8400London KY 40742
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-63• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
First Health(800) 654-5321
First Health(800) 654-5321
Carlson Restaurants Worldwide - Silver
Affiliated With: Carlson Holdings Inc.
Fund No: H8240PlanType: Group Health
First Health(800) 654-5321
First HealthPO Box 8400London KY 40742
CHECK BENEFIT CARD CHECK BENEFIT CARDCARRIAGE INCAffiliated With: ALLIED BENEFIT SYSTEMS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CORESOURCE(800) 327-5462
CORESOURCE(866) 794-0770
CARROLL DISTRIBUTING COMPANY
Affiliated With: CORESOURSE
Fund No:PlanType: Group Health
CORESOURCE(800) 327-5462
CORESOURCE5200 77 CENTER DR STE 400CHARLOTTE NC 28217
Claims Administrative Services, Inc.(800) 765-2412
Forte(800) 580-4567
CAS - Claims Administrative Services
Affiliated With: STRATACARE
Fund No:PlanType: Workers' Compensation
Claims Administrative Services, Inc.(800) 765-2412
Claims Administrative Services, Inc.501 Shelley DrTyler TX 75711
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
CASCADE AUTOMOTIVE, INC.Affiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
ASSURECARE1011 SW EMKAY DR STE 209BEND OR 97702
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-64• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
CASHMAN EQUIPMENTAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
CASHMAN PHOTO ENTERPRISES OF NEVADA - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
ASSURECARE(800) 968-6616
CARELINE(763) 383-4800
CATAAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823
MBA OF WYOMING MBA OF WYOMINGCATHEDRAL HOMES FOR CHILDREN
Affiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING MOUNTAIN STATES REVIEWPO Box 94WORLAND WY 82401
OSF HealthPlans, Inc.(800) 673-5222
CHECK BENEFIT CARDCATHOLIC DIOCESE OF PEORIAAffiliated With: OSF HEALTHPLANS INC #20714
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(309) 677-8356
OSF HealthPlans, Inc.PO Box 5128PEORIA IL 61601-5128
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-65• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SCHALLER ANDERSON HEALTHCARE INC. LLC
CHECK BENEFIT CARDCATHOLIC HEALTHCARE WEST CHW ARIZONA
Affiliated With: SCHALLER ANDERSON HEALTHCARE LLC
Fund No:PlanType: Group Health
SCHALLER ANDERSON HEALTHCARE INC. LLC
SCHALLER ANDERSON HEALTHCARE INC. LLCPO Box 62735PHOENIX AZ 85082-2735
AMERICAS CHOICE HEALTHPLANS(800) 633-4226
HEALTHCARE SOLUTIONS GROUP, INC.(800) 582-1535
CAVLIER TELEPHONEAffiliated With: AMERICAS CHOICE HEALTHPLAN
Fund No:PlanType: Group Health
AMERICAS CHOICE HEALTHPLANS(800) 633-4226
AMERICAS CHOICE HEALTHPLANS13111 Northwest Fwy, Ste 510Houston TX 77040
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
CHECK BENEFIT CARDCayman IslandsAffiliated With: International Medical Group, Inc.
Fund No:PlanType: Group Health
The First Health® Network is not used for Chiropractic services.
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDCAYUCOS ELEMENTARY SCHOOLAffiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
CCASAPEAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-66• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
CCASAPE/Clark County School District - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CHECK BENEFIT CARD CHECK BENEFIT CARDCCLC INTLAffiliated With: ADMINISTRATIVE CONCEPTS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD CHECK BENEFIT CARDCCN ELECTRONIC DIRECTORY GH
Affiliated With: CCN ELECTRONIC DIRECTORY FORMERLY POW
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD CHECK BENEFIT CARDCCN ELECTRONIC DIRECTORY INTERNATIONAL
Affiliated With: CCN ELECTRONIC DIRECTORY FORMERLY POW
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
CCSD SUPPORT STAFFAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-67• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDCEGA GROUPAffiliated With: STAR HEALTHCARE NETWORK INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CREATIVE PLAN ADMINISTRATORS(301) 695-0480
AMERICAN HEALTH HOLDINGS(866) 648-5554
CENTER IMTAffiliated With: CREATIVE PLAN ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
CREATIVE PLAN ADMINISTRATORS(301) 695-0480
CREATIVE PLAN ADMINISTRATORSPO Box 734BUCKEYSTOWN MD 21717
HEALTHCOMP TPA(800) 442-7247
CHECK BENEFIT CARDCENTRAL CALIFORNIA ELECTRICAL WORKERS (CCEW)
Affiliated With: HEALTHCOMP THIRD PARTY ADMINISTRATORS
Fund No:PlanType: Group Health
HEALTHCOMP TPA(800) 442-7247
HEALTHCOMP TPAPO Box 45018Fresno CA 93718
FISERV HEALTH KANSAS(800) 235-7160
AVIDYN / VALUE CHECK(866) 802-1328
CENTRAL DETROIT DIESEL - ALLISON INC
Affiliated With: FISERV HEALTH - KANSAS
*
Fund No:PlanType: Group Health
FISERV HEALTH KANSAS(800) 235-7160
FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520
CENTRAL IOWA HCS (3708)
CHECK BENEFIT CARDCENTRAL IOWA HCS 3708Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
CENTRAL IOWA HCS (3708) CENTRAL IOWA HCS (3708)
3600 30TH STREETDES MOINES IA 50310
Attn: FEE OAS-D
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-68• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MAKSIN MANAGEMENT CORP(800) 220-1123
UM NOT APPLICABLECENTRAL METHODIST UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
MAKSIN MANAGEMENT CORP(800) 220-1123
MAKSIN MANAGEMENT CORP2500 McClellan AvePennsauken NJ 08109
HCH ADMINISTRATION INC(877) 876-5969
CHECK BENEFIT CARDCENTRAL STATES INDUSTRIAL EQUIPMENT & SERVICE, INC
Affiliated With: HEALTH DATA SERVICE
Fund No:PlanType: Group Health
HCH ADMINISTRATION INC(877) 876-5969
HCH ADMINISTRATION INCPO Box 1986PEORIA IL 61656
ADVENTIST HEALTH SYSTEM WEST
CHECK BENEFIT CARDCENTRAL VALLEY GENERAL HOSPITAL
Affiliated With: ADVENTIST HEALTH SYSTEM/WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH SYSTEM/WEST C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
CHECK BENEFIT CARD5594992450
CHECK BENEFIT CARDCENTRAL VALLEY TRUSTAffiliated With: HEALTHCOMP ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD5594992450
CHECK BENEFIT CARD
SISCO(800) 547-4726
CHECK BENEFIT CARDCENTURY FOODSAffiliated With: SISCO/Cottingham & Butler
Fund No:PlanType: Group Health
SISCO(800) 547-4726
SISCOPO Box 389DUBUQUE IA 52004-0389
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-69• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
CHECK BENEFIT CARDCENTURY WESTPORTAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226
CERES c/o World Insurance(800) 786-7557
CHECK BENEFIT CARDCERES GROUP - CRS100 FHAffiliated With: AMERICAN REPUBLIC INSURANCE CO.
Fund No:PlanType: Group Health
CERES c/o World Insurance(800) 786-7557
CERES c/o World InsurancePO Box 2804Clinton IA 52733
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
CERSOSIMO INDUSTRIES, INCAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
CERSOSIMO LUMBER COMPANY, INC
Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
Info as of 12/27/2007
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For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-70• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
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UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CERES c/o World Insurance(800) 253-4641
CHECK BENEFIT CARDCGI MAJOR MEDICAL CRS100 CCN
Affiliated With: AMERICAN REPUBLIC INSURANCE CO.
Fund No:PlanType: Group Health
CERES c/o World Insurance(800) 253-4641
CERES c/o World InsurancePO Box 2804Clinton IA 52733
ULTRABENEFITS INC(866) 858-7223
CHECK BENEFIT CARDCHADWICK MEDICAL ASSOCIATES, P.C.
Affiliated With: ULTRABENEFITS, INC.
Fund No:PlanType: Group Health
ULTRABENEFITS INC(866) 858-7223
ULTRABENEFITS INCPO Box 763WESTBORO MA 01581
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
CHALLENGE ENTERPRISES OF NORTH FLORIDA
Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
CHARLESTON AUTO PARTSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CHARLESTON VAMC (RALPH H JOHNSON)
CHECK BENEFIT CARDCHARLESTON VAMC (RALPH H JOHNSON VA) 3539
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
CHARLESTON VAMC (RALPH H JOHNSON)
CHARLESTON VAMC (RALPH H JOHNSON)
109 BEE STCHARLESTON SC 29401
Attn: FEE BASIS 136F
Info as of 12/27/2007
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For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-71• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ACORDIA NATIONAL C/O CCN(888) 685-7774
CHECK BENEFIT CARDCHATHAM STEEL CORPAffiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR
*
Fund No:PlanType: Group Health
ACORDIA NATIONAL C/O CCN(888) 685-7774
ACORDIA NATIONAL C/O CCNPO Box 3262CHARLESTON WV 25332
MCMC LLC(888) 350-1150 Ext 228
MCMC LLC(888) 350-1150 Ext 228
CHELMSFORD AUTOAffiliated With: MCMC LLC
Fund No:PlanType: Auto
MCMC LLC(888) 350-1150 Ext 228
MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317
CONTACT EMPLOYER CONTACT EMPLOYERCherokee InsuranceAffiliated With: Cherokee Insurance
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
HEALTHSCOPE BENEFITS INC(800) 560-4664
CHECK BENEFIT CARDCHESAPEAKE ENERGY CORPORATION
Affiliated With: HEALTHSCOPE BENEFITS
*
Term Effective: 12/31/2007Fund No:PlanType: Group Health
HEALTHSCOPE BENEFITS INC(800) 560-4664
HEALTHSCOPE BENEFITS INC27 CORPORATE HILL DRLITTLE ROCK AR 72205
CHECK BENEFIT CARD CHECK BENEFIT CARDChevron CorporationAffiliated With: Chevron Corporation
Fund No:PlanType: Workers' Compensation
Chevron Chevron6001 Bollinger Canyon Rd Ste ESan Ramon CA 94583-2324
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-72• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHEYENNE VAMC CHECK BENEFIT CARDCHEYENNE VAMC 3531Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
CHEYENNE VAMC CHEYENNE VAMC
WILLIAM ST off HWY 12 WESTFORT HARRISON MT 59636
Attn: FEE BASIS
JESSE BROWN VAMC CHECK BENEFIT CARDCHICAGO (JESSE BROWN VAMC) 3160
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
JESSE BROWN VAMC JESSE BROWN VAMC
820 S DAMEN AVE 5210CHICAGO IL 60612
Attn: FEE 136E
CHECK BENEFIT CARD CHECK BENEFIT CARDCHICAGO MCGILL ELECTRIC SWITCH
Affiliated With: MCGILL ELECTRIC SWITCH PRODUCT GROUP
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
PREMIER CLAIMS ADMINISTRATORS7753245644
UNIVERSAL HEALTH NETWORK(702) 356-1159
CHICAGO-VEGAS HOLDING COMPANY, INC
Affiliated With: PREMIER CLAIMS ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
PREMIER CLAIMS ADMINISTRATORS7753245644
PREMIER CLAIMS ADMINISTRATORSPO Box 19338RENO NV 89511
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
CHILDRENS HEART CENTER LV - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-73• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHILLICOTHE VA MEDICAL CENTER
CHECK BENEFIT CARDCHILLICOTHE VA MEDICAL CENTER 3524
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
CHILLICOTHE VA MEDICAL CENTER
CHILLICOTHE VA MEDICAL CENTER
17273 STATE RT 104CHILLICOTHE OH 45601
Attn: 136 BLD 27 RM 17
EBPA(802) 846-8060
CHECK BENEFIT CARDCHITTENDEN CORPORATION JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
TALL TREE ADMINISTRATORS(801) 274-8100
CORVEL(801) 269-8723
CHRISTENSEN & GRIFFITH CONSTRUCTION
Affiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
TALL TREE ADMINISTRATORS(801) 274-8100
TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107
ADVENTIST RISK MANAGEMENT, INC.(909) 353-6800
CHECK BENEFIT CARDCHRISTIAN RECORD SERVICESAffiliated With: ADVENTIST RISK MANAGEMENT, INC.
Fund No:PlanType: Group Health
ADVENTIST RISK MANAGEMENT, INC.(909) 353-6800
ADVENTIST RISK MANAGEMENT, INC.11291 Pierce St.RIVERSIDE CA 92515-8007
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARDCHROMA TECH WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
Info as of 12/27/2007
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For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-74• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARDCHROMA TECH WRAP VSTAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
CDS Group Health(775) 352-6951
UNIVERSAL HEALTH REVIEW(775) 355-0921
CHROMALLOYAffiliated With: CDS GROUP HEALTH
Fund No:PlanType: Group Health
CDS Group Health(775) 352-6951
CDS Group Health1625 E PRATER WAY BLDG C STE 101SPARKS NV 89461
PREFERRED CARE, INC. PREFERRED CARE, INC.CIGNA SPORTS AND ATHLETIC PROGRAMS
Affiliated With: PREFERRED CARE
Fund No:PlanType: Group Health
PREFERRED CARE, INC. PREFERRED CARE, INC.6 Neshaminy Interplex #205TREVOSE PA 19053
American Administrative Group(800) 658-9777
American Administrative Group(877) 202-6379 Ext 2530
CIMARRON ELECTRIC COOPERATIVE
Affiliated With: AMERICAN ADMINISTRATIVE GROUP
Fund No:PlanType: Group Health
American Administrative Group(800) 658-9777
American Administrative GroupPO Box 53070LUBBOCK TX 79453
Underwriters Safety & Claims, Inc.(800) 678-1536
Bluegrass Health Network(800) 264-7502
Cincinnati RedsAffiliated With: Underwriters Safety & Claims Inc.
Fund No:PlanType: Group Health
Underwriters Safety & Claims, Inc.(800) 678-1536
Underwriters Safety & Claims, Inc.PO Box 23507Louisville KY 40223-0507
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-75• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CINCINNATI VA MEDICAL CENTER
CHECK BENEFIT CARDCINCINNATI VA MEDICAL CENTER 3197
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
CINCINNATI VA MEDICAL CENTER
CINCINNATI VA MEDICAL CENTER
3200 VINE STCINCINNATI OH 45220
Attn: FEE BASIS 136E
FISERV HEALTH INC(800) 235-7160
AVIDYN HEALTH(214) 647-6194
CITIZENS BANK AND TRUST OF ARDMORE
Affiliated With: FISERV HEALTH
Fund No:PlanType: Group Health
FISERV HEALTH INC(800) 235-7160
FISERV HEALTH INCPO Box 530PUEBLO CO 81002-0530
NORTH AMERICAN BENEFITS NETWORK, INC. C/O CCN
CHECK BENEFIT CARDCITIZENS UTILITIESAffiliated With: NORTH AMERICAN BENEFITS NETWORK, INC.
Fund No:PlanType: Group Health
NORTH AMERICAN BENEFITS NETWORK, INC. C/O CCN
NORTH AMERICAN BENEFITS NETWORK, INC. C/O CCNPO Box 5190TAMPA FL 33675-5190
CHECK BENEFIT CARD CHECK BENEFIT CARDCITY OF CALEXICOAffiliated With: PINNACLE CLAIMS MANAGEMENT INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
GROUP BENEFIT SERVICES, INC.(800) 995-3569
GROUP BENEFIT SERVICES, INC.
CITY OF CARUTHERSVILLEAffiliated With: GROUP BENEFIT SERVICES, INC.
Fund No:PlanType: Group Health
GROUP BENEFIT SERVICES, INC.(800) 995-3569
GROUP BENEFIT SERVICES, INC.1736 E. Sunshine #200SPRINGFIELD MO 65804
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-76• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MBA OF WYOMING MBA OF WYOMINGCITY OF CASPERAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING MOUNTAIN STATES REVIEWPO Box 94WORLAND WY 82401
MANAGED BENEFITS ADMINISTRATOR AND INSURANCE CONSULTANTS(800) 877-3727
CHECK BENEFIT CARDCITY OF CHUBBUCKAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MANAGED BENEFITS ADMINISTRATOR AND INSURANCE CONSULTANTS(800) 877-3727
MANAGED BENEFITS ADMINISTRATOR AND INSURANCE CONSULTANTSPO Box 651109SALT LAKE CITY UT 84165-1109
CONSOCIATE, INC. C/O CCN2172332281
CHECK BENEFIT CARDCITY OF DECATURAffiliated With: CONSOCIATE, INC.
Fund No:PlanType: Group Health
CONSOCIATE, INC. C/O CCN2172332281
CONSOCIATE, INC. C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
GROUP & PENSION ADMINISTRATORS INC(800) 827-7223
HEALTH WATCH(972) 238-7900
CITY OF GRANBURY TRAVELAffiliated With: GROUP & PENSION ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS INC(972) 238-7900
GROUP & PENSION ADMINISTRATORS INC12770 MERIT DR STE 200DALLAS TX 75251
PARAGON BENEFITS, INC.(706) 327-9218
AMERICAN HEALTH HOLDINGS(706) 327-9218
CITY OF HAZLEHURSTAffiliated With: PARAGON BENEFITS INC
Fund No:PlanType: Group Health
PARAGON BENEFITS, INC.(706) 327-9218
PARAGON BENEFITS, INC.PO Box 12288COLUMBUS GA 31917
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-77• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002
UM NOT APPLICABLE(800) 367-9939
CITY OF HOBARTAffiliated With: EMPLOYEE BENEFIT CONSULTANTS INC
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002
EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839
JSL ADMINISTRATORS, INC.(910) 480-3100
DOCTORS DIRECT HEALTHCARE(910) 485-0510
CITY OF JACKSONVILLEAffiliated With: JSL ADMINISTRATORS
Fund No:PlanType: Group Health
JSL ADMINISTRATORS, INC.(910) 480-3100
JSL ADMINISTRATORS, INC.201 HAY STREET, STE 302FAYETTEVILLE NC 28301
CONTACT EMPLOYER CONTACT EMPLOYERCity of Long BeachAffiliated With: Tristar
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
CITY OF LOS ANGELES(213) 847-9712
CITY OF LOS ANGELES(213) 847-9712
City of Los AngelesAffiliated With: Fair Isaac Corp / Diversified HealthCare Services
Fund No:PlanType: Workers' Compensation
CITY OF LOS ANGELES(213) 847-9712
CITY OF LOS ANGELES700 E. Temple St Rm 210Los Angeles CA 90012
ASSURECARE(800) 968-6616
CARELINE(763) 383-4800
CITY OF MICHIGAN CITYAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-78• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Benefit Planners(800) 292-5386
CHECK BENEFIT CARDCITY OF NORMANAffiliated With: BENEFIT PLANNERS
Fund No:PlanType: Group Health
Benefit Planners(800) 292-5386
Benefit PlannersPO Box 690450SAN ANTONIO TX 78269
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
CITY OF OKLAHOMA FALLSAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DRBEND OR 97702
ADMINISTRATIVE SOLUTIONS INC(678) 339-0211
CHECK BENEFIT CARDCITY OF PERRYAffiliated With: ADMINISTRATIVE SOLUTIONS, INC.
Fund No:PlanType: Group Health
ADMINISTRATIVE SOLUTIONS INC(678) 339-0211
ADMINISTRATIVE SOLUTIONS INCPO Box 2490ALPHARETTA GA 30023
EMPLOYEE BENEFIT SERVICES - SHREVEPORT(800) 256-2657
CHECK BENEFIT CARDCITY OF PLANOAffiliated With: EMPLOYEE BENEFIT SERVICES, INC.
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT SERVICES - SHREVEPORT(800) 256-2657
EMPLOYEE BENEFIT SERVICES - SHREVEPORTPO Box 70100SHREVEPORT LA 71137-0100
THE EPOCH GROUP, LC(800) 365-9036
CHECK BENEFIT CARDCITY OF POPLER BLUFFAffiliated With: THE EPOCH GROUP, INC
Fund No:PlanType: Group Health
THE EPOCH GROUP, LC(800) 365-9036
THE EPOCH GROUP, LC10795 Watson RdSt. Louis MO 63129
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-79• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGCITY OF RAWLINSAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGPO Box 98WORLAND WY 82401
EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002
UM NOT APPLICABLE(800) 367-9939
CITY OF VALPARAISOAffiliated With: EMPLOYEE BENEFIT CONSULTANTS INC
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002
EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
CIVIL TOWN OF CLARKSVILLEAffiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(800) 832-8212
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259
UM NOT APPLICABLECLARCOR, INCAffiliated With: ALLIED BENEFIT SYSTEMS INC
Fund No:PlanType: Group Health
ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259
ALLIED BENEFIT SYSTEMS, INC208 S LASALLE ST STE 1300CHICAGO IL 60604
HEALTH PLAN INC(508) 752-2480
CMS(866) 325-1550
CLAREMONT FLOCK CORPORATION
Affiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-80• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
KHS, A KMG AMERICA COMPANY(800) 822-1274
CHECK BENEFIT CARDCLAREMONT RESTAURANT GROUP, LLC
Affiliated With: KHS A KMG AMERICA COMPANY
Fund No:PlanType: Group Health
KHS, A KMG AMERICA COMPANY(800) 822-1274
KHS, A KMG AMERICA COMPANY210 S WHITE STLANCASTER SC 29720
THE LOOMIS COMPANY(800) 346-1223
CHECK BENEFIT CARDCLARK COUNTYAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(800) 346-1223
THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011
PRISON HEALTH SERVICES, INC.(800) 729-0069
PRISON HEALTH SERVICES, INC.
CLARK COUNTY JAIL FACILITIES-WASHINGTON
Affiliated With: PRISON HEALTH SERVICES, INC.
Fund No:PlanType: Group Health
PRISON HEALTH SERVICES, INC.(800) 729-0069
PRISON HEALTH SERVICES, INC.105 W Park Dr STE 300BRENTWOOD TN 37027
GROUP BENEFIT SERVICES, INC.(517) 631-3469
HEALTHLINK(314) 989-6115
CLARK COUNTY MISSOURIAffiliated With: GROUP BENEFIT SERVICES
Fund No:PlanType: Group Health
GROUP BENEFIT SERVICES, INC.(800) 995-3569
GROUP BENEFIT SERVICES, INC.1736 E. Sunshine Ste 200Springfield MO 65804
Underwriters Safety & Claims, Inc.(800) 678-1536
Bluegrass Health Network(800) 264-7502
Clark District Co. of VersaillesAffiliated With: Underwriters Safety & Claims Inc.
Fund No:PlanType: Group Health
Underwriters Safety & Claims, Inc.(800) 678-1536
Underwriters Safety & Claims, Inc.PO Box 23507Louisville KY 40223-0507
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-81• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH NET FEDERAL SERVICES(214) 387-3232
CHECK BENEFIT CARDCLARKSBURG VA MEDICAL CENTER 3663
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(214) 387-3232
HEALTH NET FEDERAL SERVICES5504 HILL HEAVEN CTFRISCO TX 75035
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDCLAYTON COLLEGE & STATE UNIV AIH0057987
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDCLAYTON COLLEGE & STATE UNIV AIH0057997
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLECLAYTON COLLEGE & STATE UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
CHECK BENEFIT CARD CHECK BENEFIT CARDCLAYTON COUNTY GORGIA
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-82• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDCLAYTON STATE UNIVERSITY ICS AII61217
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
CHECK BENEFIT CARDClements and Company - USAIDAffiliated With: International Medical Group, Inc.
Fund No:PlanType: Group Health
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDCLEMSON UNIVERSITYAffiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437
CLEVELAND VA MEDICAL CENTER
CHECK BENEFIT CARDCLEVELAND VA MEDICAL CENTER 3196
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
CLEVELAND VA MEDICAL CENTER
CLEVELAND VA MEDICAL CENTER
10000 BRECKSVILLE RDBRECKSVILLE OH 44141
Attn: FEE BASIS 136BF
DELTA HEALTH SYSTEMS(209) 474-5421
UNIVERSAL HEALTH NETWORK(800) 776-6959
CLICK BOND, INCAffiliated With: DELTA HEALTH SYSTEMS
Fund No:PlanType: Group Health
DELTA HEALTH SYSTEMS(209) 474-5421
DELTA HEALTH SYSTEMSPO Box 80Stockton CA 95201
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-83• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PINNACLE CLAIMS MANAGEMENT(800) 649-9121
CHECK BENEFIT CARDCLOVIS UNIFIED SCHOOL DISTRICT
Affiliated With: PINNACLE CLAIMS MANAGEMENT
Fund No:PlanType: Group Health
PINNACLE CLAIMS MANAGEMENT(800) 649-9121
PINNACLE CLAIMS MANAGEMENTPO Box 2220NEWPORT BEACH CA 92658
HEALTH PLAN INC(508) 752-2480
CHECK BENEFIT CARDCM ALMY AND SONS - %Affiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259
AMERICAN HEALTH HOLDING(312) 906-8080 Ext 259
CM PRODUCTSAffiliated With: ALLIED BENEFIT SYSTEMS, INC.
Fund No:PlanType: Group Health
ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259
ALLIED BENEFIT SYSTEMS, INC208 S LASALLE ST STE 1300CHICAGO IL 60604
CHECK BENEFIT CARD CHECK BENEFIT CARDCMH FLOORING PRODUCTS INCAffiliated With: KHS A KMG AMERICA COMPANY
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYERCNA Commerical InsuranceAffiliated With: Crawford and Company
Fund No:PlanType: Workers' Compensation
Accessed through Crawford and Company
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-84• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDCOAST UNIFIED SCHOOL DISTRICT
Affiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDCOASTAL CAROLINA UNIVERSITYAffiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437
PARAGON BENEFITS(706) 327-9218
AMERICAN HEALTH HOLDING(877) 417-3363
COASTAL GEORGIA COMMUNITY ACTION AUTHORITY
Affiliated With: PARAGON BENEFITS INC
Fund No:PlanType: Group Health
PARAGON BENEFITS(706) 327-9218
PARAGON BENEFITSPO Box 12288COLUMBUS GA 31917
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDCOASTAL GEORGIA COMMUNITY COLLEGE AIH0058007
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDCOASTAL GEORGIA COMMUNITY COLLEGE AIH0058017
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-85• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLECOASTAL GEORGIA COMMUNITY COLLEGE UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
FCE BENEFIT ADMINISTRATORS(800) 899-9355
UM NOT APPLICABLECoastal International SecurityAffiliated With: FCE BENEFIT ADMINISTRATORS INC
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS(800) 899-9355
FCE BENEFIT ADMINISTRATORS4615 WALZEN RD STE 300SAN ANTONIO TX 78218
COATESVILLE VAMC CHECK BENEFIT CARDCOATESVILLE VAMC 3124Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
COATESVILLE VAMC COATESVILLE VAMC
1400 BLACKHORSE HILL RDCOATSVILLE PA 19320
Attn: FEE BASIS - 115E
Western Health(605) 719-4600 or (888) 341-1766
Western Health(605) 719-4640 or (800) 229-0892
Coca ColaAffiliated With: Rapid City Regional Hospital DBA Western Health
Fund No:PlanType: Group Health
Western Health(605) 719-4600 or (888) 341-1766
Western Health529 Kansas City St Ste 200Rapid City SD 57701
IntraCorp(800) 251-0669
CIGNA HEALTHCARECOCA COLA BOTTLERS ASSOCIATION THE
Affiliated With: COCA COLA BOTTLERS ASSOCIATION THE
Fund No:PlanType: Group Health
IntraCorp(800) 251-0669
IntraCorp1111 MARKETCHATTANOOGA TN 37402-3306
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-86• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GROUP & PENSION ADMINISTRATORS INC(800) 827-7223
HEALTH WATCH(972) 238-7900
COLDWELL BANKER UNITED, REALTORS
Affiliated With: GROUP & PENSION ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS INC(972) 238-7900
GROUP & PENSION ADMINISTRATORS INC12770 MERIT DR STE 200DALLAS TX 75251
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDCOLLEGE OF CHARLESTONAffiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437
ADVENTIST RISK MANAGEMENT, INC.
CHECK BENEFIT CARDCOLLEGE VIEW ACADEMYAffiliated With: ADVENTIST RISK MANAGEMENT, INC.
Fund No:PlanType: Group Health
ADVENTIST RISK MANAGEMENT, INC.
ADVENTIST RISK MANAGEMENT, INC.11291 Pierce St.RIVERSIDE CA 92515-8007
EBPA(800) 578-3272
CHECK BENEFIT CARDCOLLEY MCCOY MANAGEMENT GROUP WRAP JMS
Affiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS
Fund No:PlanType: Group Health
EBPA(800) 578-3272
EBPA
PO Box 2000Exeter NH 03833
Attn: Denise Oberg
CHECK BENEFIT CARD CHECK BENEFIT CARDCOLLINS PRODUCTS LLCAffiliated With: QVI RISK SOLUTIONS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-87• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PRIMARY PHYSICIAN CARE(704) 527-8102
PRIMARY PHYSICIAN CARE(704) 523-2758
COLONIAL GROUPAffiliated With: PRIMARY PHYSICIANCARE INC
Fund No:PlanType: Group Health
PRIMARY PHYSICIAN CARE(704) 527-8102
PRIMARY PHYSICIAN CAREPO Box 11088CHARLOTTE NC 28220
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
COLONY RESORT TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SUMMIT AMERICA INSURANCE SERVICES(877) 246-6997
CHECK BENEFIT CARDCOLORADO STATE UNIVERSITYAffiliated With: SUMMIT AMERICA INSURANCE SERVICES LC
Fund No:PlanType: Group Health
SUMMIT AMERICA INSURANCE SERVICES(877) 246-6997
SUMMIT AMERICA INSURANCE SERVICES
7400 COLLEGE BLVD STE 100OVERLAND PARK KS 66220
Attn: VIVIAN PAUL
COLUMBIA - DORN VAMC CHECK BENEFIT CARDCOLUMBIA (DORN VAMC) 3540Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
COLUMBIA - DORN VAMC COLUMBIA - DORN VAMC
6439 GARNERS FERRY RDCOLUMBIA SC 29209
Attn: FEE BASIS - 136F
HARRY S TRUMAN VAMC CHECK BENEFIT CARDCOLUMBIA (HARRY S TRUMAN VAMC) 3525
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HARRY S TRUMAN VAMC HARRY S TRUMAN VAMC
800 HOSPITAL DRCOLUMBIA MO 65201
Attn: BUSSINESS OFFICE ADMN FEE
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-88• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
UM NOT APPLICABLECOLUMBIA LIGHTHOUSE FOR THE BLIND
Affiliated With: FCE BENEFIT ADMINISTRATORS INC #10388
*
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218
PARAGON BENEFITS, INC. PARAGON BENEFITS, INC.
COLUMBUS HOUSING AUTHORITY
Affiliated With: PARAGON BENEFITS, INC.
Fund No:PlanType: Group Health
PARAGON BENEFITS, INC. PARAGON BENEFITS, INC.2221 Manchester ExpresswayCOLUMBUS GA 31904
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDCOLUMBUS STATE UNIV AIH0058027
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDCOLUMBUS STATE UNIV AIH0058037
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-89• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLECOLUMBUS STATE UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
COLUMBUS VA OPC CHECK BENEFIT CARDCOLUMBUS VA OPC 3195Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
COLUMBUS VA OPC COLUMBUS VA OPC
543 TAYLOR AVECOLUMBUS OH 43203
Attn: FEE BASIS 136B2
COMMERCE BENEFITS GROUP(440) 930-7500
COMMERCE BENEFITS GROUP(440) 930-7500
COMMERCE BENEFITS GROUP - PEPM
Affiliated With: COMMERCE BENEFITS GROUP
Fund No:PlanType: Group Health
COMMERCE BENEFITS GROUP(440) 930-7500
COMMERCE BENEFITS GROUPPO Box 900ELYRIA OH 44036
COMMERCE BENEFITS GROUP(800) 223-9941
COMMERCE BENEFITS GROUP
COMMERCE BENEFITS GROUP/BUCKEYE PREFERRED
Affiliated With: COMMERCE BENEFITS GROUP
Fund No:PlanType: Group Health
COMMERCE BENEFITS GROUP(800) 223-9941
COMMERCE BENEFITS GROUPPO Box 900ELYRIA OH 44036
COMMUNITY ADMINISTRATORS
COMMUNITY ADMINISTRATORS
COMMUNITY ADMINISTRATORSAffiliated With: THE COMMUNITY HEALTH GROUP
Fund No:PlanType: Group Health
COMMUNITY ADMINISTRATORS
COMMUNITY ADMINISTRATORSPO Box 1177CHULA VISTA CA 91912
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-90• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
COMMUNITY BANK OF NEVADAAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
*
Term Effective: 9/30/2007Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
AMERIBEN SOLUTIONS(800) 953-1801
CHECK BENEFIT CARDCOMMUNITY COLLEGE OF DENVER
Affiliated With: AMERIBEN SOLUTIONS #15255
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 953-1801
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
COMMUNITY ADMINISTRATORS
CHECK BENEFIT CARDCOMMUNITY DENTALAffiliated With: COMMUNITY HEALTH GROUP
Fund No:PlanType: Group Health
COMMUNITY ADMINISTRATORS
COMMUNITY ADMINISTRATORSPO Box 1177CHULA VISTA CA 91912
COASTAL TPA, INC.(800) 564-7475
CHECK BENEFIT CARDCOMMUNITY HOSPITAL OF THE MONTEREY PENINSULA
Affiliated With: COASTAL TPA INC
Fund No:PlanType: Group Health
COASTAL TPA, INC.(800) 564-7475
COASTAL TPA, INC.PO Box 80308SALINAS CA 93912
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
Community One Federal Credit Union - Travel
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-91• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CompIQ Corporation(800) 293-3131
UM NOT APPLICABLEComp IQ - ASPAffiliated With: CompIQ
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(800) 293-3131
CompIQ Corporation35 Tesla Way #100Irvine CA 92618
CompIQ Corporation(800) 293-3131
UM NOT APPLICABLEComp IQ - ASP AUTOAffiliated With: CompIQ
Fund No:PlanType: Auto
CompIQ Corporation(800) 293-3131
CompIQ Corporation35 Tesla Way #100Irvine CA 92618
Insurers Administrative Corp(800) 964-4948
Med-Valu(800) 522-2161
Companion Life Insurance CompanyAffiliated With: Insurers Administrative Corporation
Fund No:PlanType: Group Health
Insurers Administrative Corp(602) 906-6263
Insurers Administrative CorpPO Box 828Park Ridge IL 60068-0828
CHECK BENEFIT CARD CHECK BENEFIT CARDCompass Rose Benefit GroupAffiliated With: Compass Rose Benefit Group
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
GLOBALCARE (GLOBALCARE/WEYCO)
GLOBALCARE (GLOBALCARE/WEYCO)
COMPIQAffiliated With: GLOBAL EMERGENCY MEDICAL SERVICES, INC. (GEMS)
Fund No:PlanType: Group Health
GLOBALCARE (GLOBALCARE/WEYCO)
GLOBALCARE (GLOBALCARE/WEYCO)2001 Westside Pkwy. #120ALPHARETTA GA 30004
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-92• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CompIQ Corporation(800) 293-3131
UM NOT APPLICABLECompIQAffiliated With: CompIQ #13910
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(800) 293-3131
CompIQ Corporation35 Tesla Way #100Irvine CA 92618
NHBC(888) 621-7900
CHECK BENEFIT CARDCOMPLETE BENEFITS SOLUTIONS LLC
Affiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 East Raintree DrScottsdale AZ 85751
Network Adjusters(516) 750-1319
CONTACT EMPLOYERCompMed Advantage / City of Peekskill
Affiliated With: CompMed Advantage
Fund No:PlanType: Workers' Compensation
Network Adjusters(516) 750-1319
Network AdjustersPO Box 6008Garden City NY 11530
KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711
CHECK BENEFIT CARDCOMPONE SERVICES LTDAffiliated With: THE KEMPTON GROUP
Fund No:PlanType: Group Health
KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711
KEMPTON GROUP ADMINISTRATORS INCPO Box 54889OKLAHOMA CITY OK 73154
EBPA(802) 846-8060
CHECK BENEFIT CARDCOMPREHENSIVE BENEFIT ADMINISTRATOR INC JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-93• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EBPA(802) 846-8060
CHECK BENEFIT CARDCONCEPTS NREC INC VSTAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
ACORDIA NATIONAL(888) 685-7774
CHECK BENEFIT CARDCONCORD HOSPITALITY ENTERPRISES COMPANY
Affiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR
Fund No:PlanType: Group Health
ACORDIA NATIONAL(888) 685-7774
ACORDIA NATIONALPO Box 3262CHARLESTON WV 25332
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
CONCORDIA HOMES OF NEVADAAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
CHECK BENEFIT CARDCONNECTICUT COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS INC
Fund No:PlanType: Group Health
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706
EBPA(800) 525-8788
CHECK BENEFIT CARDCONNECTICUT STEEL WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-94• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONNECTICUT VA HEALTHCARE SYSTEM
CHECK BENEFIT CARDCONNECTICUT VA HEALTHCARE SYSTEM 3113
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
CONNECTICUT VA HEALTHCARE SYSTEM
CONNECTICUT VA HEALTHCARE SYSTEM
555 WILLIARD AVENEWINGTON CT 06111
Attn: FEE BASIS (04F)
Brokerage Concepts, Inc. BENEFIT CONCEPTS, INC.(800) 883-2000
CONNOLLY BOVE LODGE & HUTZ LLP
Affiliated With: BROKERAGE CONCEPTS BENEFIT CONCEPTS, INC.
Fund No:PlanType: Group Health
BENEFIT CONCEPTS, INC. BENEFIT CONCEPTS, INC.1021 W 8TH AVEKING OF PRUSSIA PA 19406
GROUP & PENSION ADMINISTRATORS(800) 827-7223
HEALTH WATCH(972) 238-7900
CONSOLIDATED CASTING TRAVEL
Affiliated With: GROUP & PENSION ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223 Ext 2325
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
ADMINONE CORPORATION(800) 967-2077
MEDCAREONE CORP(800) 816-1206
CONSOLIDATED HEALTH PLANAffiliated With: ADMINONE CORPORATION
Fund No:PlanType: Group Health
ADMINONE CORPORATION(800) 967-2077
RESOURCEONE ADMINSTRATORS
PO Box 489BUCKEYSTOWN MD 21717
Attn: Mary Shepherd
MERCER ADMINISTRATION8005624023
CARE ALLIES(972) 307-2700
CONSOLIDATED RESOURCES INCAffiliated With: MERCER ADMINISTRATION #10442
Fund No:PlanType: Group Health
MERCER ADMINISTRATION8005624023
MERCER ADMINISTRATIONPO Box 1520IOWA CITY IA 52244
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-95• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ULTRABENEFITS INC(800) 323-4890
INTRACORP(800) 875-5315
CONSTRUCTION DATA COMPANYAffiliated With: UNITED BENEFITS DIVISION
Fund No:PlanType: Group Health
ULTRABENEFITS INC(800) 323-4890
ULTRABENEFITS INCPO Box 2480DAYTONA BEACH FL 32115-2480
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
Consumer Credit Services Inc TravelAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
*
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Insurers Administrative Corporation (IAC)(602) 906-6263
Insurers Administrative Corporation (IAC)(602) 395-7096
CONSUMER'S CHOICE/USAAffiliated With: AMERICAS HEALTH CARE BENEFIT PLAN
Fund No:PlanType: Group Health
Insurers Administrative Corporation (IAC)(602) 906-6263
Insurers Administrative Corporation (IAC)PO Box 39119Phoenix AZ 85069-9119
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
CONSUMERS INTERSTATE CORPORATION
Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
CONTINENTAL GENERAL INSURANCE COMPANY
CERES HEALTH CARE INC
CONTINENTAL GENERAL INSURANCE COMPANY
Affiliated With: AMERICAN REPUBLIC INSURANCE CO.
Fund No:PlanType: Group Health
CONTINENTAL GENERAL INSURANCE COMPANY
CONTINENTAL GENERAL INSURANCE COMPANYPO Box 247007OMAHA NE 68124
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-96• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERContinental Western GroupAffiliated With: Genex Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
BAC(614) 863-8780
BAC(614) 863-8780
CONTRACT LUMBERAffiliated With: BUSINESS ADMNISTRATORS & CONSULTANTS INC
Fund No:PlanType: Group Health
BAC(614) 863-8780
BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068
HEALTH PLAN INC(508) 752-2480
CARE MANAGEMENT SERVICES(866) 325-1550
CONTROL DEVICES INC DBA FIRST TECHNOLOGY
Affiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
EBPA(802) 846-8060
CHECK BENEFIT CARDCONTROL TECHNOLOGIES JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARDCONTROL TECHNOLOGIES WRAP JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-97• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Benefit Planners(800) 292-5386
CHECK BENEFIT CARDCOOPER CAMERON CORPORATION
Affiliated With: BENEFIT PLANNERS
*
Fund No:PlanType: Group Health
Benefit Planners(800) 292-5386
Benefit PlannersPO Box 690450SAN ANTONIO TX 78269
Health Design Plus(877) 286-3559
Health Design Plus(800) 385-7085
COOPER TIRE & RUBBER COMPANY
Affiliated With: HEALTH DESIGN PLUS
Fund No:PlanType: Group Health
Health Design Plus(877) 286-3559
Health Design Plus1755 GEORGETOWN ROADHUDSON OH 44236
CHECK BENEFIT CARD8007773575
CHECK BENEFIT CARDCORBIS CORPORATIONAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8007773575
CHECK BENEFIT CARD
THE LOOMIS COMPANY(877) 634-9814
HINES & ASSOCIATES(888) 826-5769
CORESLAB STRUCTURESAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(877) 634-9814
THE LOOMIS COMPANYPO Box 7045Wyomissing PA 19610
CHECK BENEFIT CARD CHECK BENEFIT CARDCORNISH COLLEGE OF THE ARTSAffiliated With: ADMINISTRATIVE CONCEPTS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-98• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDCORPORATE BENEFIT SERVICES OF AMERICA (CBSA)
Affiliated With: CORPORATE BENEFIT SERVICES OF AMERICA (CBSA)
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
ACORDIA NATIONAL(888) 685-7774
ACORDIA NATIONAL(304) 353-8743
CORPORATE WINGSAffiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR
Fund No:PlanType: Group Health
ACORDIA NATIONAL(888) 685-7774
ACORDIA NATIONALPO Box 3262CHARLESTON WV 25332
ENTRUST INC(281) 368-7878
MEDICAL HELPLINE(877) 463-3435
CORRPRO COMPANIESAffiliated With: ENTRUST INC
Fund No:PlanType: Group Health
ENTRUST INC(281) 368-7878
ENTRUST INC14701 ST MARY'S LN STE 150HOUSTON TX 77079
AMERICAN INSURANCE ADMINISTRATORS(800) 654-7900
CHECK BENEFIT CARDCOTKIN, COLLINS & GINSBURGAffiliated With: AMERICAN INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
AMERICAN INSURANCE ADMINISTRATORS(800) 654-7900
AMERICAN INSURANCE ADMINISTRATORS13191 CROSSROADS PARK NORTH STE 205CITY OF INDUSTRY CA 91746-3434
SISCO(563) 587-5175
SISCO(563) 587-5175
Cottingham and Butler SISCOAffiliated With: Fair Isaac Corporation
Fund No:PlanType: Workers' Compensation
SISCO(563) 587-5175
SISCOPO Box 28Dubuque IA 52004
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-99• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
International Medical Group, Inc.(317) 636-4721
Check Benefit CardCUNA Mutual Insurance SocietyPO Box 1648Madison WI 52701 or
Council on International Educational Exchange (CIEE)
Affiliated With: International Medical Group, Inc.
Fund No:PlanType: Group Health
International Medical Group, Inc.(317) 636-4721
International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684
GALLAGHER BENEFIT ADMINISTRATORS INC(888) 478-2650
GALLAGHER BENEFIT ADMINISTRATORS INC(630) 493-3925
COUNTY OF KERN POS PLANAffiliated With: GALLAGHER BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
GALLAGHER BENEFIT ADMINISTRATORS INC(888) 478-2650
GALLAGHER BENEFIT ADMINISTRATORS INCPO Box 5227LISLE IL 60532
GALLAGHER BENEFIT ADMINISTRATORS INC(888) 478-2650
GALLAGHER BENEFIT ADMINISTRATORS INC(630) 493-3925
COUNTY OF KERN PPO PLANAffiliated With: GALLAGHER BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
GALLAGHER BENEFIT ADMINISTRATORS INC(888) 478-2650
GALLAGHER BENEFIT ADMINISTRATORS INCPO Box 5227LISLE IL 60532
COUNTY OF LOS ANGELES(213) 637-0822
COUNTY OF LOS ANGELES(213) 637-0822
County Of Los AngelesAffiliated With: Diversified HealthCare Services
Fund No:PlanType: Workers' Compensation
COUNTY OF LOS ANGELES(213) 637-0822
COUNTY OF LOS ANGELES3333 Wilshire Blvd Ste 1000Los Angeles CA 90010
DELTA HEALTH SYSTEMS(209) 474-5647
HEALTH CARE EVALUATION(209) 951-6711
COUNTY OF MENDOCINOAffiliated With: DELTA HEALTH SYSTEMS
Fund No:PlanType: Group Health
DELTA HEALTH SYSTEMS(209) 474-5647
DELTA HEALTH SYSTEMSPO Box 1147STOCKTON CA 95201
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-100• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERCounty of Santa BarbaraAffiliated With: Stratacare
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
VALLEY HEALTH PLAN(408) 885-4582
VALLEY HEALTH PLAN(888) 421-8444
COUNTY OF SANTA CLARA - DEPT OF CORRECTIONS
Affiliated With: COUNTY OF SANTA CLARA
Fund No:PlanType: Group Health
VALLEY HEALTH PLAN(408) 885-4582
VALLEY HEALTH PLAN2325 Enborg Lane #290San Jose CA 95128
VALLEY HEALTH PLAN(888) 421-8444
VALLEY HEALTH PLAN(888) 421-8444
COUNTY OF SANTA CLARA DBA: SANTA CLARA VALLEY HEALTH & HOSPITAL SYSTEM
Affiliated With: COUNTY OF SANTA CLARA
Fund No:PlanType: Group Health
VALLEY HEALTH PLAN(888) 421-8444
VALLEY HEALTH PLAN2325 Enborg Lane #290San Jose CA 95128
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(877) 782-6828
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
COURTESY AUTOMOTIVE GROUP TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295
CHECK BENEFIT CARDCOURTNEY & PHARRAffiliated With: CAROLINA BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295
CAROLINA BENEFIT ADMINISTRATORS333 SOUTH PINE STSPARTANBURG SC 29302
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-101• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Coventry HealthCare of Louisiana, Inc.(800) 708-9355
Coventry HealthCare of Louisiana, Inc.(800) 708-9355
Coventry Health CareAffiliated With: Coventry Health Care
Fund No:PlanType: Group Health
Coventry HealthCare of Louisiana, Inc.(800) 341-6613
Coventry HealthCare of Louisiana, Inc.PO Box 7707London KY 40742
CHECK BENEFIT CARD CHECK BENEFIT CARDCOVENTRY OF KANSAS CITYAffiliated With: COVENTRY HEALTH CARE INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
GROUP & PENSION ADMINISTRATORS INC(800) 827-7223
HEALTH WATCH(972) 238-7900
CPR HEARTPLACEAffiliated With: GROUP & PENSION ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS INC(972) 238-7900
GROUP & PENSION ADMINISTRATORS INC12770 MERIT DR STE 200DALLAS TX 75251
CONTACT EMPLOYER CONTACT EMPLOYERCracker BarrelAffiliated With: Genex Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7345
CRAFTSMEN INDUSTRIES INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-102• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Crawford & Company(888) 382-0039
Crawford & Company(800) 241-2541
Crawford & Company
Fund No:PlanType: Auto
Crawford & Company(888) 382-0039
CONTACT EMPLOYER
Attn:
BENEFIT PLAN MANAGEMENT(781) 753-7559
CONTACT EMPLOYERCREATIVE OFFICE PAVILLIONAffiliated With: BENEFIT PLAN MANAGEMENT
Fund No:PlanType: Group Health
BENEFIT PLAN MANAGEMENT(781) 753-7559
BENEFIT PLAN MANAGEMENTPO Box 536ROCKLAND MA 02370
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
CREDIT ONE TRAVEL PLANAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
CREEL PRINTINGAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SELF INSURED SERVICES COMPANY (SISCO)(800) 457-4726
HEALTHCORP(800) 457-4726
CRESCENT ELECTRIC SUPPLY CO
Affiliated With: SELF INSURED SERVICES COMPANY
Fund No:PlanType: Group Health
SELF INSURED SERVICES COMPANY (SISCO)(800) 457-4726
SELF INSURED SERVICES COMPANY (SISCO)PO Box 28Dubuque IA 52004
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-103• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CERES c/o World Insurance(800) 247-2190
CHECK BENEFIT CARDCRL MAJOR MEDICAL CRS100 POK
Affiliated With: AMERICAN REPUBLIC INSURANCE CO.
Fund No:PlanType: Group Health
CERES c/o World Insurance(800) 247-2190
CERES c/o World InsurancePO Box 2804Clinton IA 52733
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
CROWN POINT CABINETRYAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
MBA OF WYOMING MBA OF WYOMINGCRUM ELECTRICAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING MOUNTAIN STATES REVIEWPO Box 94WORLAND WY 82401
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
CUMMINS CUMBERLANDAffiliated With: PREFERRED HEALTH PLAN INC 962550088
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(502) 992-4535
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
GLOBALCARE, INC.(678) 341-1922
UM NOT APPLICABLECUSTOM DESIGN BENEFITS - CINCOM
Affiliated With: GLOBALCARE INC
Fund No:PlanType: Group Health
GLOBALCARE, INC.(678) 341-1922
GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-104• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GLOBALCARE, INC.(678) 341-1922
UM NOT APPLICABLECUSTOM DESIGN BENEFITS - NEFF PACKAGING
Affiliated With: GLOBALCARE INC
Fund No:PlanType: Group Health
GLOBALCARE, INC.(678) 341-1922
GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
ASSURECARE(800) 968-6616
CARELINE(763) 383-4800
CUSTOMATIONAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823
GLOBALCARE(678) 341-1811
CHECK BENEFIT CARDCYPRESS-CREATIVE FORMINGAffiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1811
GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
CHECK BENEFIT CARDDAHL - CHASE PATHOLOGY ASSOCIATES
Affiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
CHECK BENEFIT CARDDAHL-CHASE DIAGNOSTIC SERVICES
Affiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-105• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD8002779476
CHECK BENEFIT CARDDAK AMERICAS LLCAffiliated With: CORPORATE BENEFITS SERVICE INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8002779476
CHECK BENEFIT CARD
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDDALLAS BAPTISTAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
GENEX SERVICES, INC. GENEX SERVICES, INC.DALLAS NATIONALAffiliated With: GENEX SERVICES, INC.
Fund No:PlanType: Workers' Compensation
GENEX SERVICES, INC. GENEX SERVICES, INC.440 E. SWEDESFORD RD STE 3050WAYNE PA 19087
CompIQ Corporation(949) 923-4021
CHECK BENEFIT CARDDallas National Insurance CompanyAffiliated With: CompIQ #13910
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(949) 923-4021
CompIQ Corporation35 Tesla Way #100Irvine CA 92618
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDDALLAS THEOLOGICAL SEMINARY
Affiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 426-9786
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-106• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
DALLAS VA MEDICAL CENTER
CHECK BENEFIT CARDDALLAS VA MEDICAL CENTER 3168
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
DALLAS VA MEDICAL CENTER
DALLAS VA MEDICAL CENTER
4500 S LANCASTERDALLAS TX 75216
Attn: FEE BASIS 136E
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEDALTON STATE COLLEGE UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDDALTON STATE UNIV AIH0058047Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDDALTON STATE UNIV AIH0058057Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
AMERICAN HEALTH GROUP
AMERICAN HEALTH GROUP
DANA CORPORATIONAffiliated With: AMERICAN HEALTH GROUP
Fund No:PlanType: Group Health
AMERICAN HEALTH GROUP
AMERICAN HEALTH GROUP570 LongbowMAUMEE OH 43537
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-107• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
DANVILLE VA MEDICAL CENTER
CHECK BENEFIT CARDDANVILLE VA MEDICAL CENTER 3154
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
DANVILLE VA MEDICAL CENTER
DANVILLE VA MEDICAL CENTER
1900 E MAIN STDANVILLE IL 61832
Attn: FEE BASIS (136A7)
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEDARTON COLLEGE UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
CHECK BENEFIT CARD CHECK BENEFIT CARDDAVE KINGSTON PRODUCE AFFILIATED COMPANIES
Affiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
FISERV HEALTH INC(800) 235-7160
AVIDYN HEALTH(214) 647-6194
DAYTON SUPERIORAffiliated With: FISERV HEALTH KANSAS - 11297
Fund No:PlanType: Group Health
FISERV HEALTH INC(800) 235-7160
FISERV HEALTH INCPO Box 520Pueblo CO 81002-0520
DAYTON VA MEDICAL CENTER
CHECK BENEFIT CARDDAYTON VA MEDICAL CENTER 3194
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
DAYTON VA MEDICAL CENTER
DAYTON VA MEDICAL CENTER
4100 W 3RD STDAYTON OH 45428
Attn: FEE BASIS 136
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-108• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MERITAIN HEALTH(877) 777-6076
GUIDED2HEALTH(952) 593-6447
DCI BIOLOGICALS, INCAffiliated With: CORPORATE BENEFIT SERVICE OF AMERICA
Fund No:PlanType: Group Health
MERITAIN HEALTH(877) 777-6076
MERITAIN HEALTHPO Box 1065AMHERST NY 14226
JSL ADMINISTRATORS, INC.(770) 683-1024
CHECK BENEFIT CARDDCR Services Inc.Affiliated With: JSL ADMINISTRATORS INC
*
Fund No:PlanType: Group Health
JSL ADMINISTRATORS, INC.(770) 683-1024
JSL ADMINISTRATORS, INC.PO BOX 71489Newnan GA 30271
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 587-3272
HEALTH CARE STRATEGIES8005821535
DEAD RIVER COMPANYAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 587-3272
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05407
EBPA(802) 846-8060
CHECK BENEFIT CARDDEAD RIVER COMPANY JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
AFFORDABLE BENEFIT ADMINISTRATORS, INC.
AFFORDABLE BENEFIT ADMINISTRATORS, INC.
DEARDEN'SAffiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC. (ABA)
Fund No:PlanType: Group Health
AFFORDABLE BENEFIT ADMINISTRATORS, INC.
AFFORDABLE BENEFIT ADMINISTRATORS, INC.PO Box 10787BURBANK CA 91510
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-109• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.(800) 990-9058
HCM(800) 990-9058
DEBRUCE GRAINAffiliated With: FMH BENEFIT SERVICES INC A DIVISION OF CORESOURCE
Fund No:PlanType: Group Health
FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.(800) 990-9058
FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.PO Box 25946OVERLAND PARK KS 66225-5946
CONSOCIATE, INC. C/O CCN(800) 798-2422
CHECK BENEFIT CARDDECATUR PUBLIC SCHOOL DISTRICT
Affiliated With: CONSOCIATE, INC.
Fund No:PlanType: Group Health
CONSOCIATE, INC. C/O CCN(800) 798-2422
CONSOCIATE, INC. C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
DECO PAPER PRODUCTSAffiliated With: PREFERRED HEALTH PLAN INC 962550088
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(502) 992-4535
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
Definiti(415) 973-8017
UM NOT APPLICABLEDefiniti / P G & EAffiliated With: COMP IQ
Fund No:PlanType: Workers' Compensation
Definiti(415) 973-8017
Definiti77 Beale StSan Francisco CA 94105
EBA&M(800) 776-1545
HINES & ASSOCIATES(800) 528-2498
DEFT, INCAffiliated With: EBA&M
Fund No:PlanType: Group Health
EBA&M(800) 776-1545
EBA&MPO Box 5079WESTLAKE VILLAGE CA 91359
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-110• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
THE EPOCH GROUP THE EPOCH GROUPDELAVAL INCAffiliated With: THE EPOCH GROUP, L.C.
Fund No:PlanType: Group Health
THE EPOCH GROUP THE EPOCH GROUPPO Box 12170OVERLAND PARK KS 66282
ADMINISTRATIVE CONCEPTS INC(888) 293-9229
UM NOT APPLICABLEDELAWARE VALLEY COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS, INC.
Fund No:PlanType: Group Health
ADMINISTRATIVE CONCEPTS INC(888) 293-9229
ADMINISTRATIVE CONCEPTS INC
997 Old Eagle School Rd. #215WAYNE PA 19087-1706
Attn: Customer Service Dept
Underwriters Safety & Claims, Inc.(800) 678-1536
Bluegrass Health Network(800) 264-7502
Desa InternationalAffiliated With: Underwriters Safety & Claims Inc.
Fund No:PlanType: Group Health
Underwriters Safety & Claims, Inc.(800) 678-1536
Underwriters Safety & Claims, Inc.PO Box 23507Louisville KY 40223-0507
Deseret Mutual Benefit Administrators(800) 777-3622
Deseret Mutual Benefit Administrators(800) 777-3622
Deseret Mutual Benefit Administrators
Affiliated With: Deseret Mutual Benefit Administrators
Fund No:PlanType: Group Health
Deseret Mutual Benefit Administrators(801) 578-5652
Deseret Mutual Benefit AdministratorsPO Box 45530Salt Lake City UT 84145-0530
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
DESERT LUMBERAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-111• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
DESERT ORTHOPAEDIC TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
DESERT RADIOLOGIST - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
STAR HEALTHCARE NETWORK(212) 581-8228
UM NOT APPLICABLEDESJARDINAffiliated With: STAR HEALTHCARE NETWORK INC
*
Fund No:PlanType: Group Health
STAR HEALTHCARE NETWORK(212) 581-8228
STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019
DETROIT VA MEDICAL CENTER
CHECK BENEFIT CARDDETROIT VA MEDICAL CENTER 3155
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
DETROIT VA MEDICAL CENTER
DETROIT VA MEDICAL CENTER
4646 JOHN RDETROIT MI 48201
Attn: FEE BASIS 001B-SS
CONTACT EMPLOYER CHECK BENEFIT CARDDHSI - California Pacific Medical Center (CPMC)
Affiliated With: Fair Isaac Corp / Diversified Healthcare Systems
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-112• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CHECK BENEFIT CARDDHSI - Creative Risk FundingAffiliated With: Diversified Healthcare Systems
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
ALTERNATIVE INSURANCE RESOURCES(202) 871-3229
CHECK BENEFIT CARDDIAGNOS-TECHS, INCAffiliated With: ALTERNATIVE INSURANCE RESOURCES
Fund No:PlanType: Group Health
ALTERNATIVE INSURANCE RESOURCES(202) 871-3229
ALTERNATIVE INSURANCE RESOURCESPO Box 660787BIRMINGHAM AL 35266
ADMINISTRATIVE CONCEPTS INC(888) 293-9229
UM NOT APPLICABLEDICKINSON COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS, INC.
Fund No:PlanType: Group Health
ADMINISTRATIVE CONCEPTS INC(888) 293-9229
ADMINISTRATIVE CONCEPTS INC
997 Old Eagle School Rd. #215WAYNE PA 19087-1706
Attn: Customer Service Dept
COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 846-8060
HEALTH CARE STRATEGIES(800) 582-1535
DINGLEY PRESS IPNAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATORPO Box 2365SOUTH BURLINGTON VT 05407
COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 846-8060
HEALTH CARE STRATEGIES(800) 582-1535
DINGLEY PRESS JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATORPO Box 2365SOUTH BURLINGTON VT 05407
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-113• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 846-8060
HEALTH CARE STRATEGIES(800) 582-1535
DINGLEY PRESS SCAN DIRECTAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATORPO Box 2365SOUTH BURLINGTON VT 05407
MBA OF MARYLAND(307) 347-6151
MOUNTAIN STATES REVIEW(307) 347-7979
DIOCESE OF CHEYENNEAffiliated With: MBA OF WYOMING 13039
Fund No:PlanType: Group Health
MBA OF MARYLAND(307) 347-6151
MBA OF MARYLANDPO Box 98WORLAND WY 82401
FCE BENEFIT ADMINISTRATORS(800) 899-9355
UM NOT APPLICABLEDIPLOMATIC PAINTING & BUILDING SERVICES COMPANY
Affiliated With: FCE BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS(800) 899-9355
FCE BENEFIT ADMINISTRATORS4615 WALZEN RD STE 300SAN ANTONIO TX 78218
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
UM NOT APPLICABLEDIPLOMATIC PAINTING & BUILDING SERVICES COMPANY
Affiliated With: FCE BENEFIT ADMINISTRATORS INC #10388
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMIN. CORP.Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-114• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CORESOURCE, INC.(800) 223-3843
CORESOURCE, INC.(800) 223-3843
DIVERSIFIED COMMUNICATIONSAffiliated With: COURESOURCE, INC
Fund No:PlanType: Group Health
CORESOURCE, INC.(800) 223-3843
CORESOURCE, INC.PO Box 83301LANCASTER PA 17608-3301
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
DIVERSIFIED CONTRACTORS, INC.
Affiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
Diversified Health Care Services, Inc.(714) 918-2590 Ext 104
Diversified Health Care Services, Inc.(714) 918-2590 Ext 104
Diversified Health Care Service (DHSI)
Affiliated With: Diversified Health Care Service
Fund No:PlanType: Workers' Compensation
Diversified Health Care Services, Inc.(714) 918-2590 Ext 104
Diversified Health Care Services, Inc.201 East Sandpointe, Suite 320Santa Ana CA 92707
CONTACT EMPLOYER CONTACT EMPLOYERDiversified Healthcare SystemsAffiliated With: Fair Isaac Corporation
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CHECK BENEFIT CARD CHECK BENEFIT CARDDIXON BROS, INCAffiliated With: WESTERN HEALTH
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-115• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
BAC(614) 863-8780
BAC(614) 863-8780
DLZ CORPORATIONAffiliated With: BUSINESS ADMINISTRATORS AND CONSULTANTS
Fund No:PlanType: Group Health
BAC(614) 863-8780
BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068
CONTACT EMPLOYER CONTACT EMPLOYERDMIAffiliated With: CompIQ #13910
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(800) 293-3131
CompIQ Corporation35 Tesla Way #100Irvine CA 92618
Health Design Plus(877) 230-0990
CHECK BENEFIT CARD(800) 434-1305
Donatos Pizzeria CorporationAffiliated With: Health Design Plus
Fund No:PlanType: Group Health
Health Design Plus(877) 230-0990
Health Design PlusPO Box 2582HUDSON OH 44236
EBPA(800) 578-3272
CHECK BENEFIT CARDDORKS UNLIMITED JMSAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS
Fund No:PlanType: Group Health
EBPA(800) 578-3272
EBPA
PO Box 2000Exeter NH 03833
Attn: Denise Oberg
EBPA(800) 578-3272
CHECK BENEFIT CARDDORKS UNLIMITED WRAP % JMSAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS
Fund No:PlanType: Group Health
EBPA(800) 578-3272
EBPA
PO Box 2000Exeter NH 03833
Attn: Denise Oberg
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-116• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDDOUG ANDRUS DISTRIBUTINGAffiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
MARTIN BOYER(800) 442-7247
CHECK BENEFIT CARDDOUGLAS COUNTY SCHOOL DISTRICT
Affiliated With: HEALTHCOMP TPA
Fund No:PlanType: Group Health
HEALTHCOMP TPA(800) 442-7247
HEALTHCOMP TPAPO Box 45018Fresno CA 93718
CHECK BENEFIT CARD CHECK BENEFIT CARDDOUGLASS FERTILIZER CHEMICAL INC
Affiliated With: HERITAGE CONSULTANTS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
CHECK BENEFIT CARDDOWN EAST TOYOTA BUICKAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226
CENBEN USA(614) 797-5204
CHECK BENEFIT CARDDR SYSTEMSAffiliated With: CENBEN USA INC
Fund No:PlanType: Group Health
CENBEN USA(614) 797-5204
CENBEN USA
4079 Executive PkwyWesterville OH 43081
Attn: Melissa Joseph
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-117• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONSUMER HEALTH SOLUTIONS(877) 573-9541
CHECK BENEFIT CARDDRIVERS CHOICEAffiliated With: CONSUMER HEALTH SOLUTIONS
Fund No:PlanType: Group Health
CONSUMER HEALTH SOLUTIONS(877) 573-9541
CONSUMER HEALTH SOLUTIONS333 SOUTH PINE STSPARTANBURG SC 29302
PREFERRED HEALTH PLANS INC.(800) 832-8212
CHECK BENEFIT CARDDRYWALL SYSTEMS PLUSAffiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(800) 832-8212
PREFERRED HEALTH PLANS INC.PO Box 437017Louisville KY 40253
DUBLIN VAMC CHECK BENEFIT CARDDUBLIN VAMC 3546Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
DUBLIN VAMC DUBLIN VAMC
1826 VETERANS BLVDDUBLIN GA 31021
Attn: FEE BASIS 04
Western Health(605) 719-4600 or (888) 341-1766
Western Health(605) 719-4640 or (800) 229-0892
Duhamel Broadcasting EnterprisesAffiliated With: Rapid City Regional Hospital DBA Western Health
Fund No:PlanType: Group Health
Western Health(605) 719-4600 or (888) 341-1766
Western Health529 Kansas City St Ste 200Rapid City SD 57701
PRIMARY PHYSICIANCARE, INC.(704) 527-8102
PRIMARY PHYSICIANCARE, INC.(704) 523-2758
DUNCAN-PARNELLAffiliated With: PRIMARY PHYSICIANCARE INC
Fund No:PlanType: Group Health
PRIMARY PHYSICIANCARE, INC.(704) 527-8102
PRIMARY PHYSICIANCARE, INC.PO Box 11088CHARLOTTE NC 28220
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-118• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002
UM NOT APPLICABLE(800) 367-9939
DUNELAND SCHOOL CORPORATION
Affiliated With: EMPLOYEE BENEFIT CONSULTANTS INC
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002
EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839
NGS AMERICAN8005211555
NGS AMERICAN8005211555
DURA AUTOMOTIVEAffiliated With: NGS AMERICAN
Fund No:PlanType: Group Health
NGS AMERICAN8005211555
NGS AMERICAN, INC.PO Box 7676DETROIT MI 48080
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
DURHAM EXCHANGE CLUB INDUSTRIES
Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
DURHAM VAMC CHECK BENEFIT CARDDURHAM VAMC 3135Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
DURHAM VAMC DURHAM VAMC
508 FULTON STDURHAM NC 27705
Attn: FEE BASIS
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
DYNAMIC POWER SOURCE, LLCAffiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(800) 832-8212
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-119• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EBPA(802) 846-8060
CHECK BENEFIT CARDDYNAPOWER CORPORATION JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARDDYNAPOWER CORPORATION WRAP JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
TALL TREE ADMINISTRATORS(801) 274-8100
CORVEL(801) 269-8723
DYNATEC CORP USAAffiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
TALL TREE ADMINISTRATORS(801) 274-8100
TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107
NORTH AMERICAN ADMINISTRATORS INC(877) 777-6076
AMERICAN HEALTH HOLDINGS INC(800) 337-0506
DYSON KYSSNER MORAN CORPORATION
Affiliated With: NORTH AMERICAN ADMINISTRATORS - NY
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS INC(877) 777-6076
NORTH AMERICAN ADMINISTRATORS INCPO Box 1065AMHERST NY 14226
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-120• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
E GADSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
E GADS TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
GROUP & PENSION ADMINISTRATORS(800) 827-7223
CHECK BENEFIT CARDEagle Pass ISD (Travel)Affiliated With: GROUP & PENSION ADMINISTRATORS
*
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
SELF INSURED SERVICES COMPANY (SISCO)(319) 583-7344
CHECK BENEFIT CARDEAST BALT COMMAffiliated With: SELF INSURED SERVICES COMPANY SISCO
Fund No:PlanType: Group Health
SELF INSURED SERVICES COMPANY (SISCO)(319) 583-7344
SELF INSURED SERVICES COMPANY (SISCO)PO Box 389DUBUQUE IA 52004-0389
STUDENT ASSURANCE SERVICES INC(800) 328-2739
CHECK BENEFIT CARDEAST CENTRAL COLLEGEAffiliated With: STUDENT ASSURANCE SERVICES INC
Fund No:PlanType: Group Health
STUDENT ASSURANCE SERVICES INC(800) 328-2739
STUDENT ASSURANCE SERVICES INC333 N. MAIN STREETSTILLWATER MN 55082
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-121• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MORRIS ASSOCIATES(800) 950-6789
CHECK BENEFIT CARDEAST CENTRAL ILLINOIS PIPE TRADES H & W FUND
Affiliated With: MORRIS ASSOCIATES
Fund No:PlanType: Group Health
MORRIS ASSOCIATES(800) 950-6789
MORRIS ASSOCIATES9045 E 59TH STINDIANAPOLIS IN 46250
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDEAST GEORGIA COLLEGE AIH0058087
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDEAST GEORGIA COLLEGE AIH0058097
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
EAST ORANGE VA MEDICAL CENTER
CHECK BENEFIT CARDEAST ORANGE VA MEDICAL CENTER 3119
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
EAST ORANGE VA MEDICAL CENTER
EAST ORANGE VA MEDICAL CENTER
385 TREEMONT AVEEAST ORANGE NJ 07018
Attn: FEE BASIS 04
CONTACT EMPLOYER CONTACT EMPLOYEREastern AllianceAffiliated With: Eastern Alliance Insurance Group
Fund No:PlanType: Workers' Compensation
Exclude PT providers
CONTACT EMPLOYER CONTACT EMPLOYER
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-122• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EASTERN BENEFIT SYSTEMS, INC.(800) 524-0227
BEECH STREET(800) 227-7464
EASTERN BENEFIT SYSTEMS, INC.
Fund No:PlanType: Group Health
EASTERN BENEFIT SYSTEMS, INC.(800) 524-0227
EASTERN BENEFIT SYSTEMS, INC.200 Freeway Dr, EastEast Orange 07018
EASTERN COLORADO VA HC SYSTEM
CHECK BENEFIT CARDEASTERN COLORADO VA HCS 3532
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
EASTERN COLORADO VA HC SYSTEM
EASTERN COLORADO VA HC SYSTEM1055 CLERMONT STDENVER CO 80220
CONSOLIDATED HEALTH PLANS INC(800) 633-7867
CHECK BENEFIT CARDEASTERN NAZARENE COLLEGEAffiliated With: CONSOLIDATED HEALTH PLANS INC
Fund No:PlanType: Group Health
CONSOLIDATED HEALTH PLANS INC(800) 633-7867
CONSOLIDATED HEALTH PLANS INC195 STAFFORD STSPRINGFIELD MA 01104
USI ADMINISTRATORS(877) 277-5718
USI ADMINISTRATORSEASTERN OREGON UNIVERSITYAffiliated With: FIRST UNDERWRITERS INC
Fund No:PlanType: Group Health
USI ADMINISTRATORS(877) 277-5718
USI ADMINISTRATORSPO Box 3357FORT WORTH TX 76113
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONS(800) 786-7930
EASTERN OREGON UNIVERSITY INTERNATIONAL AND DOMESTIC
Affiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-123• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH PLAN INC5087522480
CMS INC(866) 325-1550
EASTPOINT PROPERTIESAffiliated With: HEALTH PLANS, INC.
Fund No:PlanType: Group Health
HEALTH PLAN INC(866) 325-1550
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
EATON CORPORATION(800) 891-6506
CHECK BENEFIT CARDEaton CorporationAffiliated With: Eaton Corporation
Fund No:PlanType: Group Health
EATON CORPORATION(800) 891-6506
EATON CORPORATIONPO Box 8400London KY 40742
CHECK BENEFIT CARD CHECK BENEFIT CARDEATON METAL PRODUCTSAffiliated With: CNIC HEALTH SOLUTIONS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD8007773575
CHECK BENEFIT CARDEBMS EMPLOYEE HEALTH PLANAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8007773575
CHECK BENEFIT CARD
EDWARD HINES JR VAMC CHECK BENEFIT CARDEDWARD HINES JR VAMC 3162Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
EDWARD HINES JR VAMC EDWARD HINES JR VAMC
5TH AVE & ROOSEVELT RDHINES IL 60141
Attn: FEE SERVICES
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-124• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
EDWARD M BERSTEIN & ASOCIATES - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
GREATER LA HCS (SEPULVEDA VAMC)PO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
EFFICIENT ENTERPRISES TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
COMPUSYS(800) 628-6562
UM NOT APPLICABLEEIGHTH DISTRICT ELECTRICAL BENEFIT FUND / ID MT WY
Affiliated With: EIGHTH DISTRICT ELECTRICAL BENEFIT FUND
Fund No:PlanType: Group Health
COMPUSYS(800) 628-6562
COMPUSYS2156 W 2200 SSALT LAKE CITY UT 84119-1326
TALL TREE ADMINISTRATORS8774534201
UM NOT APPLICABLEEL CENTRO REGIONAL MEDICAL CENTER
Affiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
TALL TREE ADMINISTRATORS8774534201
TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-125• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PARADIGM HEALTH CORPORATION(888) 621-7900
CHECK BENEFIT CARDEL PASO FIRST HEALTH PLANSAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
EL PASO VAMC CHECK BENEFIT CARDEL PASO VAMC 3174Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
EL PASO VAMC EL PASO VAMC
5001 N PEIDRASEL PASO TX 79930
Attn: FEE BASIS - 04
CONTACT EMPLOYER CONTACT EMPLOYERElectric Insurance
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER First HealthElectric Insurance CompanyAffiliated With: Electric Insurance Company
Fund No:PlanType: Workers' Compensation
First Health First HealthPO Box 11930Tucson AZ 85734
CHECK BENEFIT CARD CHECK BENEFIT CARDElectrical Construction Industry Health and Welfare Fund
Fund No: V5123PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-126• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
ELECTRICAL WHOLESALE SUPPLY CO., INC.
Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
PEARCE ADMINISTRATION(888) 722-1668
CHECK BENEFIT CARDELIZABETH CITY STATE UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(888) 722-1668
PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDELK HILLS SCHOOLAffiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDELLAAffiliated With: UnitedHealthcare StudentResources #11689
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARDELM ELECTRIC WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-127• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CORESOURCE INC(866) 682-3152
CORESOURCE INC(866) 831-5677
EMERGENCY MEDICINE PHYSICIANS
Affiliated With: CORESOURCE INC
Fund No:PlanType: Group Health
CORESOURCE INC(866) 682-3152
CORESOURCE INCPO Box 2920CLINTON OH 52733-2920
CHECK BENEFIT CARD8007773575
CHECK BENEFIT CARDEMERITUS ASSISTED LIVINGAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8007773575
CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYEREmerson ElectricAffiliated With: Genex Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
WAUSAU BENEFITS, INC. CHECK BENEFIT CARDEMERSON ELECTRIC CO. FOR IN-SINK-ERATOR
Affiliated With: EMERSON ELECTRIC CO. FOR IN-SINK-ERATOR
Fund No:PlanType: Group Health
WAUSAU BENEFITS, INC. WAUSAU BENEFITS, INC.PO Box 8013WAUSAU WI 54402-8013
CHECK BENEFIT CARD8003659036
CHECK BENEFIT CARDEMERSON TELECOMMUNICATION PRODUCTS INC
Affiliated With: THE EPOCH GROUP L C
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8003659036
CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-128• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
EMINENCE SPEAKER, LLCAffiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(800) 832-8212
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
Benefits/Eligibility(800) 843-3106
CHECK BENEFIT CARDEmpire Fire and MarineAffiliated With: Insurers Administrative Corporation
Fund No:PlanType: Group Health
Benefits/Eligibility(800) 843-3106
Benefits/EligibilityPO Box 39119Phoenix AZ 85069-9119
EMPLOYEE BENEFIT PLAN ADMINISTRATION(800) 268-7298
HEALTHCARE STRATEGIES(800) 582-1535
EMPLOYEE BENEFIT PLAN ADMINISTRATION IPN
Affiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATION
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT PLAN ADMINISTRATION(603) 773-4521
EMPLOYEE BENEFIT PLAN ADMINISTRATION
PO Box 2000Exeter NH 03833
Attn: Denise Oberg
EMPLOYEE BENEFIT PLAN ADMINISTRATION(800) 268-7298
HEALTHCARE STRATEGIES(800) 582-1535
EMPLOYEE BENEFIT PLAN ADMINISTRATION JMS
Affiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATION
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT PLAN ADMINISTRATION(603) 773-4521
EMPLOYEE BENEFIT PLAN ADMINISTRATION
PO Box 2000Exeter NH 03833
Attn: Denise Oberg
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-129• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EMPLOYEE BENEFIT PLAN ADMINISTRATION(800) 268-7298
HEALTHCARE STRATEGIES(800) 582-1535
EMPLOYEE BENEFIT PLAN ADMINISTRATION NATIONAL WRAP SCANDIRECT
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT PLAN ADMINISTRATION(603) 773-4521
EMPLOYEE BENEFIT PLAN ADMINISTRATION
PO Box 2000Exeter NH 03833
Attn: Denise Oberg
THE PLAN HANDLERS, INC.(800) 538-5512
THE PLAN HANDLERS, INC.
ENCINITAS UNION SCHOOL DISTRICT
Affiliated With: CBIZ/SCEET
Fund No:PlanType: Group Health
THE PLAN HANDLERS, INC.(800) 538-5512
THE PLAN HANDLERS, INC.930 Canterbury Pl.ESCONDIDO CA 92025
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
ENCORE PRODUCTIONSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
ENCORE PRODUCTIONS - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
ACORDIA NATIONAL(888) 685-7774
CHECK BENEFIT CARDENERGY WESTAffiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR
Fund No:PlanType: Group Health
ACORDIA NATIONAL(888) 685-7774
ACORDIA NATIONAL
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-130• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CNIC HEALTH SOLUTIONS(800) 426-7453
CNIC HEALTH SOLUTIONS(800) 426-7453
ENGINEERED DATA PRODUCTS HOLDINGS LLC
Affiliated With: CINC HEALTH SOLUTIONS
Fund No:PlanType: Group Health
CNIC HEALTH SOLUTIONS(800) 426-7453
CNIC HEALTH SOLUTIONSPO Box 3559ENGLEWOOD CO 80155-3559
CHECK BENEFIT CARD CHECK BENEFIT CARDENGINEERED QUALITY PLASTICSAffiliated With: THE EPOCH GROUP L C
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
GROUP & PENSION ADMINISTRATORS INC(800) 827-7223
HEALTH WATCH(800) 827-7223
ENNIS, INCAffiliated With: GROUP & PENSION ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS INC(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
AMERIBEN SOLUTIONS(800) 786-7930
CHECK BENEFIT CARDENSIGN US DRILLING %Affiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
AMERIBEN SOLUTIONS(800) 786-7930
CHECK BENEFIT CARDENSIGN US DRILLING PEPMAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-131• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MIDWEST SECURITY ADMINISTRATORS INC(608) 783-8718
UM NOT APPLICABLEENZYMATIC THERAPY, INCAffiliated With: MIDWEST SECURITY ADMINISTRATORS
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS INC(608) 783-8718
MIDWEST SECURITY ADMINISTRATORS INC2700 Midwest Dr.ONALASKA WI 54650
CONTACT EMPLOYER CONTACT EMPLOYEREpicAffiliated With: Innovative Risk Management
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
EPISCOPAL CHURCH HOMEAffiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(800) 832-8212
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
CHECK BENEFIT CARD CHECK BENEFIT CARDEPT MCGILL BEARINGAffiliated With: THE EPOCH GROUP #10469
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
ERIE VAMC CHECK BENEFIT CARDERIE VAMC 3125Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
ERIE VAMC ERIE VAMC
135 E 38TH STERIE PA 16504
Attn: FEE BASIS 174E
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-132• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERESIS
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
HEALTHCOMP(559) 499-2450
HEALTHCOMP(559) 499-2450
EskatonAffiliated With: HEALTHCOMP
Fund No:PlanType: Group Health
HEALTHCOMP(559) 499-2450
HEALTHCOMPPO Box 45018Fresno CA 93718
EVANSVILLE OPC VA CHECK BENEFIT CARDEVANSVILLE OPC VA 3309Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
EVANSVILLE OPC VA EVANSVILLE OPC VA
500 E WALNUT STEVANSVILLE IN 47713
Attn: FEE BASIS
GROUP & PENSION ADMINISTRATORS INC(800) 827-7223
CHECK BENEFIT CARDEVERCOM SYSTEMSAffiliated With: GROUP AND PENSION ADMINISTRATORS INC
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS INC(800) 827-7223
GROUP & PENSION ADMINISTRATORS INCPO Box 749075DALLAS TX 75374-9075
CONTACT EMPLOYER CONTACT EMPLOYEREverest ACCA San FranciscoAffiliated With: Everest ACCA
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-133• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYEREverest NationalAffiliated With: Everest SRS
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
EVEREST NATIONAL INSURANCE CO.(949) 330-6892
EVEREST NATIONAL INSURANCE CO.(949) 330-6892
EVEREST NATIONAL INSURANCE CO.
Affiliated With: EVEREST NATIONAL INSURANCE CO.
Fund No:PlanType: Workers' Compensation
EVEREST NATIONAL INSURANCE CO.(949) 330-6892
EVEREST NATIONAL INSURANCE CO.65 Enterprise Suite 235Aliso Viejo CA 92656
CHECK BENEFIT CARD CHECK BENEFIT CARDEVOLUTION BUSINESS SOLUTIONS
Affiliated With: TALL TREE AADMINISTRATORS
*
Term Effective: 11/1/2007Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Brokerage Concepts, Inc.(888) 554-7629
PERFORMAX / AMERICAN HEALTH HOLDING(614) 818-3222
EXPERIENCE WORKS, INC.Affiliated With: PERFORMAX BCI
Fund No:PlanType: Group Health
Brokerage Concepts, Inc.(888) 554-7629
Brokerage Concepts, Inc.PO Box 61505KING OF PRUSSIA PA 19406
BOON CHAPMAN(800) 252-9653
PRIME DX(800) 477-4625
EZCORP, INC.Affiliated With: BOON CHAPMAN BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
BOON CHAPMAN(800) 252-9653
BOON CHAPMANPO Box 9201AUSTIN TX 78766
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-134• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
F RODGERS SPECIALTY CONTRACTORS INC
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
FARA - F. A. Richard & Associates, Inc.(985) 624-6740
FARA - F. A. Richard & Associates, Inc.(985) 624-6740
F. A. Richard & Associates, Inc.Affiliated With: F. A. Richard & Associates, Inc.
Fund No:PlanType: Workers' Compensation
Exclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)
FARA - F. A. Richard & Associates, Inc.(985) 624-6740
FARA - F. A. Richard & Associates, Inc.1625 W. Causeway ApproachMandeville LA 70471
CONTACT EMPLOYER CONTACT EMPLOYERFair Isaac CorporationAffiliated With: Fair Isaac Corporation
Fund No:PlanType: Workers' Compensation
Includes Exclusive Preferred Providers (OCN ONLY)
CONTACT EMPLOYER CONTACT EMPLOYER
PIONEER MANAGEMENT SYSTEMS(413) 534-8658
UM NOT APPLICABLEFairfield University International Students
Affiliated With: PIONEER MANAGEMENT SYSTEMS
*
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(413) 534-8658
PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01089
GISC, INC(800) 242-4472
GISC TOTALCARE(800) 999-1077
Falvey LinenAffiliated With: GROUP INSURANCE SERVICE CENTER
*
Fund No:PlanType: Group Health
GISC, INC(800) 242-4472
GISC, INC20 WINTER STPEMBROKE MA 02359
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-135• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GLOBALCARE, INC. GLOBALCARE, INC.FAMILY HEALTH PLANAffiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC. GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
FISERV HEALTH INC(800) 235-7160
AVIDYN HEALTH(214) 647-6194
FAMILY HOME HEALTH AGENCYAffiliated With: FISERV HEALTH
Fund No:PlanType: Group Health
FISERV HEALTH INC(800) 235-7160
FISERV HEALTH INCPO Box 520Pueblo CO 81002-0520
FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.(800) 990-9058
HCMFANCOR INCAffiliated With: FMH BENEFIT SERVICES INC
Fund No:PlanType: Group Health
FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.(800) 990-9058
FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.PO Box 25946OVERLAND PARK KS 66225-5946
BAC(614) 863-8780 Ext 3102
BAC(614) 863-8780
FANNING/HOWEY ASSOCIATES, INC.
Affiliated With: BUSINESS ADMINISTRATORS & CONSULTANTS
Fund No:PlanType: Group Health
BAC(614) 863-8780 Ext 3102
BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068
FARA - F. A. Richard & Associates, Inc.(985) 624-6740
FARA - F. A. Richard & Associates, Inc.(985) 624-6740
FARA AvondaleAffiliated With: F. A. Richard & Associates, Inc.
Fund No:PlanType: Workers' Compensation
Exclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)
FARA - F. A. Richard & Associates, Inc.(985) 624-6740
FARA - F. A. Richard & Associates, Inc.1625 W. Causeway ApproachMandeville LA 70471
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-136• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FARA - F. A. Richard & Associates, Inc.(985) 624-6740
FARA - F. A. Richard & Associates, Inc.(985) 624-6740
FARA IngallsAffiliated With: F. A. Richard & Associates, Inc.
Fund No:PlanType: Workers' Compensation
Exclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)
FARA - F. A. Richard & Associates, Inc.(985) 624-6740
FARA - F. A. Richard & Associates, Inc.1625 W. Causeway ApproachMandeville LA 70471
HEALTH NET FEDERAL SERVICES(916) 985-1259
CHECK BENEFIT CARDFARGO VAMC 3707Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(916) 985-1259
HEALTH NET FEDERAL SERVICES2025 AEROJET RDRANCHO CORDOVA CA 95742
HEALTHLINK GROUP BENEFIT SERVICES, INC.
FAYETTE R III SCHOOLSAffiliated With: GROUP BENEFIT SERVICES, INC.
Fund No:PlanType: Group Health
GROUP BENEFIT SERVICES, INC.
HEALTHLINKPO Box 419104SAINT LOUIS MO 63141-9104
FAYETTEVILLE NC VAMC CHECK BENEFIT CARDFAYETTEVILLE NC VAMC 3136Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
FAYETTEVILLE NC VAMC FAYETTEVILLE NC VAMC
2300 RAMSEY STFAYETTEVILLE NC 28301
Attn: FEE BASIS BUSINESS OFFICE (04)
PEARCE ADMINISTRATION(888) 722-1668
CHECK BENEFIT CARDFAYETTEVILLE STATE UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(888) 722-1668
PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-137• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FCCI Insurance Group(800) 226-3224
FCCI Insurance Group(800) 226-3224
FCCI Insurance GroupAffiliated With: FCCI Insurance Group
Fund No:PlanType: Workers' Compensation
FCCI Insurance Group(800) 226-3224
FCCI Insurance Group6300 University PkwySarasota FL 34240
ADVENTIST HEALTH SYSTEM WEST
CHECK BENEFIT CARDFEATHER RIVER HOSPITALAffiliated With: ADVENTIST HEALTH SYSTEM/WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002
STAR HEALTHCARE NETWORK(212) 581-8228
UM NOT APPLICABLEFEDERAL ASSISTAffiliated With: STAR HEALTHCARE NETWORK INC
*
Fund No:PlanType: Group Health
STAR HEALTHCARE NETWORK(212) 581-8228
STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019
GLOBALHEALTH(405) 280-5600
GLOBALHEALTH(405) 230-8781
Federal GovernmentAffiliated With: GLOBALHEALTH AND GENERATION HEALTHCARE
Fund No:PlanType: Group Health
GLOBALHEALTH(405) 280-5600
GLOBALHEALTH7001 NE 10th StOklahoma City OK 73104
NHBC(888) 621-7900
CHECK BENEFIT CARDFEDERATED INNSURANCEAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC) 12717
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-138• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERFedEx/RSKCo
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER CONTACT EMPLOYERFedEx/Sedgwick
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Underwriters Safety & Claims Inc.(800) 678-1536
Underwriters Safety & Claims Inc.(800) 678-1536
Feintool US Operations IncAffiliated With: Underwriters Safety & Claims Inc.
Fund No:PlanType: Group Health
Underwriters Safety & Claims Inc.(800) 678-1536
First HealthPO Box 8399Scottsdale AZ 85252-8399
Corporate Beneifit Services of America(800) 925-2272
Corporate Beneifit Services of America(800) 925-2272
FH-Savings-Corporate Benefit Services of America
Affiliated With: FH-Savings-Corporate Benefit Services of America
Fund No:PlanType: Group Health
Corporate Beneifit Services of America(800) 925-2272
Corporate Beneifit Services of America400 Highway 169 South, Ste 800Minneapolis MN 55426-1141
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.(800) 284-2273
FI PPOAffiliated With: OSF HEALTHPLANS, INC.
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-139• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295
CHECK BENEFIT CARDFidelity MortgageAffiliated With: Carolina Benefit Administrators
Fund No:PlanType: Group Health
CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295
CAROLINA BENEFIT ADMINISTRATORS333 SOUTH PINE STSPARTANBURG SC 29302
Benefits/Eligibility(800) 843-3106
CHECK BENEFIT CARDFidelty Security LifeAffiliated With: Insurers Administrative Corporation #962500302
Fund No:PlanType: Group Health
Benefits/Eligibility(800) 843-3106
Benefits/Eligibility
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
FINDLAY MANAGEMENT GOUP INC. - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 742-7345
FINDLAY MANAGEMENT GROUP INC
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CONTACT EMPLOYER CONTACT EMPLOYERFiremans Fund Insurance Co
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-140• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERFiremans Fund Insurance CompanyAffiliated With: Firemans Fund Insurance Company
Fund No:PlanType: Workers' Compensation
Includes Specialized Physical Therapy
CONTACT EMPLOYER NOT APPLICABLEPO Box 23010Tucson AZ 85734
CONTACT EMPLOYER CONTACT EMPLOYERFirst Health Group Corp.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
EBPA(800) 578-3272
CHECK BENEFIT CARDFITZ VOGT AND ASSOCIATES LTDAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS
Fund No:PlanType: Group Health
EBPA(800) 578-3272
EBPA
PO Box 2000Exeter NH 03833
Attn: Denise Oberg
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
FLETCHER JONES MANAGEMENT INC - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
FLETCHER JONES MANAGEMENT, INC. - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-141• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
NGS AMERICAN8005211555
NGS AMERICAN8005211555
FLINT GROUPAffiliated With: NGS AMERICAN INC
Fund No:PlanType: Group Health
NGS AMERICAN8005211555
NGS AMERICANPO Box 7676DETROIT MI 48080
AMERICAN SPECIAL RISK MANAGEMENT(800) 359-7475
AMERICAN SPECIAL RISK MANAGEMENT
FLORIDA GULF COAST UNIVERSITY
Affiliated With: AMERICAN SPECIAL RISK MANAGEMENT
Fund No:PlanType: Group Health
AMERICAN SPECIAL RISK MANAGEMENT(800) 359-7475
AMERICAN SPECIAL RISK MANAGEMENT509 S. Lenola Rd. #2MOORESTOWN NJ 08057
PEARCE ADMINISTRATION(843) 622-6001
UM NOT APPLICABLEFLORIDA KEYS COMMUNITY COLLEGE
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
Florida League of Cities(800) 756-3042
Florida League of Cities(877) 676-3890
Florida League of CitiesAffiliated With: Florida League of Cities
Fund No:PlanType: Group Health
Florida League of Cities(800) 756-3042
Florida League of CitiesPO Box 538140Orlando FL 32853-8140
GALLAGHER BENEFIT ADMINISTRATORS INC(866) 471-6037
CHECK BENEFIT CARDFLORISTS TRANSWORLD DELIVERY (FTD)
Affiliated With: GALLAGHER BENEFIT ADMINISTRATORS INC
Fund No:PlanType: Group Health
GALLAGHER BENEFIT ADMINISTRATORS INC(866) 471-6037
GALLAGHER BENEFIT ADMINISTRATORS INC750 WARRENVILLE RD STE 200LISLE IL 60532
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-142• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARDFOOTHILL DEANZA COMMUNITY COLLEGE DISTRICT - FACULTY
Affiliated With: CORESOURCE, MN
Fund No:PlanType: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUPPO Box 39710COLORADO SPRINGS CO 80949
ASSURECARE(800) 759-1311
Careline UR(763) 383-4800
FOREST OIL CORPAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
(800) 759-1311 ASSURECARE340 Quadrangle DrBolingbrook IL 60440
CHECK BENEFIT CARD CHECK BENEFIT CARDFORMOST PACKAGINGAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEFORT CALLEY UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDFORT VALLEY STATE UNIV AIH0058107
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-143• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDFORT VALLEY STATE UNIV AIH0058117
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Forte(800) 580-1642
Forte(800) 580-2273
ForteAffiliated With: Forte
Fund No:PlanType: Workers' Compensation
Forte(800) 580-1642
Forte
ASSURANT HEALTH(800) 743-8469
CHECK BENEFIT CARDFORTIS REMOTE REPRICINGAffiliated With: ASSURANT HEALTH
Fund No:PlanType: Group Health
ASSURANT HEALTH(800) 743-8469
ASSURANT HEALTH
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
FOUNTAINBLEAU RESORTS TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
ASSURECARE(800) 968-6616
CARELINE(763) 383-4800
FOX BROTHERSAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-144• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERFrank Gates Service CompanyAffiliated With: Frank Gates Service Company
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
ADMINISTRATIVE CONCEPTS INC(888) 293-9229
UM NOT APPLICABLEFRANKLIN & MARSHALL COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS, INC.
Fund No:PlanType: Group Health
ADMINISTRATIVE CONCEPTS INC(888) 293-9229
ADMINISTRATIVE CONCEPTS INC
997 Old Eagle School Rd. #215WAYNE PA 19087-1706
Attn: Customer Service Dept
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
FRASIER TIMBER UNLIMITEDAffiliated With: NORTH AMERICAN ADMINISTRATORS-NY
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARDFREDS PLUMBING AND HEATING WRAP JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
FREEDOM LIFE INSURANCE CO. OF AMERICA
FREEDOM LIFE INSURANCE CO. OF AMERICA(800) 387-9027
FREEDOM LIFE INSURANCE CO. OF AMERICA
Affiliated With: FREEDOM LIFE INSURANCE CO. OF AMERICA
Fund No:PlanType: Group Health
FREEDOM LIFE INSURANCE CO. OF AMERICA
FREEDOM LIFE INSURANCE CO. OF AMERICA110 W 7TH ST STE 300FORT WORTH TX 76120
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-145• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.
FREEDOM PLASTICSAffiliated With: MIDWEST SECURITY ADMINISTRATORS INC
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.PO Box 574ONALASKA WI 54650
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
FREMONT MILLWORK CO.Affiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
MBA OF WYOMING MBA OF WYOMINGFREMONT MOTOR COMPANIESAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING MOUNTAIN STATES REVIEWPO Box 94WORLAND WY 82401
HEALTH NET FEDERAL SERVICES(916) 985-1259
CHECK BENEFIT CARDFRESNO VA MEDICAL CENTER 3188
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(916) 985-1259
HEALTH NET FEDERAL SERVICES2025 AEROJET RDRANCHO CORDOVA CA 95742
CONSOLIDATED HEALTH PLANS(800) 633-7867
UM NOT APPLICABLEFringe MIni-Med Hospital - Hospital & Professional
Affiliated With: CONSOLIDATED HEALTH PLANS
Fund No:PlanType: Group Health
CONSOLIDATED HEALTH PLANS(800) 633-7867
CONSOLIDATED HEALTH PLANS195 STAFFORD STSPRINGFIELD MA 01104
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-146• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONSOLIDATED HEALTH PLANS(800) 633-7867
UM NOT APPLICABLEFringe Mini-Med Professional OnlyAffiliated With: CONSOLIDATED HEALTH PLANS
Fund No:PlanType: Group Health
CONSOLIDATED HEALTH PLANS(800) 633-7867
CONSOLIDATED HEALTH PLANS195 STAFFORD STSPRINGFIELD MA 01104
HEALTH PLAN INC(508) 752-2480
CARE MANAGEMENT SERVICES(866) 325-1550
FRISBIE MEMORIAL HOSPITALAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
FT WAYNE VA MEDICAL CENTER
CHECK BENEFIT CARDFT WAYNE VA MEDICAL CENTER 3159
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
FT WAYNE VA MEDICAL CENTER
FT WAYNE VA MEDICAL CENTER
2121 LAKE AVEFT WAYNE IN 46805
Attn: FEE BASIS 136A
BAS(709) 799-7400
CHECK BENEFIT CARDFull -O-Pep AppliancesAffiliated With: BENEFIT ADMINISTRATIVE SYSTEMS
Fund No:PlanType: Group Health
BAS(709) 799-7400
BAS17475 JOVANNA DRHOMEWOOD IL 60430
CHECK BENEFIT CARD CHECK BENEFIT CARDFULLER THEOLOGICAL SEMINARY
Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-147• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
America's TPA(952) 896-1255
CHECK BENEFIT CARDFURST- MCNESS COMPANYAffiliated With: AMERICAS TPA
Fund No:PlanType: Group Health
America's TPA(952) 896-1255
America's TPAPO Box 398220Bloomington MN 55439
DIVERSIFIED HEALTHCARE SVCS
DIVERSIFIED HEALTHCARE SVCS
FUTURE CARE MEDCHECK
Fund No:PlanType: Group Health
DIVERSIFIED HEALTHCARE SVCS
DIVERSIFIED HEALTHCARE SVCS201 SANDPOINTESANTA ANA CA 92707
ASSURECARE(800) 968-6616
CARELINE(763) 383-4800
G & C INDUSTRIESAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823
CONTACT EMPLOYER CONTACT EMPLOYERGAB Business Services
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDGAINESVILLE COLLEGE AIH 0058127
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-148• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDGAINESVILLE COLLEGE AIH0058137
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEGAINESVILLE COLLEGE UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
AMERIHEALTH ADMINISTRATORS(800) 480-5032
AMERIHEALTH ADMINISTRATORS(800) 952-3404
GALAXY SCIENTIFIC CORPORATION
Affiliated With: AMERIHEALTH ADMINISTRATORS
Fund No:PlanType: Group Health
AMERIHEALTH ADMINISTRATORS(800) 480-5032
AMERIHEALTH ADMINISTRATORS720 BLAIR MILL RDHORSHAM PA 19044
First Health(800) 370-0594
CONTACT EMPLOYERGallagher Bassett Managed Care Services
Affiliated With: Gallagher Bassett Managed Care Services
Fund No:PlanType: Workers' Compensation
First Health(800) 370-0594
First HealthPO Box 23812Tucson AZ 85734
CONTACT EMPLOYER NOT APPLICABLEGallagher Bassett Services, Inc.Affiliated With: Gallagher Bassett Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-149• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
GAMING PARTNERS INTERNATIONAL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
GAMING PARTNERS INTERNATIONAL - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
PACIFIC LIFE & ANNUITY COMPANY(800) 542-6642
CHECK BENEFIT CARDGASDEN LAWN & LANDSCAPEAffiliated With: PACIFIC LIFE & ANNUITY
Fund No:PlanType: Group Health
PACIFIC LIFE & ANNUITY COMPANY(800) 542-6642
PACIFIC LIFE & ANNUITY COMPANYPO Box 295Onalaska WI 54650
Western Health(605) 719-4600 or (888) 341-1766
Western Health(605) 719-4640 or (800) 229-0892
Gases PlusAffiliated With: Rapid City Regional Hospital DBA Western Health
Fund No:PlanType: Group Health
Western Health(605) 719-4600 or (888) 341-1766
Western Health529 Kansas City St Ste 200Rapid City SD 57701
CONTACT EMPLOYER CONTACT EMPLOYERGates McDonald
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
ADVANCED BENEFIT RESOURCES
CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-150• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER First Health(800) 370-0594
GE/ERC
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER First HealthPO Box 23812Tucson AZ 85734
EBMS(800) 777-3575
EBMS(800) 777-3575
GELCO CONSTRUCTIONAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES
Fund No:PlanType: Group Health
EBMS(800) 777-3575
EBMSPO Box 21367BILLINGS MT 59104-1367
MBA OF WYOMING MBA OF WYOMINGGEM CITY BONE AND JOINTAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING MOUNTAIN STATES REVIEWPO Box 94WORLAND WY 82401
CBCA Administrators Inc CBCA Administrators IncGEN PROBE INCAffiliated With: CBCA Administrators, Inc.
Fund No:PlanType: Group Health
CBCA Administrators Inc CBCA ADMINISTRATORS, INC.PO Box 9498MINNEAPOLIS MN 55440-9498
Coventry Health Care(724) 778-5362
CHECK BENEFIT CARDGENERAL ELECTRICAffiliated With: COVENTRY HEALTH CARE
Fund No:PlanType: Group Health
Coventry Health Care(724) 778-5362
Coventry Health Care120 E Kensinger DrCranberry Township PA 16066
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-151• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDGENERAL GROWTH PROPERTIES INC
Affiliated With: ALLIED BENEFIT SYSTEMS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Genesis Managed Care(704) 321-3909
Genesis Managed Care(704) 321-3909
Genesis Managed Care
Fund No:PlanType: Workers' Compensation
Genesis Managed Care(704) 321-3909
Genesis Managed CarePO Box 17076Charlotte NC 28227
CONTACT EMPLOYER CONTACT EMPLOYERGENEX Services Exclusive - CCN Transition
Affiliated With: GENEX Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER CONTACT EMPLOYERGENEX Services Exclusive AUTOAffiliated With: GENEX Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER CONTACT EMPLOYERGenex Services, Inc.Affiliated With: Genex Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-152• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERGENEX Services, Inc. EPPAffiliated With: GENEX Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDGEORGE FOX UNIVERSITYAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
GEORGE SCHMITT & CO.Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEGEORGIA COLLEGE & STATE UNIVERSITY UNDERGRAD
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDGEORGIA COLLEGE AND STATE UNIVERSITY AIH0058167
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-153• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDGEORGIA COLLEGE AND STATE UNIVERSITY AIH0058177
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDGEORGIA HIGHLANDS COLLEGE AIH0058197
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDGEORGIA HIGHLANDS COLLEGE IAH0058187
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEGEORGIA HIGHLANDS COLLEGE UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-154• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDGEORGIA INSTITUTE OF TECHNOLOGY AIH0058207
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEGEORGIA INSTITUTE OF TECHNOLOGY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDGEORGIA PERIMETER COLLEGE AIH0058237
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEGEORGIA PERIMETER COLLEGE UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-155• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDGEORGIA SOUTHERN UNIV AIH0058247
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDGEORGIA SOUTHERN UNIV AIH0058257
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEGEORGIA SOUTHERN UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDGEORGIA SOUTHWESTERN STATE UNIVERSITY AIH0058267
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-156• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDGEORGIA SOUTHWESTERN STATE UNIVERSITY AIH0058277
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEGEORGIA SOUTHWESTERN STATE UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEGEORGIA STATE UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
ADMINISTRATIVE CONCEPTS INC(888) 293-9229
UM NOT APPLICABLEGETTYSBURG COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS, INC.
Fund No:PlanType: Group Health
ADMINISTRATIVE CONCEPTS INC(888) 293-9229
ADMINISTRATIVE CONCEPTS INC
997 Old Eagle School Rd. #215WAYNE PA 19087-1706
Attn: Customer Service Dept
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-157• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PREFERRED CARE, INC.(215) 639-6208
CHECK BENEFIT CARDGETTYSBURG HEALTH ADMINISTRATORS
Affiliated With: PREFERRED CARE INC
Fund No:PlanType: Group Health
PREFERRED CARE, INC.(215) 639-6208
PREFERRED CARE, INC.1300 VIRGINIA DR STE 315FT. WASHINGTON PA 19034
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.
GILMAN ENGINEERINGAffiliated With: MIDWEST SECURITY ADMINISTRATORS INC
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.PO Box 574ONALASKA WI 54650
GROUP & PENSION ADMINISTRATORS(800) 827-7223
CHECK BENEFIT CARDGinny's Copying Services inc (TRAVEL)
Affiliated With: GROUP & PENSION ADMINISTRATORS
*
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
PINNACLE CLAIMS MANAGEMENT INC(800) 777-7898
UM NOT APPLICABLEGIUMARRA VINEYARDSAffiliated With: PINNACLE CLAIMS MANAGEMENT INC
Fund No:PlanType: Group Health
PINNACLE CLAIMS MANAGEMENT INC(800) 777-7898
PINNACLE CLAIMS MANAGEMENT INCPO Box 2220NEWPORT BEACH CA 92658
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-158• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GLOBALCARE GLOBALCAREGLOBAL EMERGENCY MEDICAL SERVICES, INC. (GEMS)
Affiliated With: GLOBAL EMERGENCY MEDICAL SERVICES, INC. (GEMS)
Fund No:PlanType: Group Health
GLOBALCARE GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005
GLOBAL EXCEL MANAGEMENT(819) 566-2901
GLOBAL EXCEL MANAGEMENT(819) 566-2901
GLOBAL EXCEL MANAGEMENTAffiliated With: GLOBAL EXCEL MANAGEMENT
Fund No:PlanType: Group Health
GLOBAL EXCEL MANAGEMENT(819) 566-2901
GLOBAL EXCEL MANAGEMENT73 QUEEN STLENNOXVILLE QC J1M 1J3
STAR HEALTHCARE NETWORK(212) 581-8228
UM NOT APPLICABLEGLOBAL EXCHANGE INCAffiliated With: STAR HEALTHCARE NETWORK INC
*
Fund No:PlanType: Group Health
STAR HEALTHCARE NETWORK(212) 581-8228
STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019
International Medical Group, Inc.(800) 628-4664
International Medical Group, Inc.(800) 628-4664
Global Select WorldwideAffiliated With: International Medical Group Inc
Fund No:PlanType: Group Health
International Medical Group, Inc.(800) 628-4664
International Medical Group, Inc.2960 N Meridian StIndianapolis IN 46208
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
CHECK BENEFIT CARDGlobalcare IndividualsAffiliated With: International Medical Group, Inc.
Fund No:PlanType: Group Health
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-159• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
CHECK BENEFIT CARDGlobalcare ScholarsAffiliated With: International Medical Group, Inc.
Fund No:PlanType: Group Health
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
GMP INTERNATIONALAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
GMP RETIREDAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
IAA(800) 283-2524
HEALTHCARE STRATEGIES INC(800) 582-1535
GODWIN PUMPS OF AMERICA INCAffiliated With: INSURANCE ADMIN OF AMERICA INC
Fund No:PlanType: Group Health
IAA(800) 283-2524
IAAPO Box 5082MT LAUREL NJ 08054
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONS(800) 786-7930
GOLDEN GATE UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-160• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
TRANSWESTERN INSURANCE ADMINISTRATORS, INC.(559) 499-2000
CHECK BENEFIT CARDGOLDEN STATE BULB GROWERS, INC
Affiliated With: TRANSWESTERN INSURANCE
Fund No:PlanType: Group Health
TRANSWESTERN INSURANCE ADMINISTRATORS, INC.(559) 499-2000
TRANSWESTERN INSURANCE ADMINISTRATORS, INC.955 N StreetFresno CA 93721
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
GOOD VOCATIONS HEALTH & BENEFIT SYSTEMS
Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
PATIENT ADVOCATES LLC(800) 290-8559
UM NOT APPLICABLEGood Will HinckleyAffiliated With: PATIENT ADVOCATES LLC
*
Fund No:PlanType: Group Health
PATIENT ADVOCATES LLC(800) 290-8559
PATIENT ADVOCATES LLCPO Box 1959Gray ME 04039
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
GOODFELLOW CORP - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
GOODWILL EASTER SEALS OF THE MIAMI INC.
Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-161• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
GOODWILL INDUSTRIAL SERVICES CORPORATION
Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 523-0582
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH & WELFARE BENEFIT(800) 283-4927
GOODWILL INDUSTRIES OF CENTRAL INDIANA
Affiliated With: HEALTH AND WELFARE BENEFIT SYSTEMS INC
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC3241 ELECTRIC RD BLDG D STE 2-BROANOKE VA 24018
CORESOURCE(866) 280-4120
UM NOT APPLICABLEGoodwill Industries of Lower South Carolina
Affiliated With: CORESOURCE
Fund No:PlanType: Group Health
CORESOURCE(866) 280-4120
CORESOURCEPO Box 2920CLINTON OH 52733-2920
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
GOODWILL INDUSTRIES OF NORTH GEORGIA
Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
GOODWILL SERVICES INC.Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-162• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GROUP & PENSION ADMINISTRATORS(800) 827-7223
HEALTH WATCH(972) 238-7900
Goose Creek TravelAffiliated With: GROUP & PENSION ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
CONSOLIDATED HEALTH PLANS INC(800) 633-7867
CHECK BENEFIT CARDGORDON COLLEGEAffiliated With: CONSOLIDATED HEALTH PLANS INC
Fund No:PlanType: Group Health
CONSOLIDATED HEALTH PLANS INC(800) 633-7867
CONSOLIDATED HEALTH PLANS INC195 STAFFORD STSPRINGFIELD MA 01104
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDGORDON COLLEGE AIH0058307Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEGORDON COLLEGE UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PIONEER MANAGEMENT SYSTEMS(877) 868-9060
CHECK BENEFIT CARDGORDON CONWELL THEOLOGICAL SEMINARY
Affiliated With: PIONEER MANAGEMENT SYSTEMS
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(877) 868-9060
PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01090
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-163• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTHCOMP(800) 442-7247
HEALTHCOMP(800) 755-7247
GOWAN COMPANYAffiliated With: HEALTHCOMP TPA
Fund No:PlanType: Group Health
HEALTHCOMP(800) 442-7247
HEALTHCOMPPO Box 45018Fresno CA 93718
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
GRAEAGLE CONSTRUCTION & DEVELOPMENT LLC
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
GRAFOXATIONAffiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(800) 832-8212
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
GLOBALCARE(678) 341-1811
UM NOT APPLICABLEGRAHAM ENTERPRISES - PEPMAffiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1811
GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005
GLOBALCARE(678) 341-1811
UM NOT APPLICABLEGRAHAM ENTERPRSES - % OF SAVINGS
Affiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1811
GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-164• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GRAND JUNCTION VAMC CHECK BENEFIT CARDGRAND JUNCTION VAMC 3533Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
GRAND JUNCTION VAMC GRAND JUNCTION VAMC
WILLIAM ST off HWY 12 WESTFORT HARRISON MT 59636
Attn: FEE BASIS
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
GRAND SIERRA CONSULTINGAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CHECK BENEFIT CARD CHECK BENEFIT CARDGRANGER MEDICAL CLINICAffiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
HEALTH PLAN INC(508) 752-2480
CHECK BENEFIT CARDGRANITE STATE GLASSAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
Benefit Planners(800) 292-5386
CHECK BENEFIT CARDGRANT PRIDECOAffiliated With: BENEFIT PLANNERS
*
Fund No:PlanType: Group Health
Benefit Planners(800) 292-5386
Benefit PlannersPO Box 690450SAN ANTONIO TX 78269
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-165• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
The Gray Insurance Company(713) 671-2534 (909) 353-6800
The Gray Insurance Company(713) 671-2534
Gray Insurance Company TheAffiliated With: Gray Insurance Company The
Fund No:PlanType: Workers' Compensation
ADVENTIST RISK MANAGEMENT, INC.(800) 293-3131 (909) 353-6800
The Gray Insurance Company1717 East Loop Ste 333Houston TX 77029
CONTACT EMPLOYER CONTACT EMPLOYERGreat American InsuranceAffiliated With: Fair Isaac
Fund No:PlanType: Workers' Compensation
Includes Exclusive Preferred Providers (OCN ONLY)
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850
AMERICAN HEALTH GROUP(888) 877-7994
GREAT BASIN GOLDAffiliated With: TRUSTEED PLANS SERVICE CORP
Fund No:PlanType: Group Health
TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850
TRUSTEED PLANS SERVICE CORPORATIONPO Box 1894TACOMA WA 98401-1894
American Administrative Group Inc.(877) 782-6828
American Administrative Group Inc.(800) 538-5222
Great Lakes Dredge and Dock Company
Affiliated With: American Administrative Group
Fund No:PlanType: Group Health
American Administrative Group Inc.(877) 782-6828
American Administrative Group Inc.PO Box 5227LISLE IL 60532ECS Payor ID 57283
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
UM NOT APPLICABLEGREAT PLAINSAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-166• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540
MUTUAL ASSURANCE ADVANTAGE(818) 715-0558
GREAT WHITE ENERGY SERVICES, LLC
Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS
*
Term Effective: 10/31/2007Fund No:PlanType: Group Health
MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540
MUTUAL ASSURANCE ADMINISTRATORS3121 QUAIL SPRINGS PKWYOKLAHOMA CITY OK 73134
GREATER LA HCS (SEPULVEDA VAMC)
CHECK BENEFIT CARDGREATER LA HCS (SEPULVEDA VAMC) 3189
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
GREATER LA HCS (SEPULVEDA VAMC)
GREATER LA HCS (SEPULVEDA VAMC)
16111 PLUMMER STSEPULVEDA CA 91343
Attn: BLDG 1, ROOM A165
CONTACT EMPLOYER CONTACT EMPLOYERGreater NY New JerseyAffiliated With: Greater New York Company
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CHECK BENEFIT CARD CHECK BENEFIT CARDGREENE CONCRETE CUTTINGAffiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD8002615511
CHECK BENEFIT CARDGREENWOOD CONSTRUCTIONAffiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8002615511
CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-167• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MERITAIN HEALTH(877) 777-6076
GUIDED2HEALTH(952) 593-6447
GRIFFITH ENERGY SERVICESAffiliated With: CORPORATE BENEFIT SERVICE OF AMERICA
Fund No:PlanType: Group Health
MERITAIN HEALTH(877) 777-6076
MERITAIN HEALTHPO Box 1065AMHERST NY 14226
PIAG HEALTH GUARD TRUST(800) 288-1894
PIAG HEALTH GUARD TRUST
GRIZZARD BENEFITS TRUSTAffiliated With: MARKETING SERVICES GROUP, INC. BENEFITS TRUST
Fund No:PlanType: Group Health
PIAG HEALTH GUARD TRUST(800) 288-1894
PIAG HEALTH GUARD TRUST5020 Highlands Pkwy.SMYRNA GA 30082
MEDICAL CLAIMS SERVICES, INC.(888) 225-0522
AMERICAN HEALTH HOLDINGS INC(800) 592-9858
GROB SYSTEMS INCAffiliated With: MEDICAL CLAIMS SERVICE INC
Fund No:PlanType: Group Health
MEDICAL CLAIMS SERVICES, INC.(888) 225-0522
MEDICAL CLAIMS SERVICES, INC.1 WALL ST STE 2ARAVENSWOOD WV 26164
CHECK BENEFIT CARD CHECK BENEFIT CARDGROSSMONT CUYAMACA COMMUNITY COLLEGE DISTRICT
Affiliated With: BENEFIT AND RISK MANAGEMENT SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
GROUP & PENSION ADMINISTRATORS(800) 827-7223
HEALTH WATCH(972) 238-7900
GROUP & PENSION ADMINISTRATORS
Affiliated With: GROUP & PENSION ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-168• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GLOBALCARE(678) 341-1811
GROUP HEALTH MANAGERS
GROUP HEALTH MANAGERSAffiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1811
GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005
GLOBALCARE(910) 485-0510
HINES & ASSOCIATES(800) 670-7718
GROUP MANAGEMENT SERVICES - DLORAH, INC. GMS-402
Affiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1811
GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005
GLOBALCARE(678) 341-1922
UM NOT APPLICABLEGROUP MANAGEMENT SERVICES - TASLER
Affiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1922
GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005
THE EPOCH GROUP(800) 365-9036
INTRACORP(800) 716-8506
GROUP360 INC.Affiliated With: THE EPOCH GROUP #10469
Fund No:PlanType: Group Health
THE EPOCH GROUP(800) 365-9036
THE EPOCH GROUP10795 Watson RdSt. Louis MO 63129
Benefits/Eligibility(800) 843-3106
CHECK BENEFIT CARD(800) 522-2161
Guarantee Life Insurance CompanyAffiliated With: Insurers Administrative Corporation #962500302
Fund No:PlanType: Group Health
Benefits/Eligibility(800) 843-3106
Benefits/EligibilityPO Box 828Park Ridge IL 60068-0828
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-169• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
UM NOT APPLICABLEGULF COAST ENTERPRISESAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218
MBA OF WYOMING MBA OF WYOMINGGULLEY ENTERPRISES INCAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING MOUNTAIN STATES REVIEWPO Box 94WORLAND WY 82401
ASSURECARE(800) 759-7422
Careline UR(763) 383-4800
GYPSUM MANAGEMENT AND SUPPLY COMPANY
Affiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 759-7422
ASSURECARE340 Quadrangle DrBolingbrook IL 60440
HCH ADMINISTRATION INC(800) 447-3227
HCH ADMINISTRATION INC(877) 876-5969
H C DUKE AND SON INCAffiliated With: HEALTH DATA SERVICES INC (HDS) 12791
Fund No:PlanType: Group Health
HCH ADMINISTRATION INC(800) 447-3227
HCH ADMINISTRATION INCPO Box 1986PEORIA IL 61656
CHECK BENEFIT CARD CHECK BENEFIT CARDH K CONTRACTORS INCAffiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-170• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDHAA PREFERRED PARTNERS LLCAffiliated With: HAA PREFERRED PARTNERS LLC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
HAAS CABINET CO INCAffiliated With: PREFERRED HEALTH PLAN INC 962550088
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(502) 992-4535
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
DELTA HEALTH SYSTEMS(209) 939-3426
DELTA TEAM CARE(800) 336-0123
HALLMARK AVIATION GROUPAffiliated With: DELTA HEALTH SYSTEMS
Fund No:PlanType: Group Health
DELTA HEALTH SYSTEMS(209) 939-3426
DELTA HEALTH SYSTEMSPO Box 2128STOCKTON CA 95201
GISC, INC(800) 242-4472
GISC TOTALCARE(800) 999-1077
HAMILTON STORAGE TECH INC..Affiliated With: GROUP INSURANCE SERVICE CENTER
Fund No:PlanType: Group Health
GISC, INC(800) 242-4472
GISC, INC20 WINTER STPEMBROKE MA 02359
PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750
PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750
HAMMEL, GREEN & ABRAHAMSON, INC.
Affiliated With: PREFERREDONE ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750
PREFERREDONE ADMINISTRATIVE SERVICESPO Box 59212MINNEAPOLIS MN 55459
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-171• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PIONEER MANAGEMENT SYSTEMS(877) 868-9060
CHECK BENEFIT CARDHAMPSHIRE COLLEGEAffiliated With: PIONEER MANAGEMENT SYSTEMS
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(877) 868-9060
PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01090
HAMPTON VAMC CHECK BENEFIT CARDHAMPTON VAMC 3548Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HAMPTON VAMC HAMPTON VAMC100 EMANCIPATION DRHAMPTON VA 23667
ADVENTIST HEALTH SYSTEM WEST
CHECK BENEFIT CARDHANFORD COMMUNITY MEDICAL CENTER
Affiliated With: ADVENTIST HEALTH SYSTEM/WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002
SELF INSURED PLANS LLC(239) 403-7884
CHECK BENEFIT CARDHANNIBAL CARBIDE TOOL INCAffiliated With: SELF INSURED PLANS
Fund No:PlanType: Group Health
SELF INSURED PLANS LLC(239) 403-7884
SELECT CARE RISK MANAGEMENT CORPORATION1016 COLLIER CENTER WAY STE 200NAPLES FL 34110
CONTACT EMPLOYER Citizens Insurance Co.(800) 322-9025
Hanover Insurance Company AUTOAffiliated With: The Hanover Insurance Company
Fund No:PlanType: Auto
Citizens Insurance Co.(800) 322-9025
Citizens Insurance Co.PO Box 290Howell MI 48844
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-172• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERHanover Insurance Company WCAffiliated With: Hanover Insurance Company
Fund No:PlanType: Workers' Compensation
-Also recognized as Citizens Insurance Company of America, Massachusetts Bay Insurance Company and Hanover American Insurance Company
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295
CHECK BENEFIT CARDHarbor Furniture MFGAffiliated With: Carolina Benefit Administrators
Fund No:PlanType: Group Health
CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295
CAROLINA BENEFIT ADMINISTRATORS333 SOUTH PINE STSPARTANBURG SC 29302
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
HARD ROCKAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
HARD ROCK - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-173• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EBMS(800) 777-3575
CHECK BENEFIT CARDHARDWOODS SPECIALTY PRODUCTS US LP
Affiliated With: EBMS (EMPLOYEE BENEFIT MANAGEMENT SERVICES)
Fund No:PlanType: Group Health
EBMS(800) 777-3575
EBMSPO Box 21367BILLINGS MT 59104-1367
NORTH AMERICAN ADMINISTRATORS(800) 397-2122
CHECK BENEFIT CARDHARLAN SPRAGUE DAWLEYAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS(800) 397-2122
NORTH AMERICAN ADMINISTRATORSPO Box 730AMHERST NY 14226
GISC, INC(800) 242-4472
GISC TOTALCARE(800) 999-1077
HARLFINGER COMPANIESAffiliated With: GROUP INSURANCE SERVICE CENTER
Fund No:PlanType: Group Health
GISC, INC(800) 242-4472
GISC, INC20 WINTER STPEMBROKE MA 02359
GISC, INC(800) 242-4472
GISC TOTALCARE(800) 999-1077
HARLFINGER COMPANIES / HARPAK, LD PLASTICS, FBM
Affiliated With: GROUP INSURANCE SERVICE CENTER
Fund No:PlanType: Group Health
GISC, INC(800) 242-4472
GISC, INC20 WINTER STPEMBROKE MA 02359
GLOBALCARE8008601111 Ext 1722
GLOBALCAREHARRINGTONAffiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE8008601111 Ext 1722
HELLER ASSOCIATES2755 Bristol St STE 250COSTA MESA CA 92626
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-174• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDHarrington Benefit ServicesAffiliated With: Harrington Benefit Services
Fund No:PlanType: Group Health
-Network participation is contingent upon proper member identification. The First Health® Network Logo must be on the benefit card.
CHECK BENEFIT CARD CHECK BENEFIT CARD
ECS Payor ID 95266
HEALTHCOMP TPA(800) 442-7247
CHECK BENEFIT CARDHARRIS FARMSAffiliated With: HEALTHCOMP THIRD PARTY ADMINISTRATORS
Fund No:PlanType: Group Health
HEALTHCOMP TPA(800) 442-7247
HEALTHCOMP TPAPO Box 45018Fresno CA 93718
CHECK BENEFIT CARD CHECK BENEFIT CARDHARRIS MORAN SEEDAffiliated With: HEALTHCOMP ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
HARTT TRANSPORTATIONAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-175• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTHCARE MANAGEMENT ADMINISTRATORS(425) 462-1000
HEALTHCARE MANAGEMENT ADMINISTRATORS(425) 462-1000
HARTUNG INDUSTRIES INCAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS #11608
Fund No:PlanType: Group Health
HEALTHCARE MANAGEMENT ADMINISTRATORS(425) 462-1000
HEALTHCARE MANAGEMENT ADMINISTRATORS220 120TH Ave NE Bldg DBellevue WA 98005
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN(800) 249-8440
EMPLOYEE BENEFIT ADMINISTRATION & MGMT
HARVARD-WESTLAKE SCHOOLAffiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN(800) 249-8440
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
HARVEST FORDAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
NGS AMERICAN8005211555
NGS AMERICAN8005211555
HAWK CORPORATIONAffiliated With: NGS AMERICAN INC
Fund No:PlanType: Group Health
NGS AMERICAN8005211555
NGS AMERICANPO Box 7676DETROIT MI 48080
HEALTH RISK MANAGEMENT, INC.(800) 422-0055
HEALTH RISK MANAGEMENT, INC.
HCA THE HEALTHCARE COMPANY
Affiliated With: HCA THE HEALTHCARE COMPANY
Fund No:PlanType: Group Health
HEALTH RISK MANAGEMENT, INC.(800) 422-0055
HEALTH RISK MANAGEMENT, INC.PO Box 1479MINNEAPOLIS MN 55440
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-176• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERHCA The Healthcare CompanyAffiliated With: HCA
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
HCJB RadioAffiliated With: International Medical Group, Inc.
Fund No:PlanType: Group Health
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
International Medical Group, Inc.2960 N Meridian StIndianapolis IN 46208
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
HCP PACKAGING USA INCAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
Amalgamated Life Insurance Co.
Amalgamated Life Insurance Co.(800) 356-0850
Health and Welfare Luggage IndustryAffiliated With: Amalgamated Life Insurance Co.
Fund No:PlanType: Group Health
Amalgamated Life Insurance Co.(212) 539-5681
Amalgamated Life Insurance Co.730 Broadway8th Fl ClaimsNew York NY 10003ECS Payor ID 13550
Health Net Inc(800) 289-2818
First Health(800) 932-6690
Health Net ArizonaAffiliated With: Health Net Inc
Fund No: V5058PlanType: Group Health
The First Health® Network is not used for Behavioral Health services.
Health Net Inc(800) 289-2818
ACS/Health Net IncPO Box 14225Lexington KY 40512
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-177• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Health Net Inc(800) 641-7761
First Health(800) 932-6690
Health Net CaliforniaAffiliated With: Health Net Inc
Fund No: V5056PlanType: Group Health
Health Net Inc(800) 641-7761
Health Net Commercial ClaimsPO Box 14702Lexington KY 40512
Health Net Inc(800) 641-7761
Health Net Inc(800) 977-7282
Health Net California Travel BenefitAffiliated With: Health Net Inc
Fund No: V5057PlanType: Group Health
Health Net Inc(800) 641-7761
Health Net Commercial ClaimsPO Box 14702Lexington KY 40512
Health Net Inc(888) 747-7823
First Health(800) 932-6690
Health Net New York Out of Area Plans
Affiliated With: Health Net Inc
Fund No: V5059PlanType: Group Health
The First Health® Network is not used for Behavioral Health services.
Health Net Inc(888) 747-7823
Health Net IncPO Box 14700Lexington KY 40512
Health Net Inc(203) 402-4899
UM NOT APPLICABLEHEALTH NET NORTHEAST - IPI BRICKLAYERS TRAVEL
Affiliated With: HEALTH NET INC
Fund No:PlanType: Group Health
Health Net Inc(203) 402-4899
Health Net Inc1 Far Mill CrossingShelton CT 06484
Health Net Inc(888) 747-7823
Health Net Inc(888) 747-7823
Health Net Northeast Travel Member Benefit
Affiliated With: Health Net Inc
Fund No: V5050PlanType: Group Health
The First Health® Network is not used for Behavioral Health services.
Health Net Inc(888) 747-7823
Health Net IncPO Box 14700Lexington KY 40512
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-178• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Health Net Inc(203) 402-4899
UM NOT APPLICABLEHEALTH NET NORTHEAST-IPI/BRICKLAYERS TRAVEL
Affiliated With: HEALTH NET INC.
Fund No:PlanType: Group Health
Health Net Inc(203) 402-4899
Health Net Inc1 Far Mill CrossingShelton CT 06484
Health Net Inc(888) 802-7001
First Health(800) 932-6690
Health Net OregonAffiliated With: Health Net Inc
Fund No: V5057PlanType: Group Health
The First Health® Network is not used for Behavioral Health services.
Health Net Inc(888) 802-7001
Health Net IncPO Box 14130Lexington KY 40512
Health Net Inc(888) 802-7001
Health Net Inc(888) 802-7001
Health Net Oregon Travel BenefitAffiliated With: Health Net Inc
Fund No: V5057PlanType: Group Health
The First Health® Network is not used for Behavioral Health services.
Health Net Inc(888) 802-7001
Health Net IncPO Box 14130Lexington KY 40512
GLOBALCARE, INC. GLOBALCARE, INC.HEALTH PLAN OF NEVADAAffiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC. GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
GLOBALCARE, INC.8008601111
Health Plan of Upper Ohio Valley(740) 695-3585
HEALTH PLAN OF UPPER OHIO VALLEY
Affiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC.6783411722
GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-179• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH PLAN INC(800) 343-7674
CHECK BENEFIT CARDHEALTH PLANS INC % OF SAVI NGS
Affiliated With: HEALTHPLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(800) 343-7674
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
HEALTH PLAN INC(508) 752-2480
CMS(866) 325-1550
HEALTH PLANS INC. - PEPMAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
GLOBALCARE, INC.6783411722
HINES & ASSOCIATES(800) 944-9401
HEALTH PLUS OF MICHIGANAffiliated With: GLOBALCARE INC
Fund No:PlanType: Group Health
GLOBALCARE, INC.6783411722
GLOBALCARE, INC.6875 SHILOH RD EALPHARETTA GA 30005
MERITAIN HEALTH(800) 455-1938
EMPLOYERS RISK SERVICES(800) 705-3765
HealthcoAffiliated With: MERITAIN HEALTH
Fund No:PlanType: Group Health
MERITAIN HEALTH(800) 455-1938
MERITAIN HEALTHPO Box 1090EVANSVILLE IN 47706
ASSURECARE(800) 759-1311
Careline UR(763) 383-4800
HEARTWOOD CREATIONSAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 759-1311
ASSURECARE340 Quadrangle DrBolingbrook IL 60440
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-180• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Health Net Inc(800) 289-2818
Health Net Inc(800) 289-2818
Heath Net Arizona Travel Member Benefit
Affiliated With: Health Net Inc
Fund No: V5058PlanType: Group Health
The First Health® Network is not used for Behavioral Health services.
Health Net Inc(800) 289-2818
ACS/Health Net IncPO Box 14225Lexington KY 40512
CORESOURCE CORESOURCEHEIDELBERG USAAffiliated With: CORESOURCE INC
Fund No:PlanType: Group Health
CORESOURCE CORESOURCEPO Box 2920CLINTON OH 52733-2920
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDHELLENIC COLLEGE / HOLY GREEK ORTHODOX SCHOOL
Affiliated With: UnitedHealthcare StudentResources #11689
Term Effective: 8/31/2007Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
STUDENT INSURANCE A DIVISION OF UICIPO Box 809026DALLAS TX 75038
ULTRABENEFITS INC(866) 858-7223
CHECK BENEFIT CARDHENKE SASS WOLF OF AMERICA INC
Affiliated With: ULTRABENEFITS, INC.
Fund No:PlanType: Group Health
ULTRABENEFITS INC(866) 858-7223
ULTRABENEFITS INCPO Box 763WESTBORO MA 01581
CHECK BENEFIT CARD3129068000
CHECK BENEFIT CARDHERBST LAZAR BELL INCAffiliated With: ALLIED BENEFIT SYSTEMS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD3129068000
CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-181• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTHCOMP THIRD PARTY ADMINISTRATORS INC(800) 442-7247
CHECK BENEFIT CARDHERCULES INDUSTRIESAffiliated With: HEALTHCOMP THIRD PARTY ADMINISTRATORS
Fund No:PlanType: Group Health
HEALTHCOMP THIRD PARTY ADMINISTRATORS INC(800) 442-7247
HEALTHCOMP THIRD PARTY ADMINISTRATORS INCPO Box 45018FRESNO CA 93721
CONTACT EMPLOYER CONTACT EMPLOYERHewitt, Coleman and Associates, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 816-6049
UM NOT APPLICABLEHIAWATHA COMMUNITY HOSPTIAL
Affiliated With: WATERSTONE BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 816-6049
WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116
ACORDIA NATIONAL(888) 685-7774
CHECK BENEFIT CARDHICKORY SPRINGS MANUFACTURING CO
Affiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR
*
Fund No:PlanType: Group Health
ACORDIA NATIONAL(888) 685-7774
ACORDIA NATIONAL
CONTACT EMPLOYER CONTACT EMPLOYERHIH America Comp & Liab
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-182• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SISCO(800) 547-4726
CHECK BENEFIT CARDHILLCREST FAMILY SERVICEAffiliated With: SISCO/Cottingham & Butler
Fund No:PlanType: Group Health
SISCO(800) 547-4726
SISCOPO Box 389DUBUQUE IA 52004-0389
CONTACT EMPLOYER CONTACT EMPLOYERHinz Claim Management Inc
Fund No:PlanType: Workers' Compensation
Hinz Claim Management, Inc.(217) 698-1280
Hinz Claim Management, Inc.2815 Old Jacksonville Rd Ste 204Springfield IL 62704
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONS(800) 786-7930
HM ELECTRONICS, INC.Affiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
HMA Administrators, LLC(617) 581-6655 Ext 228
CHECK BENEFIT CARDHMA ADMINISTRATORS, LLCAffiliated With: HMA ADMINISTRATORS, LLC
Fund No:PlanType: Group Health
HMA Administrators, LLC(617) 581-6655 Ext 228
HMA Administrators, LLC7 Wells Avenue, Suite 24Newton MA 02459
BENEFIT CONCEPTS, INC.(610) 337-2600
UM NOT APPLICABLEHMA DIRECTAffiliated With: BROKERAGE CONCEPTS INC/BENEFIT CONCEPTS INC
Fund No:PlanType: Group Health
BENEFIT CONCEPTS, INC.(610) 337-2600
BENEFIT CONCEPTS, INC.PO Box 60608King of Prussia PA 19406
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-183• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.(800) 284-2273
HMOAffiliated With: OSF HEALTHPLANS, INC.
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128
FISERV HEALTH INC(210) 558-2100
CHECK BENEFIT CARDHOBBY LOBBYAffiliated With: HEALTH DATA SERVICES
Fund No:PlanType: Group Health
FISERV HEALTH INC(210) 558-2100
FISERV HEALTH INCPO Box 690450SAN ANTONIO TX 78269
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
HOLDEN BUSINESS FORMSAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
EBPA(802) 846-8060
CHECK BENEFIT CARDHOLYOKE HOSPITAL WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
GLOBALCARE, INC. GLOBALCARE, INC.HOMETOWN HEALTH NETWORKAffiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC. GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-184• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HONOLULU VAMC CHECK BENEFIT CARDHONOLULU VAMC 3183Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HONOLULU VAMC HONOLULU VAMC
459 PATTERSON RDHONOLULU HI 96819
Attn: FEE 043MD
ADMINISTRATIVE SOLUTIONS INC(678) 339-0211
CHECK BENEFIT CARDHOOVER MATERIALS HANDLING GROUP
Affiliated With: ADMINISTRATIVE SOLUTIONS, INC.
Fund No:PlanType: Group Health
ADMINISTRATIVE SOLUTIONS INC(678) 339-0211
ADMINISTRATIVE SOLUTIONS INCPO Box 2490ALPHARETTA GA 30023
AMERIBEN SOLUTIONS(800) 654-7900 (800) 786-7930
AMERIBEN SOLUTIONS(800) 786-7930
HOPE UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HORIZON GOODWILL INDUSTRIESAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
Horizon Managed Care(916) 631-1220
Horizon Managed Care(916) 631-1220
Horizon Managed CareAffiliated With: CompIQ #13910
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(800) 293-3131
Horizon Managed Care2868 Prospect Park DrRancho Cordova CA 95670
Info as of 12/27/2007
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For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-185• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MMA(800) 348-7468
CHECK BENEFIT CARDHorizon Transport IncAffiliated With: MENNONITE MUTUAL AID
*
Fund No:PlanType: Group Health
MMA(800) 348-7468
MMAPO Box 483GOSHEN IN 46527
THE LOOMIS COMPANY(866) 473-6615
CHECK BENEFIT CARDHospitality Partners Health & Welfare Trust
Affiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(866) 473-6615
THE LOOMIS COMPANY850 N PARK RDWYOMISSING PA 19610
MBA OF WYOMING MBA OF WYOMINGHOT SPRINGS COUNTYAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING MOUNTAIN STATES REVIEWPO Box 94WORLAND WY 82401
COASTAL HEALTHCARE ADMINISTRATORS(800) 564-7475
COASTAL HEALTHCARE ADMINISTRATORS
HOUSING AUTHORITY OF THE COUNTY OF MONTEREY
Affiliated With: COASTAL TPA INC
Fund No:PlanType: Group Health
COASTAL HEALTHCARE ADMINISTRATORS(800) 564-7475
COASTAL HEALTHCARE ADMINISTRATORSPO Box 80308SALINAS CA 93912
HRH Insurance HRH InsuranceHRH InsuranceAffiliated With: Fair Isaac Corporation
Fund No:PlanType: Workers' Compensation
HRH Insurance HRH Insurance
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-186• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
WELLS FARGO TPA, INC.(800) 624-8605
CHECK BENEFIT CARDHUB FOLDING BOXAffiliated With: ACCORDIA NATIONAL
Fund No:PlanType: Group Health
WELLS FARGO TPA, INC.(304) 353-8661
WELLS FARGO TPA, INC.602 VIRGINIA ST EASTCHARLESTON WV 25301
HUDSON VALLEY VA HEALTHCARE SYSTEM
CHECK BENEFIT CARDHUDSON VALLEY VA HEALTHCARE SYSTEM 3198
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HUDSON VALLEY VA HEALTHCARE SYSTEM
HUDSON VALLEY VA HEALTHCARE SYSTEM
CAMPUS RT 9DCASTLE POINT NY 12511
Attn: FEE BASIS 136M
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.
HUFCOR, INC.Affiliated With: MIDWEST SECURITY ADMINISTRATORS INC
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.PO Box 574ONALASKA WI 54650
CHECK BENEFIT CARD8007159414
CHECK BENEFIT CARDHUISH DETERGENTS INCAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8007159414
CHECK BENEFIT CARD
AMERICAN INSURANCE ADMINISTRATORS/ROSA MONOSTORI(800) 654-7900
CHECK BENEFIT CARDHUMBOLDT STATE UNIVERSITYAffiliated With: AMERICAN INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
AMERICAN INSURANCE ADMINISTRATORS/ROSA MONOSTORI(800) 654-7900
AMERICAN INSURANCE ADMINISTRATORS/ROSA MONOSTORI3415 S. Sepulveda Blvd #200LOS ANGELES CA 90034-6035
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-187• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
DELTA HEALTH SYSTEMS DELTA HEALTH SYSTEMS
HUNTINGTON MEMORIAL HOSPITAL
Affiliated With: DELTA HEALTH SYSTEMS
Fund No:PlanType: Group Health
DELTA HEALTH SYSTEMS DELTA HEALTH SYSTEMSPO Box 1168STOCKTON CA 95201
HUNTINGTON VAMC CHECK BENEFIT CARDHUNTINGTON VAMC 3149Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HUNTINGTON VAMC HUNTINGTON VAMC
1540 SPRING VALLEY DRHUNTINGTON WV 25704
Attn: FEE BASIS (136F)
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
HUTCHISON & STEFFENAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
MIDWEST SECURITY ADMINISTRATORS INC(800) 236-8672
UM NOT APPLICABLEHYDRITE CHEMICAL COMPANYAffiliated With: MIDWEST SECURITY ADMINISTRATORS
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS INC(800) 236-8672
MIDWEST SECURITY ADMINISTRATORS INC2700 Midwest Dr.ONALASKA WI 54650
CONSOCIATE, INC. C/O CCN(800) 798-2422
CHECK BENEFIT CARDHYDRO-GEAR, INC.Affiliated With: CONSOCIATE, INC.
Fund No:PlanType: Group Health
CONSOCIATE, INC. C/O CCN(800) 798-2422
CONSOCIATE, INC. C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
Info as of 12/27/2007
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Page CCL AK-188• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Hygeia Corporation(416) 595-1094 Ext 243
Hygeia Corporation(416) 595-1094 Ext 243
Hygeia CorporationAffiliated With: Hygeia Corporation
Fund No:PlanType: Group Health
Hygeia Corporation(416) 595-1094 Ext 243
Hygeia Corporation121 Richmond St W PenthouseToronto, Ontario Canada M5H 2K1
CHECK BENEFIT CARD CHECK BENEFIT CARDI.U.P.A.T. DISTRICT COUNCIL 78 HEALTH AND WELFARE FUND
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
INSURERS ADMINISTRATIVE CORP. C/O CCN(800) 843-3106
CHECK BENEFIT CARDIAC INTERNATIONALAffiliated With: INSURERS ADMINISTRATIVE CORPORATION
Fund No:PlanType: Group Health
INSURERS ADMINISTRATIVE CORP. C/O CCN(800) 843-3106
INSURERS ADMINISTRATIVE CORP. C/O CCNPO Box 5190TAMPA FL 33675-5190
FLORIDA HEALTH ADMINISTRATORS(954) 366-0111
CORVEL CORPORATION(517) 784-0821
IBC GROUP, INC.Affiliated With: FLORIDA HEALTH ADMINISTRATORS DBA FHA-TPA DIVISION
Fund No:PlanType: Group Health
FLORIDA HEALTH ADMINISTRATORS(954) 366-0111
FLORIDA HEALTH ADMINISTRATORSPO Box 327810Fort Lauderdale FL 33332
COMPUSYS(800) 628-6562
UM NOT APPLICABLEIBEW WESTERN UTILITIES HEALTH & WELFARE TRUST FUND / ID MT OR WA WY
Affiliated With: IBEW WESTERN UTILITIES HEALTH & WELFARE TRUST FUND
Fund No:PlanType: Group Health
COMPUSYS(800) 628-6562
COMPUSYS2156 W 2200 SSALT LAKE CITY UT 84119-1326
Info as of 12/27/2007
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Page CCL AK-189• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
IBEW-NECA Southwestern Health and Benefit Fund(800) 527-0320
First Health(800) 932-3869
IBEW-NECA Southwestern Health & Benefit Fund
Affiliated With: IBEW-NECA Southwestern Health & Benefit Fund
Fund No:PlanType: Group Health
IBEW-NECA Southwestern Health and Benefit Fund(800) 527-0320
IBEW-NECA Southwestern Health and Benefit Fund4040 McEwen Ste 100Dallas TX 75244-5092
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
IBS INDUSTRIES INCAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
CHECK BENEFIT CARD CHECK BENEFIT CARDIDAHO STATE UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
CHECK BENEFIT CARD HEALTH SPECIAL RISK, INC4001 N JOSEY LANECARROLLTON TX 75007
STRATEGIC HEALTH DEVELOPMENT CORP(888) 532-3467
STRATEGIC HEALTH DEVELOPMENT CORP(888) 532-3467
IEC GROUP BENEFIT TRUST FUND
Affiliated With: MEDICAL BENEFITS ADMINISTRATORS OF MD, INC.
Fund No:PlanType: Group Health
STRATEGIC HEALTH DEVELOPMENT CORP(888) 532-3467
STRATEGIC HEALTH DEVELOPMENT CORP9501 N. E. 2ND AVENUEMIAMI SHORES FL 33138
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-190• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CHECK BENEFIT CARDIGA GROUP EMPLOYEE BENEFIT TRUST
Affiliated With: MBA OF MARYLAND
Fund No:PlanType: Group Health
CONTACT EMPLOYER CONTACT EMPLOYER
STATE OF ILLINOIS(217) 782-2548
STATE OF ILLINOIS(217) 782-2548
Illinois Industrial Commission (IIC)Affiliated With: STATE OF ILLINOIS
Fund No:PlanType: Workers' Compensation
STATE OF ILLINOIS(217) 782-2548
STATE OF ILLINOIS604 William G. Stratton Office BuildingSpringfield IL 62706
INTERNATIONAL MANAGED CARE SERVICES(305) 463-9696
CHECK BENEFIT CARDIMCS PUERTO RICOAffiliated With: INTERNATIONAL MANAGED CARE SERVICES
Fund No:PlanType: Group Health
INTERNATIONAL MANAGED CARE SERVICES(305) 463-9696
INTERNATIONAL MANAGED CARE SERVICES7205 Corporate Center Dr. #405MIAMI FL 33126
HEALTH PLAN INC(508) 752-2480
CMS(866) 325-1550
IMMUNOGEN, INCAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
Indemni-Med Management(972) 606-9100 Ext 1308
Indemni-Med Management (Clinical Operations)(972) 606-9108
Indemni-Med ManagementAffiliated With: Indemni-Med Management
Fund No:PlanType: Workers' Compensation
Indemni-Med Management(972) 606-9100 Ext 1308
Indemni-Med Management2080 N Highway 360 Ste 345Grand Prairie TX 75050
Info as of 12/27/2007
www.firsthealth.com
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Page CCL AK-191• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GROUP & PENSION ADMINISTRATORS(800) 827-7223
CHECK BENEFIT CARDIndependent Bank Group Inc. (TRAVEL)
Affiliated With: GROUP & PENSION ADMINISTRATORS
*
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
CHECK BENEFIT CARD CHECK BENEFIT CARDINDEPENDENT MEDICAL SYSTEMS
Affiliated With: STAR HEALTHCARE NETWORK INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.(800) 990-9058
CHECK BENEFIT CARDINDEPENDENT STAVE COMPANY INC
Affiliated With: FMH BENEFIT SERVICES INC A DIVISION OF CORESOURCE
Fund No:PlanType: Group Health
FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.(800) 990-9058
FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.PO Box 25946OVERLAND PARK KS 66225-5946
CHECK BENEFIT CARD CHECK BENEFIT CARDINDIAN SUMMER CARPET MILLSAffiliated With: AMERICAN HEALTHCARE ALLIANCE
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDINDIANA STATE UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
Info as of 12/27/2007
www.firsthealth.com
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Page CCL AK-192• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Professional Benefit Administrators, Inc.(800) 435-5694
ICM(800) 728-0327
INDIANA WESLEYAN UNIVERSITYAffiliated With: PROFESSIONAL BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
Professional Benefit Administrators, Inc.(800) 435-5694
Professional Benefit Administrators, Inc.900 Jorie Blvd Ste 250Oakbrook IL 60523
INDIANAPOLIS VA MEDICAL CENTER
CHECK BENEFIT CARDINDIANAPOLIS VA MEDICAL CENTER 3156
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
INDIANAPOLIS VA MEDICAL CENTER
INDIANAPOLIS VA MEDICAL CENTER
1700 E 38TH STMARION IN 46953
Attn: FEE BASIS 136C3
HEALTHCOMP(559) 499-2450
CHECK BENEFIT CARDINDUSTRIAL METAL SUPPLIESAffiliated With: HEALTHCOMP ADMINISTRATORS
Fund No:PlanType: Group Health
HEALTHCOMP(559) 499-2450
HEALTHCOMPPO Box 45018Fresno CA 93718
HEALTHCOMP(559) 499-2450
CHECK BENEFIT CARDINDUSTRIAL METAL SUPPLYAffiliated With: HEALTHCOMP ADMINISTARTORS INC.
Fund No:PlanType: Group Health
HEALTHCOMP(559) 499-2450
HEALTHCOMPPO Box 45018Fresno CA 93718
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
INDUSTRIAL SAFETY SUPPLYAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
Info as of 12/27/2007
www.firsthealth.com
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Page CCL AK-193• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GLOBALCARE, INC. GLOBALCARE, INC.INDUSTRY BUYING GROUPAffiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC. GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
PRINCIPAL FINANCIAL GROUP(800) 533-5044
CHECK BENEFIT CARDINFRA-METALS COAffiliated With: PRINCIPAL FINANCIAL GROUP
Fund No:PlanType: Group Health
PRINCIPAL FINANCIAL GROUP(800) 533-5044
PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDINGLEWOOD UNIFIED SCHOOL DISTRICT
Affiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
KMG AMERICA(800) 822-1274
CHECK BENEFIT CARDINLAND SEAFOODAffiliated With: KHS, A KMG AMERICA COMPANY
Fund No:PlanType: Group Health
KMG AMERICA(800) 822-1274
KMG AMERICAPO Box 1000LANCASTER SC 29721
AMERICAN HEALTH HOLDINGS INC
AMERICAN HEALTH HOLDINGS INC
INNERPAC INC - PERFORMAXAffiliated With: NORTH AMERICAN ADMINISTRATORS - NY
Fund No:PlanType: Group Health
AMERICAN HEALTH HOLDINGS INC
AMERICAN HEALTH HOLDINGS INC921 EASWINDWESTERVILLE OH 43081
Info as of 12/27/2007
www.firsthealth.com
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Page CCL AK-194• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
INNOVATIVE ADMINISTRATIVE SERVICES(949) 442-6600
CHECK BENEFIT CARDINNOVATIVE ADMINISTRATIVE SERVICES (WRAP)
Affiliated With: INNOVATIVE ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
INNOVATIVE ADMINISTRATIVE SERVICES(949) 442-6600
INNOVATIVE ADMINISTRATIVE SERVICES540 WALD AVEIRVINE CA 92618
EBPA(802) 846-8060
CHECK BENEFIT CARDINSTITUTE OF PROFESSIONAL PRACTICE JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
INSURCORPAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
INSURERS ADMINISTRATIVE CORP. C/O CCN(800) 843-3106
CHECK BENEFIT CARDINSURERS ADMINISTRATIVE CORPORATION
Affiliated With: INSURERS ADMINISTRATIVE CORPORATION
Fund No:PlanType: Group Health
INSURERS ADMINISTRATIVE CORP. C/O CCN(800) 843-3106
INSURERS ADMINISTRATIVE CORP. C/O CCNPO Box 5190TAMPA FL 33675-5190
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-195• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
INTEGRAL YOUTH SERVICESAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INCPO Box 1121Alhambra CA 91802-1121
CompIQ Corporation(949) 923-4021
CHECK BENEFIT CARDIntegrated Care SystemsAffiliated With: CompIQ #13910
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(949) 923-4021
CompIQ Corporation35 Tesla Way #100Irvine CA 92618
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
INTEGRITY CHRYSLER JEEP DODGE MEGASTORE
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
AMERICAN STERLING INSURANCE SERVICES(913) 498-9096
CHECK BENEFIT CARDINTERCONNECT DEVICES INCAffiliated With: AMERICAN STERLING
Term Effective: 10/31/2007Fund No:PlanType: Group Health
AMERICAN STERLING INSURANCE SERVICES(913) 498-9096
AMERICAN STERLING INSURANCE SERVICES10975 Grandview Dr, Ste 100 Bldg 27Overland Park KS 66210
CONTACT EMPLOYER CONTACT EMPLOYERIntermedAffiliated With: CompIQ #13910
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-196• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GILSBAR(888) 472-4352
MedCom Services, Inc.(800) 643-4416
INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT
Affiliated With: GILSAR INC
Fund No:PlanType: Group Health
GILSBAR(888) 472-4352
GILSBARPO Box 2947COVINGTON LA 70434
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGINTERMOUNTAIN LABORATORIESAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGPO Box 98WORLAND WY 82401
International Brotherhood of Boilermakers(913) 342-2882
International Brotherhood of Boilermakers(888) 560-8932
International Brotherhood of Boilermakers
Affiliated With: Boilermakers National Health & Welfare Fund
Fund No:PlanType: Group Health
International Brotherhood of Boilermakers(913) 342-2882
International Brotherhood of BoilermakersPO Box 23825Tucson AZ 85734
HEALTHCOMP TPA(559) 499-2450
CHECK BENEFIT CARDINTERNATIONAL COFFEE AND TEA, LLC
Affiliated With: HEALTHCOMP TPA
Fund No:PlanType: Group Health
HEALTHCOMP TPA(559) 499-2450
HEALTHCOMP TPAPO Box 45018Fresno CA 93718
INTERNATIONAL HEALTHCARE(619) 407-4082
INTERNATIONAL HEALTHCARE
INTERNATIONAL HEALTHCAREAffiliated With: INTERNATIONAL HEALTHCARE
Fund No:PlanType: Group Health
INTERNATIONAL HEALTHCARE(619) 407-4082
INTERNATIONAL HEALTHCARE303 HCHULA VISTA CA 91910
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-197• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
INTERNATIONAL MANAGED CARE SERVICES
INTERNATIONAL MANAGED CARE SERVICES
INTERNATIONAL MANAGED CARE SERVICES
Affiliated With: INTERNATIONAL MANAGED CARE SERVICES
Fund No:PlanType: Group Health
INTERNATIONAL MANAGED CARE SERVICES
INTERNATIONAL MANAGED CARE SERVICES7205 Corporate Center Dr. #405MIAMI FL 33126
STAR HEALTHCARE NETWORK(212) 581-8228
UM NOT APPLICABLEINTERNATIONAL MED CAREAffiliated With: STAR HEALTHCARE NETWORK INC
*
Fund No:PlanType: Group Health
STAR HEALTHCARE NETWORK(212) 581-8228
STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019
CONTACT EMPLOYER CONTACT EMPLOYERIntracorpAffiliated With: Intracorp
Fund No:PlanType: Workers' Compensation
Includes Specialized Physical Therapy
CONTACT EMPLOYER First HealthPO Box 11158Scottsdale AZ 85271-1158
CONTACT EMPLOYER CONTACT EMPLOYERIntracorp AutoAffiliated With: Intracorp
Fund No:PlanType: Auto
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Underwriters Safety & Claims, Inc.(800) 678-1536
Bluegrass Health Network(800) 264-7502
Intratech Dental ProductsAffiliated With: Underwriters Safety & Claims Inc.
Fund No:PlanType: Group Health
Underwriters Safety & Claims, Inc.(800) 678-1536
Underwriters Safety & Claims, Inc.PO Box 23507Louisville KY 40223-0507
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-198• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SMITH ADMINISTRATORS(801) 261-5511
SERVICE ADVOCATES(801) 261-5511
INUNISONAffiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
SMITH ADMINISTRATORS(801) 261-5511
SMITH ADMINISTRATORS428 E WINCHESTER ST, STE 200SALT LAKE CITY UT 84107
TRUSTEED PLANS SERVICE GROUP(800) 426-9786
QUALIS8007838606
Investco Insurance TrustAffiliated With: Trusteed Plans Service Corporation
Fund No:PlanType: Group Health
TRUSTEED PLANS SERVICE GROUP(800) 426-9786
TRUSTEED PLANS SERVICE GROUPPO Box 1894TACOMA WA 98406-1705
IOWA CITY VA MEDICAL CENTER
CHECK BENEFIT CARDIOWA CITY VAMC 3709Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
IOWA CITY VA MEDICAL CENTER
IOWA CITY VA MEDICAL CENTER
HIGHWAY 6 WESTIOWA CITY IA 52246
Attn: FEE 136B
IRON MOUNTAIN VAMC CHECK BENEFIT CARDIRON MOUNTAIN VAMC 3163Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
IRON MOUNTAIN VAMC IRON MOUNTAIN VAMC
325 E H STIRON MOUNTAIN MI 49801
Attn: FEE BASIS 585/170
IRON WORKERS DISTRICT COUNCIL C/O CCN
CHECK BENEFIT CARDIRON WORKERS DISTRICT COUNCIL
Affiliated With: PREFERRED CARE
Fund No:PlanType: Group Health
IRON WORKERS DISTRICT COUNCIL C/O CCN
IRON WORKERS DISTRICT COUNCIL C/O CCNPO Box 5190TAMPA FL 33675-5190
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-199• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDIRVINE VALLEY COLLEGE INTL STUDENT SRVCS
Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDIRVING VALLEY COLLEGEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
EBMS(800) 777-3575
EBMS CARELINK(406) 245-3575
ISEC INCAffiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES (EBMS)
Fund No:PlanType: Group Health
EBMS(800) 777-3575
EBMSPO Box 21367BILLINGS MT 59104-1367
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
IT Strategies OOAAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CHECK BENEFIT CARD CHECK BENEFIT CARDITRON INCAffiliated With: MARSH ADVANTAGE AMERICA
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-200• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
J D STREETT & COMPANY, INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
IAA(856) 470-1200
HEALTHCARE STRATEGIES INC8885991515
J KNIPPER & COMPANYAffiliated With: INSURANCE ADMINISTRATORS OF AMERICA (IAA)
Fund No:PlanType: Group Health
IAA(856) 470-1200
IAA1934 OLNEY AVE STE 200CHERRY HILL NJ 08003
BENEFIT ADMINISTRATIVE SYSTEMS(708) 799-7400
CHECK BENEFIT CARDJ SQUAREAffiliated With: BENEFIT ADMINISTRATORS SYSTEMS
Fund No:PlanType: Group Health
BENEFIT ADMINISTRATIVE SYSTEMS(708) 799-7400
BENEFIT ADMINISTRATIVE SYSTEMS17475 JOVANNA DRHOMEWOOD IL 60430
ACORDIA NATIONAL(888) 685-7774
CHECK BENEFIT CARDJ.M. SMUCKERS COMPANYAffiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR
Fund No:PlanType: Group Health
ACORDIA NATIONAL(888) 685-7774
ACORDIA NATIONAL
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN(800) 776-1545
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
JACK JONES TRUCKING, INC.Affiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN(800) 776-1545
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 5079WESTLAKE VILLAGE CA 91359
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-201• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Underwriters Safety & Claims Inc.(800) 678-1536
Underwriters Safety & Claims Inc.(800) 678-1536
Jackson Tube Service IncAffiliated With: Underwriters Safety & Claims Inc.
Fund No:PlanType: Group Health
Underwriters Safety & Claims Inc.(800) 678-1536
First HealthPO Box 3017Scottsdale AZ 85271
EBPA(802) 846-8060
CHECK BENEFIT CARDJAGER DI PAOLA KEMP DESIGN JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
DELTA HEALTH SYSTEMS(559) 448-4148
DELTA TEAM CAREJAMES HARDIE BUILDING PRODUCTS
Affiliated With: THE PLAN HANDLERS INC
Fund No:PlanType: Group Health
DELTA HEALTH SYSTEMS(559) 448-4148
DELTA HEALTH SYSTEMSPO Box 80Stockton CA 95201
EMPLOYEE BENEFIT ADMINISTRATION & MGMT(800) 249-8440
EMPLOYEE BENEFIT ADMINISTRATION & MGMT
JASON ASSOCIATESAffiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMINISTRATION & MGMT(800) 249-8440
EMPLOYEE BENEFIT ADMINISTRATION & MGMT (EBA&M)PO Box 5079WESTLAKE VILLAGE CA 91359
PREFERRED HEALTH PLANS INC.(800) 832-8212
CHECK BENEFIT CARDJASPER SEATING COMPANY INCAffiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(800) 832-8212
PREFERRED HEALTH PLANS INC.PO Box 437017Louisville KY 40253
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-202• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
JBA CONSULTING % OF SAVINGSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
JBA CONSULTING ENGINEERS - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CBCA Administrators Inc(800) 631-3441
CHECK BENEFIT CARDJCB INCAffiliated With: CBCA Administrators, Inc.
Fund No:PlanType: Group Health
CBCA Administrators Inc(912) 691-3782
CBCA Administrators Inc4150 INTERNATIONAL PLAZA STE 900FORT WORTH TX 76109
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 240-8931
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
JCMAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 240-8931
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA2720 N. Tenaya Way, Room 507Las Vegas NV 89128
ASSURECARE(800) 759-1311
Careline UR(763) 383-4800
JDC LOGISTICSAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 759-1311
ASSURECARE340 Quadrangle DrBolingbrook IL 60440
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-203• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SMITH ADMINISTRATORS, INC.(801) 261-5511
TRUSTMARK LIFE INSURANCE CO.(801) 261-5511
JEFFERSON COUNTYAffiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
SMITH ADMINISTRATORS, INC.(801) 261-5511
SMITH ADMINISTRATORS, INC.3761 S 700 E SUITE 202SALT LAKE CITY UT 84106
PREFERRED CARE, INC.(215) 639-6208
PREFERRED CARE, INC.JEFFERSON COUNTY BOARD OF EDUCATION
Affiliated With: PREFERRED CARE
Fund No:PlanType: Group Health
PREFERRED CARE, INC.(215) 639-6208
PREFERRED CARE, INC.6 Neshaminy Interplex #205TREVOSE PA 19053
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
Jefferson Rehabilitation Center IncAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
*
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
JEFFERSON STATE ROCK PRODUCTIONS, INC.
Affiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
JERRY'S NUGGET - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA8006248605
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-204• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GROUP & PENSION ADMINISTRATORS(800) 827-7223
CHECK BENEFIT CARDJetta Operating Company Inc. (TRAVEL)
Affiliated With: GROUP & PENSION ADMINISTRATORS
*
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
GLOBALCARE(888) 285-4864
CHECK BENEFIT CARDJFP BENEFIT MANAGEMENT PEPM
Affiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(888) 285-4864
GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
JMA ARCHITECTURE STUDIO - PEPM
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
JMA ARCHITECTURE STUDIO - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
JOB SQUAD INCAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-205• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
JOHN A MARTINAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
JOHN A MARTIN TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
JOHN ALDEN LIFE INSURANCE COMPANY(800) 328-4316
FortisJOHN ALDEN LIFE INSURANCE COMPANY
Affiliated With: ASSURANT HEALTH
Fund No:PlanType: Group Health
JOHN ALDEN LIFE INSURANCE COMPANY(800) 328-4316
JOHN ALDEN LIFE INSURANCE COMPANYPO Box 981602EL PASO TX 79998
KEY BENEFIT ADMINISTRATORS(866) 387-0489
FORTIS BENEFITS INSURANCE COMPANY(866) 387-3407
JOHN ALDEN REWARDSAffiliated With: FORTIS BENEFITS INSURANCE COMPANY
Fund No:PlanType: Group Health
KEY BENEFIT ADMINISTRATORS(317) 284-7649
KEY BENEFIT ADMINISTRATORS8330 ALLISON POINT TRAILINDIANAPOLIS IL 46250
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
John Davis Trucking Co Inc - TravelAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-206• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
KLAIS & COMPANY INC(800) 331-1096
CHECK BENEFIT CARDJOHNSON & WALES UNIVERSITYAffiliated With: KLAIS & COMPANY
Fund No:PlanType: Group Health
KLAIS & COMPANY INC(800) 331-1096
KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313
KLAIS & COMPANY INC(800) 331-1096
CHECK BENEFIT CARDJOHNSON & WALES UNIVERSITY PSPM
Affiliated With: KLAIS & COMPANY
Fund No:PlanType: Group Health
KLAIS & COMPANY INC(800) 331-1096
KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313
STUDENT ASSURANCE SERVICES6514397098
CHECK BENEFIT CARDJOHNSON BIBLE COLLEGEAffiliated With: STUDENT ASSURANCE SERVICES
Fund No:PlanType: Group Health
STUDENT ASSURANCE SERVICES6514397098
STUDENT ASSURANCE SERVICES333 N. MAIN STREETSTILLWATER MN 55082
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
JOHNSON BROTHERS CORPAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
MBA OF WYOMING MBA OF WYOMINGJOHNSON COUNTYAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING MOUNTAIN STATES REVIEWPO Box 94WORLAND WY 82401
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-207• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MBA OF WYOMING MBA OF WYOMINGJOHNSON COUNTY HOSPITAL DISTRICT
Affiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING MOUNTAIN STATES REVIEWPO Box 94WORLAND WY 82401
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
JONES VARGASAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)(714) 668-8920
HINES & ASSOCIATES(800) 528-2498
JON-LIN FOODSAffiliated With: EMPLOYEE BENEFITS ADMINISTRATION & MANAGEMENT
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)(714) 668-8920
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)PO Box 5079WESTLAKE VILLAGE CA 91359
CHECK BENEFIT CARD CHECK BENEFIT CARDJORDAN OUTDOOR IMMERSION GRAPHICS
Affiliated With: PARAGON BENEFITS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-208• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARDJOSEPH CARRARA & SONS WRAP JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
GLOBALCARE, INC.8008601111
JP Farley(800) 634-0173
JP FARLEYAffiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC.6783411722
GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
JSA HEALTHCARE NEVADA LLC TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
HEALTH PLAN INC(508) 752-2480
CARE MANAGEMENT SERVICES(866) 325-1550
JSI STORE FIXTURES INCAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
JULIET - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-209• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
JUPITER MEDIA CORPORATIONAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
JUPITERMEDIAAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
JVSAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
K & D CONSTRUCTION - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
ACS BENEFIT SERVICES INC(800) 849-5370
CHECK BENEFIT CARDKAESER COMPRESSORSAffiliated With: ACS BENEFIT SERVICES, INC.
Fund No:PlanType: Group Health
ACS BENEFIT SERVICES INC(800) 849-5370
ACS BENEFIT SERVICES INCPO Box 2000Winston-Salem SC 27102
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-210• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD8003824661
CHECK BENEFIT CARDKAISER PERM ROCKY MOUNTAINAffiliated With: KAISER PERMANENTE INSURANCE COMPANY ROCKY MOUNTAIN
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8003824661
CHECK BENEFIT CARD
CHECK BENEFIT CARD8008132000
CHECK BENEFIT CARDKAISER PERMANENTE NORTH WEST
Affiliated With: KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8008132000
CHECK BENEFIT CARD
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
KALB CONSTRUCTION - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
KANSAS CITY VAMC CHECK BENEFIT CARDKANSAS CITY VAMC 3526Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
KANSAS CITY VAMC KANSAS CITY VAMC
4801 LINWOOD BLVDKANSAS CITY MO 64128
Attn: FEE BASIS 136E
EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798
UM NOT APPLICABLEKAYSUN CORPORATIOMAffiliated With: EMPLOYEE BENEFIT CONSULTANT
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798
EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-211• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH PLAN INC5087522480
CMS INC(866) 325-1550
KBS BUILDING SYSTEMSAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC5087522480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798
CHECK BENEFIT CARDKEENE TECHNOLOGY, INCAffiliated With: EMPLOYEE BENEFIT CONSULTANTS
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798
EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839
EBMS(800) 777-3575
CHECK BENEFIT CARDKELLER SUPPLY COMPANYAffiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES, INC.
Fund No:PlanType: Group Health
EBMS(800) 777-3575
EBMSPO Box 21367BILLINGS MT 59104-1367
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDKENNESAW STATE UNIV AIH0058327
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDKENNESAW STATE UNIV AIH0058337
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-212• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEKENNESAW STATE UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PEARCE ADMINISTRATION(843) 622-6001
UM NOT APPLICABLEKENTUCKY CHRISTIAN UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDKERN HIGH SCHOOL DISTRICTAffiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
MANAGED CARE SYSTEMS6617167100
MANAGED CARE SYSTEMS(661) 716-7140
KERN VALLEY HEALTHCARE DISTRICT
Affiliated With: MANAGED CARE SYSTEMS
Fund No:PlanType: Group Health
MANAGED CARE SYSTEMS6617167100
MANAGED CARE SYSTEMS5080 CALIFORNIA AVE STE 120BAKERSFIELD CA 93309
ASSOCIATED ADMINISTRATORS, INC.
ASSOCIATED ADMINISTRATORS, INC.
KETTLE FOODSAffiliated With: ASSOCIATED ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
ASSOCIATED ADMINISTRATORS, INC.
ASSOCIATED ADMINISTRATORS, INC.2929 NW 31st StPORTLAND OR 97210
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-213• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Key Risk Insurance Company(800) 366-1511
Key Risk Insurance Company(800) 366-1511
Key Risk Management Services, Inc.
Affiliated With: Key Risk Insurance Company
Fund No:PlanType: Workers' Compensation
Key Risk Insurance Company(800) 366-1511
Key Risk Insurance CompanyPO Box 49129Greensboro NC 27419
SELF INSURED BENEFIT ADMINISTRATORS, INC.(800) 683-7422
UM NOT APPLICABLEKEYS INSURANCE SERVICES INCAffiliated With: SELF INSURED BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
SELF INSURED BENEFIT ADMINISTRATORS, INC.(800) 683-7422
SELF INSURED BENEFIT ADMINISTRATORS, INC.101 STARCREST DRCLEARWATER FL 33758
CHECK BENEFIT CARD CHECK BENEFIT CARDKIFI TV8Affiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
BAC(614) 863-8780
BAC(614) 863-8780
KINETICS NOISE CONTROLAffiliated With: BUSINESS ADMINISTRATORS AND CONSULTANTS
Fund No:PlanType: Group Health
BAC(614) 863-8780
BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068
CHECK BENEFIT CARD CHECK BENEFIT CARDKINRO INCAffiliated With: BOON CHAPMAN BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-214• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EBMS CHECK BENEFIT CARDKINROSS GOLD USA INC TRAVELAffiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES
Fund No:PlanType: Group Health
EBMS EBMSPO Box 21367BILLINGS MT 59104-1367
BUTLER BENEFIT SERVICES(563) 327-2240
CHECK BENEFIT CARDKINSETH HOTEL COORPORATIONAffiliated With: SISCO/Cottingham & Butler
Fund No:PlanType: Group Health
BUTLER BENEFIT SERVICES(563) 327-2240
BUTLER BENEFIT SERVICES215 N MAIN ST STE 800DAVENPORT IA 52801
GLOBALCARE(678) 341-1922
UM NOT APPLICABLEKIPP & CO PACTRUSTAffiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1922
GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005
GLOBALCARE(678) 341-1922
UM NOT APPLICABLEKIPP AND COMPANY - WRG DESIGN
Affiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1922
GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
KITTRELL GARLOCK & ASSOCIATES
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-215• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
KLAIS & COMPANY INC(800) 331-1096
CHECK BENEFIT CARDKLAIS & COMPANY - PEPMAffiliated With: KLAIS & COMPANY
Fund No:PlanType: Group Health
KLAIS & COMPANY INC(800) 331-1096
KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
KLAMATH ALCOHOL & DRUG ABUSE, INC.
Affiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
KLAMATH CHILD AND FAMILY TREATMENT CENTER
Affiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
KLAMATH COUNTY EMPLOYESSAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
KLAMATH COUNTY SCHOOLSAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DRBEND OR 97702
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-216• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
KLAMATH FALLS CITY SCHOOLSAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
KLAMATH FAMILY HEAD STARTAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
KLAMATH FAMILY PRACTICEAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
KLAMATH HEALTH PARTNERSHIPAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
KLAMATH HOSPICEAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-217• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
KLAMATH MEDICAL CLINICAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
KLAMATH ORTHOPEDIC & SPORTS MEDICINE CLINIC
Affiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
KLAMATH RADIOLOGY ASSOCIATES, PC
Affiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
PPC(800) 446-5439
PPC(704) 523-2758
KLAUSSNER FURNITURE INDUSTRIES, INC
Affiliated With: PRIMARY PHYSICIANCARE
Fund No:PlanType: Group Health
PPC(800) 446-5439
PPCPO Box 11088CHARLOTTE NC 28220
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
KNOWLEDGE HEALTHCARE, INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-218• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDKONOCTI UNIFIED SCHOOLSAffiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
ASSURECARE(800) 968-6616
CARELINE(763) 383-4800
KORTE ELECTRICAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823
HEALTHSCOPE BENEFITS INC(866) 885-4944
HEALTHSCOPE BENEFITS INC(501) 218-7691
KOYO CORPORATIONAffiliated With: HEALTHSCOPE BENEFITS, INC
Fund No:PlanType: Group Health
HEALTHSCOPE BENEFITS INC(800) 560-4664
HEALTHSCOPE BENEFITS INC27 CORPORATE HILL DRLITTLE ROCK AR 72205
HEALTHSCOPE BENEFITS INC(866) 885-4944
HEALTHSCOPE BENEFITS INC(501) 218-7691
KRAFT FOODSAffiliated With: HEALTHSCOPE BENEFITS INC
Fund No:PlanType: Group Health
HEALTHSCOPE BENEFITS INC(800) 560-4664
HEALTHSCOPE BENEFITS INC27 CORPORATE HILL DRLITTLE ROCK AR 72205
TALL TREE ADMINISTRATORS(801) 274-8100
CORVEL(810) 269-8723
KRALIS BROTHERS FOODSAffiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
TALL TREE ADMINISTRATORS(801) 274-8100
TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-219• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CORESOURCE, MN(866) 280-4120
KYOCERAAffiliated With: CORESOURCE INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
HELLER ASSOCIATES(800) 552-2929
HELLER ASSOCIATESKYOCERA WIRELESS CORPORATION
Affiliated With: KYOCERA INTERNATIONAL, INC.
Fund No:PlanType: Group Health
HELLER ASSOCIATES(800) 552-2929
HELLER ASSOCIATES2755 Bristol St STE 250COSTA MESA CA 92626
SELF INSURED SERVICES COMPANY (SISCO)(800) 457-4726
HEALTHCORP(800) 457-4726
K-Z, Inc.Affiliated With: SISCO/Cottingham & Butler
Fund No:PlanType: Group Health
SELF INSURED SERVICES COMPANY (SISCO)(800) 457-4726
SELF INSURED SERVICES COMPANY (SISCO)PO Box 389DUBUQUE IA 52004-0389
THE LOOMIS COMPANY(800) 346-1223
HINES & ASSOCIATES(888) 826-5769
L ROBERT KIMBALL AND ASSOCIATES
Affiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(800) 346-1223
THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.
LAB SAFETY SUPPLYAffiliated With: MIDWEST SECURITY ADMINISTRATORS INC
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.PO Box 574ONALASKA WI 54650
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-220• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EBPA(802) 846-8060
CHECK BENEFIT CARDLABEL TECH INC JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
THE LOOMIS COMPANY(866) 473-6615
CHECK BENEFIT CARDLABOR READYAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(866) 473-6615
THE LOOMIS COMPANY850 N PARK RDWYOMISSING PA 19610
CONTACT EMPLOYER CONTACT EMPLOYERLabor Ready/ESIS
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
EBPA(800) 578-3272
CHECK BENEFIT CARDLACONIA SAVINGS BANKAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(800) 578-3272
EBPA
PO Box 2000Exeter NH 03833
Attn: Denise Oberg
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
LAKE COUNTYAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-221• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
LAKE COUNTY PLASTERS AND CEMENT MASONS WELFARE(630) 232-7166
LAKE COUNTY PLASTERS AND CEMENT MASONS WELFARE
LAKE COUNTY PLASTERS AND CEMENT MASONS WELFARE FUND
Affiliated With: LAKE COUNTY PLASTERS & CEMENT MASONS WELFARE FUND
Fund No:PlanType: Group Health
LAKE COUNTY PLASTERS AND CEMENT MASONS WELFARE(630) 232-7166
LAKE COUNTY PLASTERS AND CEMENT MASONS WELFARE28 N. First StGENEVA IL 60134
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
LAKE DISTRICT HOSPITALAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDLAKE ELSINORE UNIFIED SCHOOLS
Affiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
CHECK BENEFIT CARDLAKE FOREST COLLEGEAffiliated With: PIONEER MANAGEMENT SERVICES
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
LAKE LAS VEGAS RESORTAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-222• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Professional Benefit Administrators, Inc.(630) 655-3755
CHECK BENEFIT CARDLAKESHORE FOODS CORPORATION
Affiliated With: PROFESSIONAL BENEFIT ADMINISTRATORS, INC. / ILLINO
Fund No:PlanType: Group Health
Professional Benefit Administrators, Inc.(630) 655-3755
PROFESSIONAL BENEFIT ADMINISTRATORS, INC. C/O CCN900 Jorie Blvd Ste 250Oakbrook IL 60523
FISERV HEALTH KANSAS(800) 235-7160
TRUSTMARK LIFE INSURANCE CO.(800) 725-6566
LAKESIDE TRAVELAffiliated With: FISERV HEALTH - KANSAS
Fund No:PlanType: Group Health
FISERV HEALTH KANSAS(800) 235-7160
FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDLAMAR UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
MERITAIN HEALTH(800) 455-1938
UM NOT APPLICABLELAND AIR EXPRESS INCAffiliated With: MERITAIN HEALTH
Fund No:PlanType: Group Health
MERITAIN HEALTH(800) 455-1938
MERITAIN HEALTHPO Box 1090EVANSVILLE IN 47706
CHECK BENEFIT CARD CHECK BENEFIT CARDLAND AIR EXPRESS OF N EAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-223• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
LANDAMRK COMMUNITIESAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(307) 347-6151
MOUNTAIN STATES REVIEW(307) 347-7979
LANDER MEDICAL CLINICAffiliated With: MANAGED BENEFITS ADMINISTRATORS & INS CONSULTANTS
Fund No:PlanType: Group Health
MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(307) 347-6151
MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTSPO Box 98WORLAND WY 82401
EBPA(800) 525-8788
CHECK BENEFIT CARDLANDMARK COLLEGE WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
EBPA(800) 525-8788
CHECK BENEFIT CARDLANDMARK COLLEGE WRAP VSTAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
CHECK BENEFIT CARD CHECK BENEFIT CARDLANDSCAPE DEVELOPMENT INCAffiliated With: PHYSICIANS DEVELOPMENT INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-224• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 742-7345
LAS VEGAS ATHLETIC CLUBAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
LAS VEGAS POLICE PROTECTIVE ASSOCIATION CIVILIAN EMPLOYEES
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Amalgamated Life Insurance Co.(212) 539-5104
ALICARE, Inc(800) 332-5426
Laundry, Dry Cleaning Workers & Allied Industries Health Fund
Affiliated With: Amalgamated Life Insurance Co
Fund No:PlanType: Group Health
Amalgamated Life Insurance Co.(212) 539-5104
Amalgamated Life Insurance Co.730 BroadwayNew York NY 10003
PROFESSIONAL BENEFIT ADMINISTRATORS(800) 435-5694
CHECK BENEFIT CARDLAUREL HEALTH CARE COMPANYAffiliated With: PROFESSIONAL BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
PROFESSIONAL BENEFIT ADMINISTRATORS(800) 435-5694
PROFESSIONAL BENEFIT ADMINISTRATORSPO Box 4687OAKBROOK IL 60522-4687
MMSI(800) 965-6674
MMSI(800) 965-6674
LB WHITE COMPANYAffiliated With: MMSI
Fund No:PlanType: Group Health
MMSI(800) 965-6674
MMSI4001 41ST STREET NWROCHESTER MN 55901
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-225• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GISC, INC(800) 242-4472
GISC TOTALCARE(800) 242-4472
LEADER DISTRIBUTION SYSTEMS INC
Affiliated With: GROUP INSURANCE SERVICE CENTER
Fund No:PlanType: Group Health
GISC, INC(800) 242-4472
GISC, INC20 WINTER STPEMBROKE MA 02359
ASSURECARE(800) 968-6616
ASSURECARE(800) 968-6616
LEAR CORPORATIONAffiliated With: ASSURECARE OF ILLINOIS
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4050 HUNSACKER DR STE 110EAST LANSING MI 48823
CHECK BENEFIT CARD CHECK BENEFIT CARDLEAVITT GROUP AGENCY ASSOCIATION
Affiliated With: P5 HEALTH SOLUTIONS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
HEALTH NET FEDERAL SERVICES(214) 387-3232
CHECK BENEFIT CARDLEBANON VAMC 3126Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(214) 387-3232
HEALTH NET FEDERAL SERVICES5504 HILL HEAVEN CTFRISCO TX 75035
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
LEDCOR HOLDINGS INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-226• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
LEDCOR HOLDINGS INC - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
LEE AND RUSSELL LAW FIRM - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CHECK BENEFIT CARD CHECK BENEFIT CARDLEICA GEOSYSTEMSAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
SELF INSURED BENEFIT ADMINISTRATORS, INC.(727) 532-0400
UM NOT APPLICABLELENNYS FURNITURE, INCAffiliated With: SELF INSURED BENEFIT ADMINISTRATORS, LLC
Fund No:PlanType: Group Health
SELF INSURED BENEFIT ADMINISTRATORS, INC.(727) 532-0400
SELF INSURED BENEFIT ADMINISTRATORS, INC.101 STARCREST DRCLEARWATER FL 33758
CHECK BENEFIT CARD CHECK BENEFIT CARDLEW A CUMMINGS PRINTING INCAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-227• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDLEWIS AND CLARK UNIVERSITYAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
CHECK BENEFIT CARD CHECK BENEFIT CARDLEWIS CLARK COLLEGE UNIVERSITY-ATHLETIC
Affiliated With: ASSOCIATED ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
KHS, A KMG AMERICA COMPANY(803) 283-5378
KHS, A KMG AMERICA COMPANY(803) 283-2737
LEWIS M CARTER MANUFACTURING COMPANY
Affiliated With: KHS, A KMG AMERICA COMPANY
Fund No:PlanType: Group Health
KHS, A KMG AMERICA COMPANY(803) 283-5378
KHS, A KMG AMERICA COMPANYPO Box 1000LANCASTER SC 29721
KHS, A KMG AMERICA COMPANY(803) 283-5378
KHS, A KMG AMERICA COMPANY(803) 283-2737
LEWIS M CARTER MANUFACTURING COMPANY PEPM
Affiliated With: KHS, A KMG AMERICA COMPANY
Fund No:PlanType: Group Health
KHS, A KMG AMERICA COMPANY(803) 283-5378
KHS, A KMG AMERICA COMPANYPO Box 1000LANCASTER SC 29721
NORTH AMERICA ADMINISTRATORS, L.P.(615) 255-6654
MED-CERT(800) 356-7126
LEWIS SEEDSAffiliated With: NORTH AMERICA ADMNISTRATORS
Fund No:PlanType: Group Health
NORTH AMERICA ADMINISTRATORS, L.P.(615) 255-6654
NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-228• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
LEXINGTON VA MEDICAL CENTER
CHECK BENEFIT CARDLEXINGTON VA MEDICAL CENTER 3147
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
LEXINGTON VA MEDICAL CENTER
LEXINGTON VA MEDICAL CENTER
1101 VETERANS DRLEXINGTON KY 40502
Attn: 4-FEE
CHECK BENEFIT CARD8772615511
CHECK BENEFIT CARDLIBERTY GOLDAffiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8772615511
CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYERLiberty Mutual Insurance Company/Liberty Northwest Companies
Affiliated With: Liberty Mutual Insurance Company/Liberty
Fund No: D8056PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
LICKING KNOX GOODWILLAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
FISERV HEALTH KANSAS(800) 235-7160
TRUSTMARK LIFE INSURANCE CO.(800) 725-6566
LIDSEEN OF NORTH CAROLINAAffiliated With: FISERV HEALTH - KANSAS
Fund No:PlanType: Group Health
FISERV HEALTH KANSAS(800) 235-7160
FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-229• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HILLCREST BENEFIT ADMINISTRATORS INC(800) 743-9264
STRATEGIC HEALTH DEVELOPMENT(800) 874-2378
LIFEGUARD TRANSPORTATION SERVICES INC
Affiliated With: HILLCREST BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
HILLCREST BENEFIT ADMINISTRATORS INC(800) 743-9264
HILLCREST BENEFIT ADMINISTRATORS INCPO Box 1516MOUNT DORA FL 32756
America's TPA(952) 896-4888
CHECK BENEFIT CARDLIFETIME FITNESSAffiliated With: AMERICA'S TPA
Fund No:PlanType: Group Health
America's TPA(952) 896-4888
America's TPAPO Box 398220Bloomington MN 55439
America's TPA(952) 896-4888
CHECK BENEFIT CARDLIFETIME FITNESS TRAVELAffiliated With: AMERICA'S TPA
Fund No:PlanType: Group Health
America's TPA(952) 896-4888
America's TPAPO Box 398220Bloomington MN 55439
LIFEWISE HEALTH PLAN OF OREGON(800) 722-3372
LIFEWISE HEALTH PLAN OF OREGON(800) 722-3372
LIFEWISE HEALTH PLAN OF OREGON
Affiliated With: LIFEWISE HEALTH PLAN OF OREGON
Term Effective: 9/6/2007Fund No:PlanType: Group Health
LIFEWISE HEALTH PLAN OF OREGON(800) 722-3372
LIFEWISE HEALTH PLAN OF OREGON815 S W BONDBEND OR 97702
THE LOOMIS COMPANY(800) 875-2364
CHN SOLUTIONS(800) 293-9795
LIFT-ALL COMPANYAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(800) 875-2364
THE LOOMIS COMPANYPO Box 14086READING PA 19612-4086
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-230• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EBA&M(800) 776-1545
UM NOT APPLICABLELIMONEIRA COMPANYAffiliated With: EMPLOYEE BENEFITS ADMINISTRATION & MGMT (EBA&M)
Fund No:PlanType: Group Health
EBA&M(800) 776-1545
EBA&MPO Box 5079WESTLAKE VILLAGE CA 91359
Professional Benefit Administrators, Inc.(630) 655-3755
First Health(800) 522-8812
Lincolnway Affiliate SchoolsAffiliated With: Lincolnway Affiliate Schools
Fund No:PlanType: Group Health
Professional Benefit Administrators, Inc.(630) 655-3755
Professional Benefit Administrators, Inc.900 Jorie Blvd Ste 250Oakbrook IL 60523
MMA(800) 348-7468
CHECK BENEFIT CARDLINDEN A SHOWALTER CPAAffiliated With: MENNONITE MUTUAL AID
Fund No:PlanType: Group Health
MMA(800) 348-7468
MMAPO Box 483GOSHEN IN 46527
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDLINFIELD COLLEGE - DOMESTICAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDLINFIELD COLLEGE INTERNATIONAL
Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-231• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750
PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750
LINK SNACKS INCAffiliated With: PREFERREDONE ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750
PREFERREDONE ADMINISTRATIVE SERVICESPO Box 59212MINNEAPOLIS MN 55459
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
LINTON-STOCKTON SCHOOL CORP
Affiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(800) 832-8212
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
CHECK BENEFIT CARD CHECK BENEFIT CARDLIPE ROLLWAY CORPORATION PRE 65 RETIREES
Affiliated With: THE EPOCH GROUP L C
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
LIUNA Staf Health and Welfare Plan(800) 548-6242
Ullicare(800) 848-9200
LIUNAAffiliated With: ULLICO
Fund No:PlanType: Group Health
LIUNA Staf Health and Welfare Plan(800) 548-6242
LIUNA Staf Health and Welfare Plan905 16th St NWWashington DC 20006ECS Payor ID 13142
HEALTHCOMP TPA CHECK BENEFIT CARDLIVERMORE UNIFIEDAffiliated With: HEALTHCOMP THIRD PARTY ADMINISTRATORS
Fund No:PlanType: Group Health
HEALTHCOMP TPA HEALTHCOMP TPAPO Box 45018Fresno CA 93718
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-232• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
INTERPLAN HEALTH GROUP(800) 266-5896
MAGNACARE(877) 335-4725
LOCAL 1730 ILA, MANAGEMENT LABOR WELFARE & PENSION FUNDS
Affiliated With: INTERPLAN HEALTH GROUP / SUPERIEN HEALTH PLAN
Fund No:PlanType: Group Health
INTERPLAN HEALTH GROUP(800) 266-5896
INTERPLAN HEALTH GROUP
PO Box 2388 CSTOW OH 44224
Attn: Supervisor of the Claims Dept
SUPERIEN HEALTH NETWORK(800) 266-5896
CHECK BENEFIT CARDLOCAL 348 PLAN D RD JETRO (RDC)
Affiliated With: SUPERIEN HEALTH NETWORK #18373
Fund No:PlanType: Group Health
SUPERIEN HEALTH NETWORK(800) 266-5896
SUPERIEN HEALTH NETWORK
PO Box 2388 CSTOW OH 44224
Attn: Supervisor of the Claims Dept
CHECK BENEFIT CARD CHECK BENEFIT CARDLocal 75 CaliforniaAffiliated With: Amalgamated Life Insurance Co.
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYERLockheed Martin Corp/ESIS
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CBSA(952) 593-6438
GUIDED2HEALTH(952) 593-6447
LODGING HOST HOTEL CORPORATION
Affiliated With: CORPORATE BENEFIT SERVICE OF AMERICA
Fund No:PlanType: Group Health
CBSA(952) 593-6438
CBSA400 Highway 169 South, Ste 800Minneapolis MN 55426-1141
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-233• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERLogans RoadhouseAffiliated With: Genex Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
LOMA LINDA VA MEDICAL CENTER
CHECK BENEFIT CARDLOMA LINDA VA MEDICAL CENTER 3190
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
LOMA LINDA VA MEDICAL CENTER
LOMA LINDA VA MEDICAL CENTER
11201 BENTON STLOMA LINDA CA 92359
Attn: FEE BASIS - 11C
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDLONE PINE UNIFIED SCHOOLSAffiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDLONG BEACH CITY COLLEGEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
LONG BEACH VAMC CHECK BENEFIT CARDLONG BEACH VAMC 3191Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
LONG BEACH VAMC(916) 985-1259
LONG BEACH VAMC
5901 E 7TH STLONG BEACH CA 90822
Attn: FEE BASIS 04F
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-234• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882
PHYSICIAN CARE OF CALIFORNIA(714) 540-5882
LONG TERM CARE WORKERS HEALTH TRUST FUND
Affiliated With: PHYSICIANS CARE INSURANCE SERVICES
Fund No:PlanType: Group Health
PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882
PHYSICIANS CARE INSURANCE SERVICES, INC.PO Box 15165SANTA ANA CA 92735
NHBC(888) 621-7900
CHECK BENEFIT CARDLONGVIEW FIBREAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
THE LOOMIS COMPANY(877) 634-9814
CHECK BENEFIT CARDLOOMIS COMPANYAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(877) 634-9814
THE LOOMIS COMPANYPO Box 7045Wyomissing PA 19610
RIVERSIDE COUNTY FOUNDATION FOR MEDICAL CARE(800) 458-5710
RIVERSIDE COUNTY FOUNDATION FOR MEDICAL CARE
LOS ALAMITOS UNIFIED SCHOOL DISTRICT
Affiliated With: LOS ALAMITOS UNIFIED SCHOOL DISTRICT
Fund No:PlanType: Group Health
RIVERSIDE COUNTY FOUNDATION FOR MEDICAL CARE(800) 458-5710
RIVERSIDE COUNTY FOUNDATION FOR MEDICAL CARE3993 JurupaRIVERSIDE CA 92506
MACORI ADMINISTRATION(800) 285-8133
UM NOT APPLICABLELOUISIANA STATE UNIVERSITY - PENNINGTON
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
MACORI ADMINISTRATION(800) 285-8133
MACORI ADMINISTRATION19609 WIEDSPRING TX 77388
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-235• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
LOUISVILLE VAMC CHECK BENEFIT CARDLOUISVILLE VAMC 3150Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
LOUISVILLE VAMC LOUISVILLE VAMC
800 ZORN AVELOUISVILLE KY 40206
Attn: FEE BASIS (136F)
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
LOVARCAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARDLOVEJOY TOOL COMPANY WRAP JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
LOWELL BROTHERS AND BAILEYAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
CONTACT EMPLOYER CONTACT EMPLOYERLSA ASSOCIATES, INC.Affiliated With: BENEFIT AND RISK MANAGEMENT SERVICES
Fund No:PlanType: Group Health
CONTACT EMPLOYER CONTACT EMPLOYER
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-236• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDLUMBER PRODUCTSAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYERLumbermans Underwriting AllianceAffiliated With: Genex Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
GROUP & PENSION ADMINISTRATORS(800) 827-7223
CHECK BENEFIT CARDM7 Aerospace TRAVELAffiliated With: GROUP & PENSION ADMINISTRATORS
*
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
MAC Risk Management, Inc.(800) 288-8415
MAC Risk Management, Inc.(800) 288-8415
MAC Risk Managament, Inc.Affiliated With: MAC Risk Managament
Fund No:PlanType: Workers' Compensation
Includes Exclusive Preferred Providers (OCN ONLY)
CONTACT EMPLOYER CONTACT EMPLOYER
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDMACON STATE COLLEGE AIH0058347
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-237• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEMACON STATE COLLEGE OF GA UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PERFORMAX / BROKERAGE CONCEPTS, INC.(888) 554-7629
PERFORMAX / AMERICAN HEALTH HOLDING(800) 337-0506
MACRO PLASTICS INCAffiliated With: BROKERAGE CONCEPTS INC/BENEFIT CONCEPTS INC.
Fund No:PlanType: Group Health
PERFORMAX / BROKERAGE CONCEPTS, INC.(888) 554-7629
PERFORMAX / BROKERAGE CONCEPTS, INC.PO Box 61505KING OF PRUSSIA PA 19406
Benefits/Eligibility(800) 843-3106
CHECK BENEFIT CARD(800) 522-2161
Madison National Life Insurance Company Inc
Affiliated With: Insurers Administrative Corporation
Fund No:PlanType: Group Health
Benefits/Eligibility(800) 843-3106
Benefits/EligibilityPO Box 828Park Ridge IL 60068-0828
MADISON VAMC CHECK BENEFIT CARDMADISON VAMC 3164Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
MADISON VAMC MADISON VAMC
2500 OVERLOOK TERRACEMADISON WI 53705
Attn: FEE 136
PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777
MedWatch(800) 432-8421
MADSEN KNEPPERS & ASSOCIATES, INC.
Affiliated With: PREFERRED BENEFIT ADMINISTRATORS INC.
Fund No:PlanType: Group Health
PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777
PREFERRED BENEFIT ADMINISTRATORS INCPO Box 916188LONGWOOD FL 32791-6188
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-238• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH PLAN INC(508) 752-2480
CARE MANAGEMENT SERVICES(866) 325-1550
MAINE DISTRIBUTORS - %Affiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
HEALTH PLAN INC(800) 532-7575
CARE MANAGEMENT SERVICES(866) 325-1550
MAINE RUBBER INTERNATIONALAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC100 FRONT ST STE 600WORCESTER MA 01608
DELTA HEALTH SYSTEMS(559) 228-4198
DELTA TEAM CARE(800) 356-2395
MAMMOTH MOUNTAIN SKI RESORT
Affiliated With: DELTA HEALTH SYSTEMS
Fund No:PlanType: Group Health
DELTA HEALTH SYSTEMS(559) 228-4198
DELTA HEALTH SYSTEMSPO Box 80Stockton CA 95201
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDMAMMOTH UNIFIED SCHOOLSAffiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
ManageAbility Inc ManageAbility IncManageability, IncAffiliated With: FDI Group DBA Manageability, Inc
Fund No:PlanType: Workers' Compensation
ManageAbility Inc ManageAbility Inc39500 High Pointe BlvdNovi MI 48375
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-239• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MANAGED CARE SYSTEMS6617167100
CHECK BENEFIT CARDMANAGED CARE SYSTEMS LPAffiliated With: MANAGED CARE SYSTEMS LP
Fund No:PlanType: Group Health
MANAGED CARE SYSTEMS6617167100
MANAGED CARE SYSTEMS4550 California Ave Ste 500Bakersfield CA 93309
BAC(614) 863-8780
BAC(614) 863-8780
MANAGEMENT INFORMATION DISCIPLINES
Affiliated With: BUSINESS ADMINISTRATORS AND CONSULTANTS
Fund No:PlanType: Group Health
BAC(614) 863-8780
BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068
MANCHESTER VA MEDICAL CENTER
CHECK BENEFIT CARDMANCHESTER VA MEDICAL CENTER 3117
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
MANCHESTER VA MEDICAL CENTER
MANCHESTER VA MEDICAL CENTER
718 SMYTH RDMANCHESTER NH 03104
Attn: FEE BASIS 136F
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARDMANSFIELD PAPER COMPANY WRAP JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-240• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
INNOVATIVE ADMINISTRATIVE SERVICES8002723433
HEALTH ASSIST(866) 214-1106
MARAVILLAAffiliated With: INNOVATIVE ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
INNOVATIVE ADMINISTRATIVE SERVICES8002723433
INNOVATIVE ADMINISTRATIVE SERVICES540 WALD AVEIRVINE CA 92618
ADMINISTRATIVE SOLUTIONS INC(678) 339-0211
INNOVATIVE CARE MANAGEMENT(800) 398-7353
MARC-JAC POULTRYAffiliated With: ADMINISTRATIVE SOLUTIONS INC
Fund No:PlanType: Group Health
ADMINISTRATIVE SOLUTIONS INC(678) 339-0211
ADMINISTRATIVE SOLUTIONS INCPO Box 2490ALPHARETTA GA 30023
MERITAIN HEALTH(800) 828-6922
HEALTHLINK(800) 624-2356
Marcone Appliance PartsAffiliated With: MERITAIN HEALTH
Fund No:PlanType: Group Health
MERITAIN HEALTH(800) 828-6922
MERITAIN HEALTH
PO Box 853921Richardson TX 75085-3921
Attn: Claims Dept
CHECK BENEFIT CARD CHECK BENEFIT CARDMARICOPA COUNTY COMMUNITY COLLEGE AKA MCCCD
Affiliated With: ZENITH ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882
PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882
MARIE CALLENDER PIE SHOPS INC
Affiliated With: PHYSICIANS CARE INSURANCE SERVICES INC
Fund No:PlanType: Group Health
PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882
PHYSICIANS CARE INSURANCE SERVICES, INC.1570 BROOKHOLLOW STE 208SANTA ANA CA 92705
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-241• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MARION IL VAMC CHECK BENEFIT CARDMARION IL VAMC 3523Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
MARION IL VAMC MARION IL VAMC
2401 WEST MAINMARION IL 62959
Attn: FISCAL SERVICE 04C
MARION IN VA MEDICAL CENTER
CHECK BENEFIT CARDMARION IN VA MEDICAL CENTER 3157
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
MARION IN VA MEDICAL CENTER
MARION IN VA MEDICAL CENTER
1700 E 38TH STMARION IN 46953
Attn: FEE BASIS 136C3
FISERV HEALTH KANSAS(800) 235-7160
TRUSTMARK LIFE INSURANCE CO.(800) 725-6566
MARKET LOGISTICS INCAffiliated With: FISERV HEALTH - KANSAS
Fund No:PlanType: Group Health
FISERV HEALTH KANSAS(800) 235-7160
FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520
TRUSTEED PLANS SERVICE GROUP(800) 426-9786
AMERICAN HEALTH HOLDING(888) 877-7994
MARKET TRANSPORT LTDAffiliated With: TRUSTEED PLANS SERVICE CORPORATION
Fund No:PlanType: Group Health
TRUSTEED PLANS SERVICE GROUP(800) 426-9786
TRUSTEED PLANS SERVICE GROUPPO Box 1894TACOMA WA 98401-1894
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
MARQUIS COMPANIESAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-242• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
MARSHALL RETAIL GROUP LLCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
MARSHALL RETAIL GROUP LLC - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Cambridge(312) 821-8800
Cambridge(312) 821-8800
Martin BoyerAffiliated With: Cambridge
Fund No:PlanType: Workers' Compensation
Cambridge(312) 821-8800
Cambridge175 W Jackson Ste 1000Chicago IL 60604
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
MARTIN HARRIS CONSTRUCTIONAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
EMPLOYEE BENEFIT PLAN ADMINISTRATION(800) 525-8788
CHECK BENEFIT CARDMARTINS POINT HEALTHCARE JMS
Affiliated With: EMPLOYEE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT PLAN ADMINISTRATION(802) 846-8060
EMPLOYEE BENEFIT PLAN ADMINISTRATION
PO Box 2000Exeter NH 03833
Attn: Denise Oberg
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-243• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MARTINSBURG VA MEDICAL CENTER
CHECK BENEFIT CARDMARTINSBURG VA MEDICAL CENTER 3133
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
MARTINSBURG VA MEDICAL CENTER
MARTINSBURG VA MEDICAL CENTER
510 BUTLER AVEMARTINSBURG WV 25401
Attn: FEE SVCS GB113
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
CHECK BENEFIT CARDMARYMOUNT COLLEGEAffiliated With: PIONEER MANAGEMENT SERVICES
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090
STUDENT ASSURANCE SERVICES INC(800) 328-2739
CHECK BENEFIT CARDMARYVILLE UNIVERSITYAffiliated With: STUDENT ASSURANCE SERVICES INC
Fund No:PlanType: Group Health
STUDENT ASSURANCE SERVICES INC(800) 328-2739
STUDENT ASSURANCE SERVICES INC333 N. MAIN STREETSTILLWATER MN 55082
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
MASAMI FOODS, INC.Affiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
FISERV HEALTH INC FISERV HEALTH INCMASCO CONTRACTOR SERVICES CENTRAL, INC.
Affiliated With: BENESIGHT, INC.
Fund No:PlanType: Group Health
FISERV HEALTH INC FISERV HEALTH INCPO Box 360PUEBLO CO 81002
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-244• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
BENESIGHT INC(877) 718-6920
BENESIGHT MEDICAL MANAGEMENT(877) 718-6920
MASTER CRAFT FABRICSAffiliated With: BENESIGHT INC
Fund No:PlanType: Group Health
BENESIGHT INC(877) 718-6920
BENESIGHT INCPO Box 370PUEBLO CO 81002
Masters, Mates and Pilots Health & Benefit Plan(410) 850-8500
First Health(800) 213-1185
Masters, Mates & PilotsAffiliated With: Master Mates & Pilots Health and Benefit Plan
Fund No:PlanType: Group Health
Masters, Mates and Pilots Health & Benefit Plan(410) 850-8500
Masters, Mates and Pilots Health & Benefit Plan5700 Hammonds Ferry RdLinthicum Heights MD 21090-1996ECS Payor ID MMPHB
ASSURECARE(800) 759-1311
Careline UR(763) 383-4800
MATERIAL SERVICESAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 759-1311
ASSURECARE340 Quadrangle DrBolingbrook IL 60440
CONTACT EMPLOYER First Health(800) 931-3439
Matrix Absence Management IncAffiliated With: Matrix Absence Management Inc
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
AFFORDABLE BENEFIT ADMINISTRATORS, INC.(800) 350-0148
AFFORDABLE BENEFIT ADMINISTRATORS, INC.
MATRIX BANCORP, INC.Affiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
AFFORDABLE BENEFIT ADMINISTRATORS, INC.(800) 350-0148
AFFORDABLE BENEFIT ADMINISTRATORS, INC.PO Box 10787BURBANK CA 91510
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-245• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Matson Navigation Company Matson Navigation Company
Matson Navigation CompanyAffiliated With: Matson Navigation Company
Fund No:PlanType: Workers' Compensation
Matson Navigation Company Matson Navigation Company555 12th StOakland CA 94607
May Department Stores(410) 298-1866
May Department Stores(410) 298-1866
May Department Stores Co - CentralAffiliated With: May Department Stores Co.
Fund No:PlanType: Workers' Compensation
Includes Exclusive Preferred Providers (OCN ONLY)
May Department Stores(410) 298-1866
May Department Stores7004 Security Blvd, Ste 304Baltimore MD 21244
May Department Stores(410) 298-1866
May Department Stores(410) 298-1866
May Department Stores Co - EasternAffiliated With: May Department Stores Co.
Fund No:PlanType: Workers' Compensation
Includes Exclusive Preferred Providers (OCN ONLY)
May Department Stores(410) 298-1866
May Department Stores7004 Security Blvd, Ste 304Baltimore MD 21244
May Department Stores(410) 298-1866
May Department Stores(410) 298-1866
May Department Stores Co - Western
Affiliated With: May Department Stores Co.
Fund No:PlanType: Workers' Compensation
Includes Exclusive Preferred Providers (OCN ONLY)
May Department Stores(410) 298-1866
May Department Stores7004 Security Blvd, Ste 304Baltimore MD 21244
GLOBALCARE(678) 341-1811
CHECK BENEFIT CARDMCARE HMO - GLOBALCARE WRAP
Affiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1811
GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-246• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
CHECK BENEFIT CARDMCCORMICK TRUCKINGAffiliated With: FCE BENEFIT ADMINISTRATORS #10388
*
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218
Benefit Planners(800) 292-5386
CHECK BENEFIT CARDMCCOY'S CORPORATIONAffiliated With: BENEFIT PLANNERS
*
Fund No:PlanType: Group Health
Benefit Planners(800) 292-5386
Benefit PlannersPO Box 690450SAN ANTONIO TX 78269
THE LOOMIS COMPANY(800) 367-3721
CHECK BENEFIT CARDMCGUIRE BEARINGS, INC.Affiliated With: LOOMIS BENEFITS WEST
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(800) 367-3721
THE LOOMIS COMPANYPO Box 13906READING PA 19612
CONTACT EMPLOYER CONTACT EMPLOYERMCO Advantage - EDIAffiliated With: MCO Advantage / PBM Corporation
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER CONTACT EMPLOYERMCO Advantage - PaperAffiliated With: MCO Advantage / PBM Corporation
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-247• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
STAR HEALTHCARE NETWORK(212) 581-8228
CHECK BENEFIT CARDMD ABROADAffiliated With: STAR HEALTHCARE NETWORK INC
*
Fund No:PlanType: Group Health
STAR HEALTHCARE NETWORK(212) 581-8228
STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019
MENNONITE MUTUAL AID & ASSOC & MMA INSURANCE(574) 533-9515
MENNONITE MUTUAL AID C/O CCN(800) 348-7468
MEBP - EASTERN MENNONITE UNIVERSITY
Affiliated With: MENNONITE MUTUAL AID ASSOC AND MMA INSURANCE CO
Fund No:PlanType: Group Health
MENNONITE MUTUAL AID & ASSOC & MMA INSURANCE(574) 533-9515
MENNONITE MUTUAL AID & ASSOC & MMA INSURANCEPO Box 483GOSHEN IN 46527
STAR HEALTHCARE NETWORK(212) 581-8228
CHECK BENEFIT CARDMEDAIREAffiliated With: STAR HEALTHCARE NETWORK INC
*
Fund No:PlanType: Group Health
STAR HEALTHCARE NETWORK(212) 581-8228
STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019
GLOBALCARE, INC. GLOBALCARE, INC.MEDBENAffiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC. GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
MEDCARE INTERNATIONAL, INC.(954) 797-0650
MEDCARE INTERNATIONAL, INC.
MEDCARE INTERNATIONAL, INC.Affiliated With: MEDCARE INTERNATIONAL, INC.
Fund No:PlanType: Group Health
MEDCARE INTERNATIONAL, INC.(954) 797-0650
MEDCARE INTERNATIONAL, INC.7301 N.W. 4th St. #109DAVIE FL 33317
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-248• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EBPA(800) 578-3272
CHECK BENEFIT CARDMEDICAL CARE DEVELOPMENT JMS
Affiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS
Fund No:PlanType: Group Health
EBPA(800) 578-3272
EBPA
PO Box 2000Exeter NH 03833
Attn: Denise Oberg
EBPA(800) 578-3272
CHECK BENEFIT CARDMEDICAL CARE DEVELOPMENT WRAP % JMS
Affiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS
Fund No:PlanType: Group Health
EBPA(800) 578-3272
EBPA
PO Box 2000Exeter NH 03833
Attn: Denise Oberg
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEMEDICAL COLLEGE OF GA UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDMEDICAL COLLEGE OF GEORGIA AIH0058367
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-249• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Medical Consultants Network(631) 454-8399
Medical Consultants Network(631) 454-8399
Medical Consultants Network
Fund No:PlanType: Workers' Compensation
Medical Consultants Network(631) 454-8399
Medical Consultants Network3 Huntington QuadMelville NY 11747
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDMEDICAL UNIVERSITY OF SOUTH CAROLINA
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437
MEDICOR UM NOT APPLICABLEMEDICOR AUTOAffiliated With: MEDICOR
Fund No:PlanType: Auto
MEDICOR MEDICOR1745 N Brown Rd Ste 400Lawrenceville GA 30043
CONTACT EMPLOYER CONTACT EMPLOYERMedicor Managed CareAffiliated With: Medicor
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
MEDICOR UM NOT APPLICABLEMediCor-DOAS_MedataAffiliated With: Medicor Managed Care LLC
Fund No:PlanType: Workers' Compensation
MEDICOR MEDICOR1745 N Brown Rd Ste 400Lawrenceville GA 30043
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-250• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MEDSAVE(516) 622-1700
CHECK BENEFIT CARDMEDSAVE, INCAffiliated With: MEDSAVE, INC
Fund No:PlanType: Group Health
MEDSAVE(516) 622-1700
MEDSAVE390 Rabro RdHauppauge NY 11788
STAR HEALTHCARE NETWORK(212) 581-8228
CHECK BENEFIT CARDMEGA ASSISTANCEAffiliated With: STAR HEALTHCARE NETWORK INC
*
Fund No:PlanType: Group Health
STAR HEALTHCARE NETWORK(212) 581-8228
STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019
MEGA LIFE & HEALTH INSURANCE COMPANY(800) 527-5504
MEGA LIFE & HEALTH INSURANCE COMPANY
MEGA LIFE & HEALTH INSURANCE COMPANY
Affiliated With: MEGA LIFE & HEALTH INSURANCE COMPANY
Fund No:PlanType: Group Health
MEGA LIFE & HEALTH INSURANCE COMPANY(800) 527-5504
MEGA LIFE & HEALTH INSURANCE COMPANYPO Box 982009NORTH RICHLAND HILLS TX 76182
CHECK BENEFIT CARD CHECK BENEFIT CARDMEGA LIFE AND HEALTH INC CO CDHP INDIVIDUAL
Affiliated With: MEGA LIFE & INSURANCE COMPANY
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
HEALTHMARKETS(866) 855-5542
CHECK BENEFIT CARDMEGA LIFE AND HEALTH INSURANCE COMPANY - CDHP
Affiliated With: MEGA LIFE & HEALTH INSURANCE COMPANY - CDHP
Fund No:PlanType: Group Health
HEALTHMARKETS8004515998
HEALTHMARKETSPO Box 982009NORTH RICHLAND HILLS TX 76182
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-251• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDMELALEUCA INCAffiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD CHECK BENEFIT CARDMELITTA NORTH AMERICAAffiliated With: SELF INSURED BENEFIT ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
CHECK BENEFIT CARDMEMORIAL HOSPITAL THE JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
MEMPHIS VA MEDICAL CENTER
CHECK BENEFIT CARDMEMPHIS VA MEDICAL CENTER 3148
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
MEMPHIS VA MEDICAL CENTER
MEMPHIS VA MEDICAL CENTER
1030 JEFFERSON AVEMEMPHIS TN 38104
Attn: FEE BASIS (136G)
INSURANCE PROGRAMMERS INC.(800) 248-7095
INSURANCE PROGRAMMERS INC.
MERCEDES-BENZ CREDIT CORPORATION
Affiliated With: INSURANCE PROGRAMMERS, INC.
Fund No:PlanType: Group Health
INSURANCE PROGRAMMERS INC.(800) 248-7095
INSURANCE PROGRAMMERS INC.60 MAINWALLINGFORD CT 06492
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-252• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
MERCER TRANSPORTATIONAffiliated With: MERCER ADMINISTRATION
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(502) 992-4535
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
CHECK BENEFIT CARD CHECK BENEFIT CARDMERCURY INSURANCEAffiliated With: MITCHELL MEDICAL
Fund No:PlanType: Auto
Mercury: Administered by Mitchell MedicalExclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)
CHECK BENEFIT CARD CHECK BENEFIT CARD
MCMC LLC(888) 350-1150 Ext 228
MCMC LLC(888) 350-1150 Ext 228
MERIT AUTOAffiliated With: MCMC LLC
Fund No:PlanType: Auto
MCMC LLC(888) 350-1150 Ext 228
MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317
MIDWEST SECURITY ADMINISTRATORS, INC.
MIDWEST SECURITY ADMINISTRATORS, INC.
MESABA AVIATION, INC.Affiliated With: HEALTHCOMP ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS, INC.
MIDWEST SECURITY ADMINISTRATORS, INC.2700 Midwest Dr.ONALASKA WI 54650
MERITAIN HEALTH(800) 828-6922
MERITAIN HEALTH(800) 828-6922
Met America Mortgage Bankers Inc.Affiliated With: MERITAIN HEALTH
Fund No:PlanType: Group Health
MERITAIN HEALTH(800) 828-6922
MERITAIN HEALTH300 CORPORATE PKWYAMHERST NY 14226
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-253• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDMetLifeAffiliated With: Mitchell Medical
Fund No:PlanType: Auto
Metlife: Administered by Mitchell MedicalExclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD CHECK BENEFIT CARDMetLife Insurance (Auto)Affiliated With: Mitchell Medical
Fund No:PlanType: Auto
Metlife: Administered by Mitchell Medical
CHECK BENEFIT CARD CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYERMetro Group 90Affiliated With: New York State Insurance Fund
*
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER New York State Insurance Fund199 Church StNew York NY 10007
CONTACT EMPLOYER CONTACT EMPLOYERMetropolitan LifeAffiliated With: Mitchell Medical div. of Thompson Publishing Corp
Fund No:PlanType: Auto
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Metro MetroMetropolitan Transit AuthorityAffiliated With: Metropolitan Transit Authority
Fund No:PlanType: Workers' Compensation
Metro Metro
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-254• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
METSCH HOURLYAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
METSCH SALARYAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
MIAMI VAMC CHECK BENEFIT CARDMIAMI VAMC 3140Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
MIAMI VAMC MIAMI VAMC
1201 NW 16TH STMIAMI FL 33125
Attn: FEE BASIS - 136B
CHECK BENEFIT CARD CHECK BENEFIT CARDMICAAffiliated With: GROUP ADMINISTRATORS, LTD
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Mountain States Administrative Services(520) 722-7133
Hines and Associates(847) 214-2780
MICROCHIPAffiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
Mountain States Administrative Services(520) 722-7133
Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-255• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH PLAN INC(508) 752-2480
CMS(866) 325-1550
MICROGROUP INCAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
MAKSIN MANAGEMENT CORP(800) 220-1123
UM NOT APPLICABLEMID CONTINENT UNIVERSITYAffiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
MAKSIN MANAGEMENT CORP(800) 220-1123
MAKSIN MANAGEMENT CORP2500 McClellan AvePennsauken NJ 08109
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDMIDDLE GEORGIA COLLEGE AIH0058377
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEMIDDLE GEORGIA COLLEGE UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
CHECK BENEFIT CARD CHECK BENEFIT CARDMIDDLEBURY COLLEGEAffiliated With: KLAIS AND COMPANY
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-256• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EBPA(800) 578-3272
CHECK BENEFIT CARDMIDDLEBURY COLLEGE - JMSAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATION
Fund No:PlanType: Group Health
EBPA(800) 578-3272
EBPA
PO Box 2000Exeter NH 03833
Attn: Denise Oberg
Deborah Storey(405) 767-1760
Deborah Storey(405) 767-1760
Midlands Injury ManagementAffiliated With: Midlands Injury Management
Fund No:PlanType: Workers' Compensation
Deborah Storey(405) 767-1760
Deborah StoreyPO Box 238804Oklahoma City OK 73116
TEDRO & ASSOCIATES C/O CCN
CHECK BENEFIT CARDMIDWESTERN TEAMSTERS HEALTH & WELFARE FUND
Affiliated With: MIDWESTERN TEAMSTERS HEALTH & WELFARE FUND
Fund No:PlanType: Group Health
TEDRO & ASSOCIATES C/O CCN
TEDRO & ASSOCIATES C/O CCNPO Box 5190TAMPA FL 33675-5190
AFFORDABLE BENEFIT ADMINISTRATORS, INC.(800) 350-0148
AFFORDABLE BENEFIT ADMINISTRATORS, INC.
MIECO, INC.Affiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC. (ABA)
Fund No:PlanType: Group Health
AFFORDABLE BENEFIT ADMINISTRATORS, INC.(800) 350-0148
AFFORDABLE BENEFIT ADMINISTRATORS, INC.PO Box 10787BURBANK CA 91510
SISCO(800) 547-4726
CHECK BENEFIT CARDMIKE BROOKS, INCAffiliated With: SISCO/Cottingham & Butler
Fund No:PlanType: Group Health
SISCO(800) 786-7930
SISCOPO Box 389DUBUQUE IA 52004-0389
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-257• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
MILES KIMBALL COMPANYAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
BAC(800) 521-2654
BAC(614) 863-8780
MILES MCCLELLAN CONSTRUCTION CO
Affiliated With: BUSINESS ADMINISTRATORS & CONSULTANTS
Fund No:PlanType: Group Health
BAC(800) 521-2654
BACPO Box 107REYNOLDSBURG OH 43068
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
MANAGED CARE STRATEGIES(800) 283-4927
MILITARY DELI AND BAKERYAffiliated With: HEALTH AND WELFARE BENEFIT SYSTEMS INC
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
MILWAUKEE VA MEDICAL CENTER
CHECK BENEFIT CARDMILWAUKEE VAMC (CLEMENT J ZABLOCKI VAMC)
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
MILWAUKEE VA MEDICAL CENTER
MILWAUKEE VA MEDICAL CENTER
5000 W NATIONAL AVEMILWAUKEE WI 53295
Attn: FEE BASIS MIS-136E
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-258• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MINNEAPOLIS VA MEDICAL CENTER
CHECK BENEFIT CARDMINNEAPOLIS VA MEDICAL CENTER 3703
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
MINNEAPOLIS VA MEDICAL CENTER
MINNEAPOLIS VA MEDICAL CENTER
ONE VETERANS DRMINNEAPOLIS MN 55417
Attn: FEE BASIS 17A2
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN(800) 249-8440
EMPLOYEE BENEFIT ADMINISTRATION & MGMT
MISSION AVIATION FELLOWSHIPAffiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN(800) 249-8440
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
INSURANCE CLAIMS SERVICES INC(800) 931-3439
CHECK BENEFIT CARDMISSION TO THE WORLD (PCA) INC
Affiliated With: ALTERNATIVE INSURANCE RESOURCES, INC.
Fund No:PlanType: Group Health
INSURANCE CLAIMS SERVICES INC(800) 931-3439
INSURANCE CLAIMS SERVICES INCPO Box 660787BIRMINGHAM AL 35266
STUDENT ASSURANCE SERVICES6514397098
CHECK BENEFIT CARDMISSOURI CONSORTIUM - NORTHWEST STATE UNIVERSITY
Affiliated With: STUDENT ASSURANCE SERVICES
Fund No:PlanType: Group Health
STUDENT ASSURANCE SERVICES6514397098
STUDENT ASSURANCE SERVICES333 N. MAIN STREETSTILLWATER MN 55082
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-259• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDMISSOURI CONSORTIUM - SOUTHEAST STATE UNIVERSITY
Affiliated With: STUDENT ASSURANCE SERVICES INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
STUDENT ASSURANCE SERVICES6514397098
CHECK BENEFIT CARDMISSOURI CONSORTIUM - SOUTHERN STATE UNIVERSITY
Affiliated With: STUDENT ASSURANCE SERVICES
Fund No:PlanType: Group Health
STUDENT ASSURANCE SERVICES6514397098
STUDENT ASSURANCE SERVICES333 N. MAIN STREETSTILLWATER MN 55082
STUDENT ASSURANCE SERVICES6514397098
CHECK BENEFIT CARDMISSOURI CONSORTIUM - TRUMAN STATE UNIVERSITY
Affiliated With: STUDENT ASSURANCE SERVICES
Fund No:PlanType: Group Health
STUDENT ASSURANCE SERVICES6514397098
STUDENT ASSURANCE SERVICES333 N. MAIN STREETSTILLWATER MN 55082
Medical Mutual of Ohio(216) 736-2522
CHECK BENEFIT CARDMMO Indemnity TravelAffiliated With: Medical Mutual of Ohio
Fund No:PlanType: Group Health
Medical Mutual of Ohio(216) 736-2522
Medical Mutual of Ohio
2060 E 9th StCleveland OH 44115
Attn: Barb Hufgard
CNIC HEALTH SOLUTIONS(800) 426-7453
CNIC HEALTH SOLUTIONS(800) 426-7453
MODERN LUXURYAffiliated With: CNIC HEALTH SOLUTIONS
Fund No:PlanType: Group Health
CNIC HEALTH SOLUTIONS(800) 426-7453
CNIC HEALTH SOLUTIONSPO Box 3559ENGLEWOOD CO 80155-3559
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-260• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FLORIDA HEALTH ADMINISTRATORS(954) 366-0111
CORVEL CORPORATION(954) 340-8990
MONROE COUNTY SCHOOL BOARD
Affiliated With: FLORIDA HEALTH ADMINISTRATORS DBA FHA - TPA
Fund No:PlanType: Group Health
FLORIDA HEALTH ADMINISTRATORS(954) 366-0111
FLORIDA HEALTH ADMINISTRATORSPO Box 327810Fort Lauderdale FL 33332
MONTANA HEALTH CARE SYSTEM
CHECK BENEFIT CARDMONTANA HEALTH CARE SYSTEM 3534
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
MONTANA HEALTH CARE SYSTEM
MONTANA HEALTH CARE SYSTEM
WILLIAM ST off HWY 12 WESTFORT HARRISON MT 59636
Attn: FEE BASIS
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
MONTEBELLO PACAKAGING INCAffiliated With: PREFERRED HEALTH PLAN INC 962550088
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(502) 992-4535
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
PACIFIC HEALTH ALLIANCE
PACIFIC HEALTH ALLIANCE
MONTEREY BAY PUBLIC EMPLOYEES TRUST
Affiliated With: PACIFIC HEALTH ALLIANCE
Fund No:PlanType: Group Health
PACIFIC HEALTH ALLIANCE
PACIFIC HEALTH ALLIANCEPO Box 9248FRESNO CA 93791
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-261• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDMONTGOMERY ESCALATOR ELEVATOR INC
Affiliated With: INTEGRITY HEALTH SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
MONTGOMERY VAMC CHECK BENEFIT CARDMONTGOMERY VAMC 3543Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
MONTGOMERY VAMC MONTGOMERY VAMC
215 PERRY HILL RDMONTGOMERY AL 36109
Attn: FEE BASIS SECTION
BENEFIT MANAGEMENT INC.(800) 290-1368
CHECK BENEFIT CARDMORIDGE MANUFACTURING, INCAffiliated With: BENEFIT MANAGEMENT INC
Fund No:PlanType: Group Health
BENEFIT MANAGEMENT INC.(800) 290-1368
BENEFIT MANAGEMENT INC.PO Box 1090GREAT BEND KS 67530
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDMORRIS COLLEGEAffiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
MORRIS TRANSFER, INC.Affiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-262• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.(800) 673-5222
MORTON WELDING COMPANY INC
Affiliated With: OSF HEALTHPLANS INC
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(309) 677-8356
OSF HealthPlans, Inc.PO Box 5128PEORIA IL 61601-5128
BENEFIT SUPPORT(800) 777-4782
CHECK BENEFIT CARDMOSLEY HOLDINGSAffiliated With: HEALTHDATAINSIGHTS DBA MVPPO
Fund No:PlanType: Group Health
BENEFIT SUPPORT(800) 777-4782
BENEFIT SUPPORT305 GREEN STGAINSVILLE GA 30501
BENEFIT MANAGEMENT INC.
MedWatch(800) 432-8421
MOSSBERG SANITATIONAffiliated With: BENEFIT MANAGEMENT INC
Fund No:PlanType: Group Health
BENEFIT MANAGEMENT INC.
BENEFIT MANAGEMENT INC.
CORESOURCE(800) 624-7143
CORESOURCE(800) 480-6658
Motel Hotel Associates, IncAffiliated With: CORESOURCE INC
Fund No:PlanType: Group Health
CORESOURCE(800) 624-7143
CORESOURCEPO Box 2920CLINTON OH 52733-2920
CHECK BENEFIT CARD CHECK BENEFIT CARDMOTOR TRUCKAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-263• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PIONEER MANAGEMENT SYSTEMS(877) 868-9060
CHECK BENEFIT CARDMOUNT HOLYOKE COLLEGEAffiliated With: PIONEER MANAGEMENT SYSTEMS
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(877) 868-9060
PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01090
MOUNTAIN HOME VA MEDICAL CENTER
CHECK BENEFIT CARDMOUNTAIN HOME VA MEDICAL CENTER 3146
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
MOUNTAIN HOME VA MEDICAL CENTER
MOUNTAIN HOME VA MEDICAL CENTER
MOUNTAIN HOME VAMCMOUNTAIN HOME TN 37684
Attn: 04F
TALL TREE ADMINISTRATORS(801) 274-8100
CORVEL(801) 269-8723
MOUNTAIN VIEW HOSPITALAffiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
TALL TREE ADMINISTRATORS(801) 274-8100
TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107
CHECK BENEFIT CARD8882954864
CHECK BENEFIT CARDMOUNTVILLE MILLS INCAffiliated With: JSL ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8882954864
CHECK BENEFIT CARD
ACORDIA NATIONAL(888) 685-7774
CHECK BENEFIT CARDMPD INCAffiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR
*
Fund No:PlanType: Group Health
ACORDIA NATIONAL(888) 685-7774
ACORDIA NATIONAL
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-264• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
THE LOOMIS COMPANY(800) 346-1223
UM NOT APPLICABLEMPR ASSOCIATES INCAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(800) 346-1223
THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011
BENESYS INC(248) 813-9800
HINES & ASSOCIATES(847) 214-2780
MRCC EMPLOYEE BENEFITS FUND/TRAVEL
Affiliated With: MRCC EMPLOYEE BENEFITS FUND
Fund No:PlanType: Group Health
BENESYS INC(248) 813-9800
BENESYS INC700 TOWER DRTROY MI 48098
CHECK BENEFIT CARD CHECK BENEFIT CARDMULLER MARTINI CORPORATIONAffiliated With: HEALTHDATAINSIGHTS / DBA MVPPO
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850
AMERICAN HEALTH HOLDING(888) 877-7994
MULVANNY G2 ARCHITECTUREAffiliated With: TRUSTEED PALNS SERVICE CORPORATION
Fund No:PlanType: Group Health
TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850
TRUSTEED PLANS SERVICE CORPORATIONPO Box 1984NASHVILLE TN 37202
MURFREESBORO VA MEDICAL CENTER
CHECK BENEFIT CARDMURFREESBORO VA MEDICAL CENTER 3151
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
MURFREESBORO VA MEDICAL CENTER
MURFREESBORO VA MEDICAL CENTER
3400 LEBANON PIKEMURFREESBORO TN 37129
Attn: FEE BASIS (136)
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-265• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FISERV HEALTH KANSAS(800) 235-7160
AVIDYN HEALTH(866) 802-1328
MURRAY BROS CADDY SHACKAffiliated With: FISERV HEALTH - KANSAS
Fund No:PlanType: Group Health
FISERV HEALTH KANSAS(800) 235-7160
FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520
PREFERRED CARE, INC.(215) 639-6208
CHECK BENEFIT CARDMUTUAL OF OMAHA - SPECIAL RISK STUDENT ATHLETIC PROGRAM
Affiliated With: PREFERRED CARE INC
Fund No:PlanType: Group Health
PREFERRED CARE, INC.(215) 639-6208
PREFERRED CARE, INC.1300 VIRGINIA DR STE 315FT. WASHINGTON PA 19034
THE LOOMIS COMPANY(800) 498-6250
HINES & ASSOCIATES(888) 826-5769
MVM INC.Affiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(800) 498-6250
THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011
ROBERT C. BOUCK, INC. ROBERT C. BOUCK, INC.N. KOHL GROCERAffiliated With: ROBERT C. BOUCK, INC.
Fund No:PlanType: Group Health
ROBERT C. BOUCK, INC. ROBERT C. BOUCK, INC.126 N. 30th #205QUINCY IL 62301
SUMMIT(888) 690-2020
UM NOT APPLICABLENA'NEELZHIIN JI OLTA TORREON DAY SCHOOL
Affiliated With: SUMMIT
Fund No:PlanType: Group Health
SUMMIT(888) 690-2020
SUMMITPO Box 25160SCOTTSDALE AZ 85255-0102
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-266• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERNassauAffiliated With: New York State Insurance Fund
*
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
CHECK BENEFIT CARDNATIONAL COLLEGE OF NATUROPATHIC MEDICINE
Affiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376
PATIENT ADVOCATES LLC(207) 657-7733
PATIENT ADVOCATES LLC(207) 657-7733
NATIONAL DISTRIBUTORSAffiliated With: PATIENT ADVOCATES LLC
Fund No:PlanType: Group Health
PATIENT ADVOCATES LLC(207) 657-7733
PATIENT ADVOCATES LLCPO Box 1959Gray ME 04039
CONTACT EMPLOYER CONTACT EMPLOYERNational Farmers Union
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER CONTACT EMPLOYERNational Grange Mutual Insurance Company
Affiliated With: Genex Services, Inc.
Fund No:PlanType: Auto
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-267• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
NATIONAL HEALTH BENEFITS CORPORATION (NHBC)(888) 621-7900
NATIONAL HEALTH BENEFITS CORPORATION (NHBC)
NATIONAL HEALTH BENEFITS CORPORATION % SAVINGS (NHBC)
Affiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)
Fund No:PlanType: Group Health
NATIONAL HEALTH BENEFITS CORPORATION (NHBC)(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
PREMIER ACCESS(888) 463-4137
CHECK BENEFIT CARDNATIONAL HEALTH INSURANCEAffiliated With: PREMIER ACCESS
Fund No:PlanType: Group Health
PREMIER ACCESS(888) 463-4137
PREMIER ACCESSPO Box 150375Arlington TX 76015
SANUS HEALTH CORPORATION(305) 572-9756
SANUS HEALTH CORPORATION(305) 572-9756
NATIONAL INSURANCE BOARDAffiliated With: SANUS HEALTH
Fund No:PlanType: Group Health
SANUS HEALTH CORPORATION(305) 572-9756
SANUS HEALTH CORPORATION12501 KENDALL DR STE 2MIAMI FL 33186
CENBEN USA(614) 797-5204
CHECK BENEFIT CARDNATIONAL PEN CORPORATIONAffiliated With: CENBEN USA INC
Fund No:PlanType: Group Health
CENBEN USA(614) 797-5204
CENBEN USA
4079 Executive PkwyWesterville OH 43081
Attn: Melissa Joseph
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7345
NATIONAL SPORTS SERVICESAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-268• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ECOM PPO ADVISORS, INC(800) 342-0719
CHECK BENEFIT CARDNATIONAL TELECOMMUNICATION COOPERATIVE ASSOCIATION
Affiliated With: ECOM PPO ADVISORS INC
Fund No:PlanType: Group Health
ECOM PPO ADVISORS, INC(800) 342-0719
ECOM PPO ADVISORS, INC
8350 N. CENTRAL EXPWY, STE 600DALLAS TX 75206
Attn: ACCOUNTING
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
National Title TravelAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CHECK BENEFIT CARD8774534201
First HealthNATIONAL WOOD PRODUCTSAffiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8774534201
CHECK BENEFIT CARD
NATIONWIDE HEALTH PLANS(800) 331-4222
NATIONWIDE HEALTH PLANS(800) 331-4222
NATIONWIDE HEALTH PLANS - CALIFORNIA SMALL GROUP PRODUCT
Affiliated With: NATIONWIDE
Fund No:PlanType: Group Health
NATIONWIDE HEALTH PLANS(800) 331-4222
NATIONWIDE HEALTH PLANSPO Box 8026DUBLIN OH 43017
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-269• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
NATIONWIDE HEALTH PLANS(800) 331-4222
NATIONWIDE HEALTH PLANS(800) 331-4222
NATIONWIDE HEALTH PLANS OHIO PRIMES LIVES
Affiliated With: NATIONWIDE HEALTH PLANS OHIO PRIMES LIVES
Fund No:PlanType: Group Health
NATIONWIDE HEALTH PLANS(800) 331-4222
NATIONWIDE HEALTH PLANSPO Box 182690COLUMBUS OH 43218
PACIFIC LIFE & ANNUITY COMPANY(800) 542-6642
CHECK BENEFIT CARDNATURES REALMAffiliated With: PACIFIC LIFE & ANNUITY
Fund No:PlanType: Group Health
PACIFIC LIFE & ANNUITY COMPANY(800) 542-6642
PACIFIC LIFE & ANNUITY COMPANYPO Box 295Onalaska WI 54650
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
NAVAGENTE GROUP INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
CHECK BENEFIT CARDNE CONSERVATORY MUSICAffiliated With: PIONEER MANAGEMENT SERVICES
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090
HEALTH NET FEDERAL SERVICES(916) 985-1259
UM NOT APPLICABLENebraska Western Iowa HCS - Grand Island 4006
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(916) 985-1259
CLAIMS MANAGER
2201 N Broadwell AveGrand Island NE 68803
Attn: Fee Basis 136F
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-270• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
UNITED CLAIM SOLUTIONS(602) 393-4553
UM NOT APPLICABLENEIL HUFFMAN INCAffiliated With: UNITED CLAIMS SOLUTIONS
Fund No:PlanType: Group Health
UNITED CLAIM SOLUTIONS(602) 393-4553
UNITED CLAIM SOLUTIONS10835 N 25TH AVE STE 105PHOENIX AZ 85029
TALL TREE ADMINISTRATORS(801) 274-8100
CORVEL(801) 269-8723
NELSON NUTRACEUTICALAffiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
TALL TREE ADMINISTRATORS(801) 274-8100
TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107
WAUSAU BENEFITS, INC.(715) 841-7802
CHECK BENEFIT CARDNESTLE, USAAffiliated With: WAUSAU BENEFITS, INC.
Fund No:PlanType: Group Health
WAUSAU BENEFITS, INC.(715) 841-7802
WAUSAU BENEFITS, INC.
PO Box 8046WAUSAU WI 54401-8046
Attn: LeAnn Fichtner
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMINISTRATION & MGMT
NETAFIM IRRIGATION, INC.Affiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
CHECK BENEFIT CARD CHECK BENEFIT CARDNETCARE LIFE & HEALTH
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-271• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGNEUMAN ENTERPRISESAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGPO Box 98WORLAND WY 82401
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
NEVADA CANCER CENTER TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
NEVADA TITLE INSURANCE COMPANY
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
NEW COM INC PEPMAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
NEW COM INC.Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-272• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PATIENT ADVOCATES LLC(800) 290-8559
PATIENT ADVOCATES LLC(800) 290-8559
NEW ENGLAND HOMESAffiliated With: PATIENT ADVOCATES LLC
Fund No:PlanType: Group Health
PATIENT ADVOCATES LLC(800) 290-8559
PATIENT ADVOCATES LLCPO Box 1959Gray ME 04039
EBPA(800) 525-8788
CHECK BENEFIT CARDNEW ENGLAND PRECISION JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
ECOM PPO ADVISORS, INC(800) 552-7879
CHECK BENEFIT CARDNEW ERA LIFE INSURANCEAffiliated With: ECOM PPO ADVISORS INC
Fund No:PlanType: Group Health
ECOM PPO ADVISORS, INC(800) 552-7879
ECOM PPO ADVISORS, INC
8350 N. CENTRAL EXPWY, STE 600DALLAS TX 75206
Attn: ACCOUNTING
International Medical Group, Inc.(800) 628-4664 or (317) 655-4500
International Medical Group, Inc.(800) 628-4664 or (317) 655-4500
New Freedom CareAffiliated With: International Medical Group, Inc.
Fund No:PlanType: Group Health
International Medical Group, Inc.(800) 628-4664 or (317) 655-4500
International Medical Group, Inc.2960 N Meridian StIndianapolis IN 46208
EMPLOYEE BENEFIT PLAN ADMINISTRATION(888) 877-6447
APS HEALTHCARE(262) 787-2200
NEW HAMPSHIRE HEALTH PLANAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATION
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT PLAN ADMINISTRATION(888) 877-6447
EMPLOYEE BENEFIT PLAN ADMINISTRATION37 INDUSTRIAL DREXETER NH 03833
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-273• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HCH ADMINISTRATORS(800) 322-1516
HCH ADMINISTRATORSNEW MEXICO INSTITUTE OF MINING AND TECHNOLOGY
Fund No:PlanType: Group Health
HCH ADMINISTRATORS(800) 322-1516
HCH ADMINISTRATORSPO Box 1986PEORIA IL 61656
CHECK BENEFIT CARD CHECK BENEFIT CARDNEW TRIBES MISSIONAffiliated With: NEW TRIBES MISSION
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
SELF INSURED PLANS LLC(239) 403-7884
MedWatch(800) 432-8421
NEW TRIBES MISSION FLORIDAAffiliated With: NEW TRIBES MISSION
Fund No:PlanType: Group Health
SELF INSURED PLANS LLC(239) 403-7884
SELF INSURED PLANS LLC1016 COLLIER CENTER STE 200NAPLES FL 34103
CONTACT EMPLOYER CONTACT EMPLOYERNew York City DivisionAffiliated With: New York State Insurance Fund
*
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER New York State Insurance Fund199 Church StNew York NY 10007
CONTACT EMPLOYER CONTACT EMPLOYERNew York Special Funds Conservation
Affiliated With: New York Special Funds Conservation
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-274• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH NET FEDERAL SERVICES(214) 387-3232
CHECK BENEFIT CARDNEW YORK VA MEDICAL CENTER 3522
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(214) 387-3232
HEALTH NET FEDERAL SERVICES5504 HILL HEAVEN CTFRISCO TX 75035
Western Health(605) 719-4600 or (888) 341-1766
Western Health(605) 719-4640 or (800) 229-0892
Newkirk's Ace HardwareAffiliated With: Rapid City Regional Hospital DBA Western Health
Fund No:PlanType: Group Health
Western Health(605) 719-4600 or (888) 341-1766
Western Health529 Kansas City St Ste 200Rapid City SD 57701
NF SG VA MEDICAL CENTER
CHECK BENEFIT CARDNF SG VA MEDICAL CENTER 3143Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
NF SG VA MEDICAL CENTER
NF SG VA MEDICAL CENTER
619 S MARIONLAKE CITY FL 32025
Attn: BUSINESS OFFICE 04
Benefits/Eligibility(800) 843-3106
CHECK BENEFIT CARD(800) 522-2161
Nippon Life Insurance Company of America
Affiliated With: Insurers Administrative Corporation #962500302
Fund No:PlanType: Group Health
Benefits/Eligibility(800) 843-3106
Benefits/EligibilityPO Box 828Park Ridge IL 60068-0828
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
NOAHS COLLECTORS GALLERYAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-275• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EBPA(802) 846-8060
CHECK BENEFIT CARDNOBLE HEALTH SYSTEMS INC WRAP JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272
COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272
NOBLE HEALTH SYSTEMS INC WRAP VST
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272
COMPREHENSIVE BENEFITS ADMINISTRATORS INCPO Box 2365SOUTH BURLINGTON VT 05407-2365
SRT ADMINISTRATORS, INC. C/O CCN
CHECK BENEFIT CARDNOOKSACK RIVER CASINOAffiliated With: SRT ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
SRT ADMINISTRATORS, INC. C/O CCN
SRT ADMINISTRATORS, INC. C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
HEALTHSCOPE BENEFITS INC(877) 266-2054
CHECK BENEFIT CARDNORDENIA USA, INCAffiliated With: HEALTHSCOPE BENEFITS, INC.
Fund No:PlanType: Group Health
HEALTHSCOPE BENEFITS INC(877) 266-2054
HEALTHSCOPE BENEFITS INCPO Box 619055DALLAS TX 75261
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-276• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
THE LOOMIS COMPANY(866) 239-7191
HINES & ASSOCIATES(888) 826-5769
NORTEL GOVERNMENT SOLUTIONS
Affiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(866) 239-7191
THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011
CHECK BENEFIT CARD CHECK BENEFIT CARDNORTH AMERICAN ADMINISTRATORS
Affiliated With: MERITAIN HEALTH
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
NORTH AMERICAN PREFERREDAffiliated With: NORTH AMERICAN ADMINISTRATORS - NY
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226
CompIQ Corporation(800) 293-3131
UM NOT APPLICABLENORTH AMERICAN RISK SERVICES (NARS)
Affiliated With: CompIQ #13910
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(800) 293-3131
CompIQ Corporation35 Tesla Way #100Irvine CA 92618
CompIQ Corporation(800) 293-3131
UM NOT APPLICABLENORTH AMERICAN RISK SERVICES (NARS) AUTO
Affiliated With: CompIQ #13910
Fund No:PlanType: Auto
CompIQ Corporation(800) 293-3131
CompIQ Corporation35 Tesla Way #100Irvine CA 92618
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-277• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540
MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540
NORTH CARE CENTERAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS 20183
Fund No:PlanType: Group Health
MUTUAL ASSURANCE ADMINISTRATORS(405) 607-2587
MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096
PEARCE ADMINISTRATION(888) 722-1668
CHECK BENEFIT CARDNORTH CAROLINA AT&T STATE UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408
PEARCE ADMINISTRATION(888) 722-1668
CHECK BENEFIT CARDNORTH CAROLINA SCHOOL OF THE ARTS
Affiliated With: MAKSIN MANAGEMENT CORPORATION
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 722-1668
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PEARCE ADMINISTRATION(888) 722-1668
CHECK BENEFIT CARDNORTH CAROLINA STATE UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT CORPORATION
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 722-1668
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-278• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(800) 251-9665
UM NOT APPLICABLENORTH CAROLINA WESLEYAN COLLEGE
Affiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(800) 251-9665
TRUE CHOICEPO Box 700307DALLAS TX 75370
NORTH CHICAGO VA MEDICAL CENTER
CHECK BENEFIT CARDNORTH CHICAGO VA MEDICAL CENTER 3165
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
NORTH CHICAGO VA MEDICAL CENTER
NORTH CHICAGO VA MEDICAL CENTER
3001 GREE BAY RDNORTH CHICAGO IL 60064
Attn: FEE 136B
EBPA(802) 846-8060
CHECK BENEFIT CARDNORTH COUNTY HEALTH SYSTEMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATOR, INC.
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
EBPA(802) 846-8060
CHECK BENEFIT CARDNORTH COUNTY HEALTH SYSTEMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 7858Burbank CA 91510-7858
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-279• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDNORTH GEORGIA COLLEGE & STATE UNIV AIH0058397
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLENORTH GEORGIA COLLEGE & STATE UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PEARCE ADMINISTRATION(843) 622-6001
GALLAGHER BENEFIT ADMINISTRATORS INC
NORTH GREENVILLE UNIVERSITY - DOMESTIC
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
TRUE CHOICE(800) 251-9665
UM NOT APPLICABLENORTH HARRIS MONTGOMERY CCD
Affiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE(800) 251-9665
TRUE CHOICEPO Box 700307DALLAS TX 75370
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-280• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH NET FEDERAL SERVICES(214) 387-3232
CHECK BENEFIT CARDNORTHAMPTON VA MEDICAL CENTER 3112
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(214) 387-3232
NORTHAMPTON VAMC
421 N MAIN STLEEDS MA 01053
Attn: FEE BASIS 001 FEE
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARDNORTHEAST KINGDOM HUMAN SERVICES
Affiliated With: COMPREHENSIVE BENEFITS ADMINISTRATOR
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05407
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARDNORTHEASTERN VERMONT REGIONAL HOSPITAL WRAP JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
BENESYS(248) 822-4200
HEALTH CARE EVALUATION(209) 951-6711
NORTHERN CA SHEET METAL WORKERS DBA "LOCAL 162" HEALTH CARE PLAN
Affiliated With: SHEET METAL WORKERS LOCAL 104 HEALTH CARE PLAN
Fund No:PlanType: Group Health
BENESYS(248) 822-4200
BENESYSPO Box 1138SAN RAMON CA 94583
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-281• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
NORTHERN CALIFORNIA HCS
CHECK BENEFIT CARDNORTHERN CALIFORNIA HCS 3184
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
NORTHERN CALIFORNIA HCS
NORTHERN CALIFORNIA HCS
201 WALNUT AVEVALLEJO CA 94592
Attn: FEE SERVICE (04F)
CHECK BENEFIT CARD CHECK BENEFIT CARDNORTHERN MAINE MEDICAL CENTER
Affiliated With: ULTRABENEFITS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
NORTHPORT VA MEDICAL CENTER
CHECK BENEFIT CARDNORTHPORT VA MEDICAL CENTER 3120
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
NORTHPORT VA MEDICAL CENTER
NORTHPORT VA MEDICAL CENTER
79 MIDDLEVILLE RDNORTHPORT NY 11768
Attn: FEE BASIS 136A
NORTHSTAR PROVIDERS, LLC(786) 507-1600
UM NOT APPLICABLENorthstar Providers LLCAffiliated With: COMP IQ
Fund No:PlanType: Auto
NORTHSTAR PROVIDERS, LLC(786) 507-1600
NORTHSTAR PROVIDERS, LLC8080 NW 155TH STMIAMI LAKES FL 33016
NORTHSTAR PROVIDERS, LLC(786) 507-1600
UM NOT APPLICABLENorthstar Providers LLCAffiliated With: COMP IQ
Fund No:PlanType: Workers' Compensation
NORTHSTAR PROVIDERS, LLC(786) 507-1600
NORTHSTAR PROVIDERS, LLC8080 NW 155TH STMIAMI LAKES FL 33016
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-282• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CRITIQUE CHECK BENEFIT CARDNORTHWEST BEC CORPORATIONAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
CRITIQUE CRITIQUEPO Box 651109S SALT LAKE UT 84165-1109
CHECK BENEFIT CARD CHECK BENEFIT CARDNORTHWEST INDIANA PAINTERSAffiliated With: PAINTERS LOCAL 460
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD CHECK BENEFIT CARDNORTHWEST METAL PRODUCTS CO
Affiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
PIONEER MANAGEMENT SYSTEMS(413) 534-8658
UM NOT APPLICABLENorwich UniversityAffiliated With: PIONEER MANAGEMENT SYSTEMS
*
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(413) 534-8658
PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01089
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-283• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
NOVA HEALTHCARE ADMINISTRATORS INC(800) 999-5703
CHECK BENEFIT CARDNOVA HEALTHCARE ADMINISTRATORS
Affiliated With: NOVA HEALTHCARE ADMINISTRATORS
Fund No:PlanType: Group Health
NOVA HEALTHCARE ADMINISTRATORS INC(716) 250-7302
NOVA HEALTHCARE ADMINISTRATORS INC250 ESSJAY RDBUFFALO NY 14221
CBA - COOPERATIVE BENEFITS CORPORATION(402) 483-9265
CHECK BENEFIT CARDNRECA - OUT OF AREA NATIONAL NETWORK (TRAVEL @ %)
Affiliated With: NRECA - National Rural Electric Cooperative
Fund No:PlanType: Group Health
CBA - COOPERATIVE BENEFITS CORPORATION(402) 483-9265
CBA - COOPERATIVE BENEFITS CORPORATIONPO Box 6249LINCOLN NE 68506-0249
EBPA(802) 846-8060
CHECK BENEFIT CARDNRF DISTRIBUTORS VSTAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
MERITAIN HEALTH(812) 429-2747
CHECK BENEFIT CARDNUNN MILLINGAffiliated With: NORTH AMERICAN
Fund No:PlanType: Group Health
MERITAIN HEALTH(812) 429-2747
MERITAIN HEALTHPO Box 1090GREAT BEND KS 67530
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-284• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDNW DOORAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
MSAG(800) 486-4068
MSAG(800) 486-4068
NYK LOGISTICS (AMERICAS) NUWDC DIVISION
Affiliated With: MID SOUTH ADMINISTRATIVE GROUP
Fund No:PlanType: Group Health
MSAG(800) 486-4068
MSAG1180 Vickery LaneCordova TN 38016
ENTRUST INC(281) 368-7878
UM NOT APPLICABLEOAK HOTELS GROUPAffiliated With: ENTRUST INC
Fund No:PlanType: Group Health
ENTRUST INC(281) 368-7878
ENTRUST INC14701 ST MARY'S LN STE 150HOUSTON TX 77079
CONTACT EMPLOYER CONTACT EMPLOYEROctagon Risk Services
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
AMERIHEALTH ADMINISTRATORS
CONTACT EMPLOYER
Attn:
Octagon Risk Services, Inc - Rancho Cordova(866) 672-9296
Octagon Risk Services, Inc - Rancho Cordova(866) 672-9296
Octagon Risk Services, IncAffiliated With: CompManagement, Inc. (CMI)
Fund No:PlanType: Workers' Compensation
Octagon Risk Services, Inc - Rancho Cordova(866) 672-9296
CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-285• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYEROffice Depot/Sedgwick CMS
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER CONTACT EMPLOYEROhio CasualtyAffiliated With: Genex Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER CONTACT EMPLOYEROhio Casualty Group
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER CONTACT EMPLOYEROhio Casualty Group AUTOAffiliated With: GENEX Services, Inc.
Fund No:PlanType: Auto
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
GLOBAL EMERGENCY MEDICAL SERVICES (GEMS)
GLOBAL EMERGENCY MEDICAL SERVICES (GEMS)
OHIO STATE UNIVERSITY BENEFITS
Affiliated With: GLOBAL EMERGENCY MEDICAL SERVICES, INC. (GEMS)
Fund No:PlanType: Group Health
GLOBAL EMERGENCY MEDICAL SERVICES (GEMS)
GLOBAL EMERGENCY MEDICAL SERVICES (GEMS)2001 Westside Pkwy. #120ALPHARETTA GA 30004
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-286• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
TRUE CHOICE(800) 251-9665
UM NOT APPLICABLEOKLAHOMA BAPTIST UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE(800) 251-9665
TRUE CHOICEPO Box 700307DALLAS TX 75370
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDOKLAHOMA CHRISTIAN UNIVERSITY
Affiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
THE KEMPTON GROUP(405) 521-1711
CHECK BENEFIT CARDOKLAHOMA CONFERENCE OF UNITED METHODIST CHURCHES
Affiliated With: THE KEMPTON GROUP INC
Fund No:PlanType: Group Health
THE KEMPTON GROUP(405) 521-1711
THE KEMPTON GROUPPO Box 54889OKLAHOMA CITY OK 73154
AMERICA'S CHOICE HEALTHPLANS, LLC
MANAGED CARE CONCEPTS(409) 886-2723
OKLAHOMA LEATHER PRODUCTS INC
Affiliated With: AMERICAS CHOICE HEALTH PLAN
Fund No:PlanType: Group Health
AMERICA'S CHOICE HEALTHPLANS, LLC
AMERICA'S CHOICE HEALTHPLANS, LLCPO Box 922043HOUSTON TX 77292
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-287• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540
UM NOT APPLICABLEOKLAHOMA PRESS ASSOCIATION/MEMBERS EMPLOYEES BENEFIT TRUST
Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540
MUTUAL ASSURANCE ADMINISTRATORS3121 QUAIL SPRINGS PKWYOKLAHOMA CITY OK 73134
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDOKLAHOMA STATE UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
STAR HEALTHCARE NETWORK(212) 581-8228
CHECK BENEFIT CARDON CALL INTERNATIONALAffiliated With: STAR HEALTHCARE NETWORK INC
*
Fund No:PlanType: Group Health
STAR HEALTHCARE NETWORK(212) 581-8228
STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019
THE LOOMIS COMPANY(800) 875-2364
HINES & ASSOCIATES(888) 826-5769
ON SITE E-DISCOVERYAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(800) 875-2364
THE LOOMIS COMPANY3220 East 26th StreetLos Angeles CA 90023
CHECK BENEFIT CARD CHECK BENEFIT CARDOne BeaconAffiliated With: Mitchell Medical
Fund No:PlanType: Auto
One Beacon: Administered by Mitchell MedicalExclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-288• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYEROne Beacon Insurance Group
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
PROFESSIONAL BUSINESS SERVICES(800) 732-3412
CHECK BENEFIT CARDOPPORTUNITIES ENTERPRISESAffiliated With: UNITED CLAIMS SOLUTIONS
Fund No:PlanType: Group Health
PROFESSIONAL BUSINESS SERVICES(800) 732-3412
PROFESSIONAL BUSINESS SERVICES2959 LUCERNE DRGRAND RAPIDS MI 48546
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(619) 574-1685
OPPORTUNITY RESOURCESAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
Benefit Planners(866) 868-8230
FISERV HEALTH INC(866) 868-8230
OPTIMUS CORPORATIONAffiliated With: FISERV BENEFIT PLANNERS
*
Fund No:PlanType: Group Health
Benefit Planners(866) 868-8230
Benefit PlannersPO Box 690450SAN ANTONIO TX 78269
GUARANTEE TRUST LIFE INSURANCE CO8006221993
GUARANTEE TRUST LIFE INSURANCE CO
ORAL ROBERTS UNIVERSITY
Fund No:PlanType: Group Health
GUARANTEE TRUST LIFE INSURANCE CO8006221993
GUARANTEE TRUST LIFE INSURANCE CO. C/O CCNPO Box 3000SCOTTSDALE AZ 85271
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-289• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDOREGON COLLEGE OF ARTS AND CRAFTS
Affiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
ADMINISTRATIVE CONCEPTS, INC.
CHECK BENEFIT CARDOREGON GRADUATE INSTITUTE SCHOOL OF SCIENCE AND ENG
Affiliated With: FIRST UNDERWRITERS INC
Fund No:PlanType: Group Health
ADMINISTRATIVE CONCEPTS, INC.
ADMINISTRATIVE CONCEPTS, INC.
997 Old Eagle School Rd. #215WAYNE PA 19087-1706
Attn: Customer Service Dept
USI ADMINISTRATORS(877) 277-5718
USI ADMINISTRATORSOREGON INSTITUTE OF TECHNOLOGY
Affiliated With: FIRST UNDERWRITERS INC
Fund No:PlanType: Group Health
USI ADMINISTRATORS(877) 277-5718
USI ADMINISTRATORSPO Box 3357FORT WORTH TX 76113
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONS(800) 786-7930
OREGON INSTITUTE OF TECHNOLOGY INTERNATIONAL & DOMESTIC
Affiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
ASSURECARE(800) 759-1311
Careline UR(763) 383-4800
ORLAND SCHOOL #135Affiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 759-1311
ASSURECARE340 Quadrangle DrBolingbrook IL 60440
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-290• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
AFFORDABLE BENEFIT ADMINISTRATORS INC(818) 842-0147
CHECK BENEFIT CARDORTHOPAEDIC CENTER OF THE ROCKIES
Affiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC. (ABA)
Fund No:PlanType: Group Health
AFFORDABLE BENEFIT ADMINISTRATORS INC(818) 842-0147
AFFORDABLE BENEFIT ADMINISTRATORS INCPO Box 10787BURBANK CA 91510-0787
OSF HealthPlans, Inc.(877) 677-8222
CHECK BENEFIT CARDOSF-H S I PARTNERSHIPAffiliated With: OSF HEALTHPLANS INC
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(877) 677-8222
OSF HealthPlans, Inc.PO Box 5128PEORIA IL 61601-5128
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.(800) 284-2273
OSFHPAffiliated With: OSF HEALTHPLANS, INC.
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128
MERITAIN HEALTH(800) 842-3216
UM NOT APPLICABLEOSLER INSTITUTEAffiliated With: MERITAIN HEALTH
Fund No:PlanType: Group Health
MERITAIN HEALTH(800) 842-3216
MERITAIN HEALTH9245 N Meridian St Ste 100Indianapolis IN 46260
CENBEN USA(614) 797-5204
CHECK BENEFIT CARDOTAY WATER DISTRICTAffiliated With: CENBEN USA INC
Fund No:PlanType: Group Health
CENBEN USA(614) 797-5204
CENBEN USA
4079 Executive PkwyWesterville OH 43081
Attn: Melissa Joseph
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-291• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MIDWEST SECURITY ADMINISTRATORS INC
MIDWEST SECURITY ADMINISTRATORS INC
OTT SCHWEITZER DISTRIBUTORS INC
Affiliated With: MIDWEST SECURITY ADMINISTRATORS INC
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS INC
MIDWEST SECURITY ADMINISTRATORS INCPO Box 574ONALASKA WI 54650
TRUE CHOICE(800) 251-9665
UM NOT APPLICABLEOUR LADY OF THE LAKE UNIVERSITY
Affiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE(800) 251-9665
TRUE CHOICEPO Box 700307DALLAS TX 75370
MERITAIN HEALTH(800) 455-1938
CHECK BENEFIT CARDOWENSBORO MEDICAL HEALTH SYSTEM
Affiliated With: MERITAIN HEALTH
Fund No:PlanType: Group Health
MERITAIN HEALTH(800) 455-1938
MERITAIN HEALTH111 SE THIRD ST STE 404EVANSVILLE IN 47708
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
PACE - TEC, INC.Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
CHECK BENEFIT CARD8004269786
CHECK BENEFIT CARDPACIFIC CATARACT AND LASER INSTITUTE
Affiliated With: TRUSTEED PLANS SERVICE CORPORATION
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8004269786
CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-292• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
PACIFIC COAST STEEL TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Pacific Gas & Electric Company(415) 973-3350
Pacific Gas & Electric Company(415) 973-3350
Pacific Gas and ElectricAffiliated With: Pacific Gas and Electric
Fund No:PlanType: Workers' Compensation
Pacific Gas & Electric Company(415) 973-3350
Pacific Gas & Electric Company77 Beale St., 28th FloorSan Francisco CA 94105
CHECK BENEFIT CARD6102939229
CHECK BENEFIT CARDPACIFIC LUTHERAN UNIVERSITYAffiliated With: ADMINISTRATIVE CONCEPTS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD6102939229
CHECK BENEFIT CARD
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDPACIFIC NORTHWEST COLLEGE OF ART
Affiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDPACIFIC UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-293• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PacificSource Customer Service(800) 624-6052
First Health(800) 449-9905
PacificSource Health PlansAffiliated With: PacificSource Health Plans
Fund No:PlanType: Group Health
PacificSource Health Plans(800) 624-6052
PacificSource Health PlansPO Box 7068Eugene OR 97401-0068
PacificSource(800) 624-6052
PacificSource Medical Affairs(800) 624-6052
PacificSource Travel BenefitAffiliated With: PacificSource Health Plans
Fund No:PlanType: Group Health
PacificSource Health Plans(800) 624-6052
PacificSource Health Plans250 Country Club RdEugene OR 97401
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
PACKAGING UNLIMITEDAffiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(800) 832-8212
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
SISCO(800) 547-4726
CHECK BENEFIT CARDPACKERS HOLDING, LLCAffiliated With: SISCO/Cottingham & Butler
Fund No:PlanType: Group Health
SISCO(800) 786-7930
SISCOPO Box 389DUBUQUE IA 52004-0389
BUTLER BENEFIT SERVICES(563) 327-2240
CHECK BENEFIT CARDPACKING TECHNOLOGIESAffiliated With: SISCO/Cottingham & Butler
Fund No:PlanType: Group Health
BUTLER BENEFIT SERVICES(563) 327-2240
BUTLER BENEFIT SERVICES215 N MAIN ST STE 800DAVENPORT IA 52801
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-294• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGPADLOCK RANCHAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGPO Box 98WORLAND WY 82401
HEALTH PLAN INC(800) 532-7575
CARE MANAGEMENT SERVICES(866) 325-1550
PAK 2000 INCAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
CENBEN USA(614) 797-5204
CHECK BENEFIT CARDPALA BAND OF MISSION INDIANSAffiliated With: CENBEN USA INC
Fund No:PlanType: Group Health
CENBEN USA(614) 797-5204
CENBEN USA
4079 Executive PkwyWesterville OH 43081
Attn: Melissa Joseph
PIONEER MANAGEMENT SYSTEMS(413) 534-8658
UM NOT APPLICABLEPalm Beach Atlantic CollegeAffiliated With: PIONEER MANAGEMENT SYSTEMS
*
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(413) 534-8658
PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01089
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDPALM BEACH COMMUNITY COLLEGE
Affiliated With: UnitedHealthcare StudentResources #11689
Term Effective: 8/31/2007Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-295• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PALO ALTO HCS CHECK BENEFIT CARDPALO ALTO HCS 3185Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
PALO ALTO HCS PALO ALTO HCS
3801 MIRANDA AVEPALO ALTO CA 94304
Attn: FEE DEPT 640/136C
ASSURECARE(800) 968-6616
CARELINE(763) 383-4800
PAM TRANSPORTAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
PAN WESTERN TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
EBA&M(714) 668-8920
HINES & ASSOCIATES(800) 528-2498
PANDOL & SONSAffiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
EBA&M(714) 668-8920
EBA&MPO Box 5079WESTLAKE VILLAGE CA 91359
GLOBAL EMERGENCY MEDICAL SERVICES (GEMS)
GLOBAL EMERGENCY MEDICAL SERVICES (GEMS)
PARADIGMAffiliated With: GLOBAL EMERGENCY MEDICAL SERVICES, INC. (GEMS)
Fund No:PlanType: Group Health
GLOBAL EMERGENCY MEDICAL SERVICES (GEMS)
GLOBAL EMERGENCY MEDICAL SERVICES (GEMS)2001 Westside Pkwy. #120ALPHARETTA GA 30004
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-296• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERParadigm Health Systems AutoAffiliated With: Paradigm Health Systems
Fund No:PlanType: Auto
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Paradigm Health (David Vargas)(925) 677-4719
Paradigm Health (David Vargas)(925) 677-4719
Paradigm Management Services, LLC
Affiliated With: Paradigm Management Services, LLC
Fund No:PlanType: Workers' Compensation
Paradigm Health (David Vargas)(925) 677-4719
Paradigm Health Claims Department1001 Galaxy Way Ste 300Concord CA 94520
ADVENTIST HEALTH SYSTEM WEST
CHECK BENEFIT CARDPARADISE VALLEY HOSPITAL - PPO
Affiliated With: ADVENTIST HEALTH SYSTEM/WEST
Term Effective: 12/31/2007Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.(800) 673-5222
Parsons CompanyAffiliated With: OSF Healthplans Inc
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(309) 677-8356
OSF HealthPlans, Inc.PO Box 5128PEORIA IL 61601-5128
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDPASO ROBLES JOINT UNIFIED SCHOOL DISTRICT
Affiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-297• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
PASSION PARTIESAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
PAT CLARK ENTERPRISES TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
PRINCIPAL FINANCIAL GROUP(800) 533-5044
CHECK BENEFIT CARDPATRICK INDUSTRIES, INC.Affiliated With: PRINCIPAL FINANCIAL GROUP
Fund No:PlanType: Group Health
PRINCIPAL FINANCIAL GROUP(800) 533-5044
PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319
BENEFIT ADMINISTRATIVE SYSTEMS(708) 799-7400
CHECK BENEFIT CARDPATRIOT HOMES, INCAffiliated With: BENEFIT ADMINISTRATIVE SYSTEM
Fund No:PlanType: Group Health
BENEFIT ADMINISTRATIVE SYSTEMS(708) 799-7400
BENEFIT ADMINISTRATIVE SYSTEMS17475 JOVANNA DRHOMEWOOD IL 60430
Patriot Risk Services Patriot Risk ServicesPatriot Risk ServicesAffiliated With: TIMCO/Guarantee Insurance Co
Fund No:PlanType: Workers' Compensation
Patriot Risk Services Patriot Risk Services1061 521 Corporate Center Dr Ste 140Fort Mill SC 29715
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-298• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH PLAN INC CARE MANAGEMENT SERVICES(866) 325-1550
PAUL G WHITE TILE COMPANY-PEPM
Affiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INCPO Box 5199WESTBOROUGH MA 01581
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
PAWN SHOP MANAGEMENTAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CONTACT EMPLOYER CONTACT EMPLOYERPBM Corp - EDIAffiliated With: MCO Advantage / PBM Corporation
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER CONTACT EMPLOYERPBM Corp - PaperAffiliated With: MCO Advantage / PBM Corporation
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
CHECK BENEFIT CARDPeace Corps VolunteersAffiliated With: International Medical Group, Inc.
Fund No:PlanType: Group Health
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-299• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Benefit Planners(800) 292-5386
CHECK BENEFIT CARDPEARCE INDUSTRIESAffiliated With: BENEFIT PLANNERS
*
Fund No:PlanType: Group Health
Benefit Planners(800) 292-5386
Benefit PlannersPO Box 690450SAN ANTONIO TX 78269
GLOBALCARE(678) 341-1922
UM NOT APPLICABLEPEDDINGHAUS CORPORATIONAffiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1922
GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
PEGGY LAWTON KITCHENS, INC.Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850
AMERICAN HEALTH HOLDING(888) 877-7994
PELTRAM PLUMBING INCAffiliated With: TRUSTED PLANS SERVICE CORPORATION
Fund No:PlanType: Group Health
TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850
TRUSTEED PLANS SERVICE CORPORATIONPO Box 1984TACOMA WA 98406
STUDENT ASSURANCE SERVICES INC(800) 328-2739
CHECK BENEFIT CARDPENINSULA COLLEGEAffiliated With: STUDENT ASSURANCE SERVICES, INC.
Fund No:PlanType: Group Health
STUDENT ASSURANCE SERVICES INC(800) 328-2739
STUDENT ASSURANCE SERVICES INC333 N. MAIN STREETSTILLWATER MN 55082
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-300• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GLOBALCARE, INC.(678) 341-1922
UM NOT APPLICABLEPENN WESTERN - NEW POSEIDON ENTERPRISES
Affiliated With: GLOBALCARE INC
Fund No:PlanType: Group Health
GLOBALCARE, INC.(678) 341-1922
GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
GLOBALCARE(678) 341-1922
MEDCOST(800) 722-2157
PENN WESTERN -AMSOLAffiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1922
GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005
GLOBALCARE(678) 341-1922
UM NOT APPLICABLEPENN WESTERN -AMSOL TRAVEL NETWORK GEORGIA
Affiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1922
GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005
CHECK BENEFIT CARD CHECK BENEFIT CARDPENSACOLA CHRISTIAN COLLEGE
Affiliated With: AMERICAN HEALTHCARE ALLIANCE
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
HOMETOWN HEALTH PROVIDERS INSURANCE(775) 982-3039
HOMETOWN HEALTH PROVIDERS INSURANCE(775) 982-3039
PEPPERMILL HOTEL CASINOAffiliated With: PEPPERMILL HOTEL CASINO
Fund No:PlanType: Group Health
HOMETOWN HEALTH PROVIDERS INSURANCE(775) 982-3039
HOMETOWN HEALTH PROVIDERS INSURANCE830 HARVARD WAYRENO NV 89502
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-301• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
American Administrative Group(800) 323-1726
CHECK BENEFIT CARDPerformance BankersAffiliated With: American Administrative Group
Fund No:PlanType: Group Health
American Administrative Group(800) 323-1726
American Administrative GroupPO Box 5227Lisle IL 60532-5227ECS Payor ID 37283
NHBC(888) 621-7900
CHECK BENEFIT CARDPERFORMANCE HEALTH (PHA)Affiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
Benefit Planners(800) 292-5386
CHECK BENEFIT CARDPERMIAN MUD SERVICES INCAffiliated With: BENEFIT PLANNERS
*
Fund No:PlanType: Group Health
(800) 292-5386 Benefit PlannersPO Box 690450SAN ANTONIO TX 78269
PERRY POINT / BALTIMORE VA MEDICAL CENTER
CHECK BENEFIT CARDPERRY POINT/BALTIMORE VA MEDICAL CENTER 3131
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
PERRY POINT / BALTIMORE VA MEDICAL CENTER
PERRY POINT / BALTIMORE VA MEDICAL CENTER
BLDG G 4H, RM 120PERRY POINT MD 21902
Attn: MAS/FEE SERVICES - 136
Employee Benefit Management Corp (EBMC)(614) 766-5800
CHECK BENEFIT CARDPERRYSBURG SCHOOLAffiliated With: EMPLOYEE BENEFIT MANAGEMENT CORP
Fund No:PlanType: Group Health
Employee Benefit Management Corp (EBMC)(614) 766-5800
Employee Benefit Management Corp (EBMC)4789 Rings RdDublin OH 43017-1599
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-302• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PERSONALCARE(800) 562-5792
PERSONALCARE(800) 562-5792
PersonalCare Freedom PPOAffiliated With: Coventry Health Care
Fund No:PlanType: Group Health
PERSONALCARE(800) 562-5792
PERSONALCAREPO Box 7141LONDON KY 40742-7141
Peter Chang Enterprises(248) 455-8972
Peter Chang Enterprises(248) 455-8972
Peter Chang EnterprisesAffiliated With: Peter Chang Enterprises
Fund No:PlanType: Workers' Compensation
Peter Chang Enterprises(248) 455-8972
Peter Chang Enterprises28530 Orchard Lake Rd Ste 101Farmington Hills MI 48334
CHECK BENEFIT CARD CHECK BENEFIT CARDPETERSON TRACTOR COMPANYAffiliated With: CAPITOL ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7345
PHC OF NEVADAAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
PHILADELPHIA VAMC CHECK BENEFIT CARDPHILADELPHIA VAMC 3127Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
PHILADELPHIA VAMC PHILADELPHIA VAMC
UNIVERSITY & WOODLANDS AVEPHILADELPHIA PA 19104
Attn: FEE BASIS 04F
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-303• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
PHILCOR TV & ELECTRONIC TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CORESOURCE(866) 280-4120
CORESOURCE(866) 794-0770
PHOENIX CEMENT COMPANYAffiliated With: CORESOURCE
Fund No:PlanType: Group Health
CORESOURCE(866) 280-4120
CORESOURCEPO Box 2920CLINTON OH 52733-2920
BENEFIT CONCEPTS, INC.(610) 337-2600
CHECK BENEFIT CARDPHOENIX COLOR CORPORATIONAffiliated With: BROKERAGE CONCEPTS BENEFIT CONCEPTS
Fund No:PlanType: Group Health
BENEFIT CONCEPTS, INC.(610) 337-2600
BENEFIT CONCEPTS, INC.1021 W. 8TH AVE STE 200KING OF PRUSSIA PA 19406
PHOENIX VAMC CHECK BENEFIT CARDPHOENIX VAMC 3173Affiliated With: HEALTH NET FEDERAL SERVICES
*
Fund No:PlanType: Group Health
PHOENIX VAMC PHOENIX VAMC
620 E INDIAN SCHOOL RDPHOENIX AZ 85012
Attn: FEE BASIS 136E5
SHASTA ADMINISTRATIVE SERVICES(541) 273-7161
SHASTA ADMINISTRATIVE SERVICES
PHP HEALTH PLANAffiliated With: SHASTA ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
SHASTA ADMINISTRATIVE SERVICES(541) 273-7161
SHASTA ADMINISTRATIVE SERVICES2751 S.W. Airport WayREDMOND OR 97756
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-304• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GLOBALCARE, INC.8008601111
PHP Management(800) 982-6257
PHP OF NORTHERN INDIANA ASOAffiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC.6783411722
GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
PHP SMALL GROUPAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
GLOBALCARE(678) 341-1811
UM NOT APPLICABLEPHYSICIANS HEALTH PLAN OF MID-MICHIGAN
Affiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1811
GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005
GILSBAR(985) 871-1863
CHECK BENEFIT CARDPHYSICIANS MUTUAL INSURANCE COMPANY-CARRIER
Affiliated With: GILSBAR INC
Fund No:PlanType: Group Health
GILSBAR(985) 871-1863
GILSBAR2100 COVINGTON CENTRECOVINGTON LA 70433
GILSBAR(985) 871-1863
CHECK BENEFIT CARDPHYSICIANS MUTUAL INSURANCE COMPANY-MEICARE SELECT
Affiliated With: GILSBAR INC
Fund No:PlanType: Group Health
GILSBAR(985) 871-1863
GILSBAR2100 COVINGTON CENTRECOVINGTON LA 70433
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-305• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Benesight(800) 752-3473
CHECK BENEFIT CARDPiccadilly Cafeterias, Inc.Affiliated With: Benesight
Fund No:PlanType: Group Health
Benesight(800) 752-3473
Piccadilly Cafeterias, Inc.PO Box 2467Baton Rouge LA 70821
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
Piercy Bowler Taylor & Kern TravelAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Western Health(605) 719-4600 or (888) 341-1766
Western Health(605) 719-4640 or (800) 229-0892
Pioneer ManorAffiliated With: Rapid City Regional Hospital DBA Western Health
Fund No:PlanType: Group Health
Western Health Western Health529 Kansas City St Ste 200Rapid City SD 57701
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
Pipe Maintenance TravelAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
*
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
PITTSBURGH VA MEDICAL CENTER
CHECK BENEFIT CARDPITTSBURGH VA MEDICAL CENTER 3130
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
PITTSBURGH VA MEDICAL CENTER
PITTSBURGH VA MEDICAL CENTER
7180 HIGHLAND DRPITTSBURGH PA 15206
Attn: FEE BASIS 04D4-H
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-306• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
PIZZA HUT OF IDAHOAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122
NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
PLAYLV GAMING OPERATION, LLC
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDPLEASANT VALLEY JT UNION ELEMENTARY
Affiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
PLUMB HOUSE INC.Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
GROUP & PENSION ADMINISTRATORS(800) 827-7223
CHECK BENEFIT CARDPointBank (TRAVEL)Affiliated With: GROUP & PENSION ADMINISTRATORS
*
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-307• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
POMPANOOSUC MILLS CORPORATION
Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
POPLAR BLUFF VA MEDICAL CNTER
CHECK BENEFIT CARDPOPLAR BLUFF VA MEDICAL CENTER 3527
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
POPLAR BLUFF VA MEDICAL CNTER
POPLAR BLUFF VA MEDICAL CNTER
1500 N WESTWOOD BLVDPOPLAR BLUFF MO 63901
Attn: FEE BASIS 04
ASSURECARE(800) 759-1311
Careline UR(763) 383-4800
POPULATION REFERENCE BUREAU (PRB)
Affiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 759-1311
ASSURECARE340 Quadrangle DrBolingbrook IL 60440
CHECK BENEFIT CARD CHECK BENEFIT CARDPORTAGE ENVIRONMENTAL INCAffiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONS(800) 786-7930
PORTLAND STATE UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-308• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONS(800) 786-7930
PORTLAND STATE UNIVERSITY INTERNATIONAL
Affiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
PORTLAND VAMC CHECK BENEFIT CARDPORTLAND VAMC 3178Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
PORTLAND VAMC PORTLAND VAMC
3710 SW US VETERANS HOSPITAL RDPORTLAND OR 97239
Attn: FEE BASIS 136F
FISERV HEALTH INC FISERV HEALTH INCPORTOLA PLAZA HOTEL AT MONTEREY BAY
Affiliated With: BENESIGHT, INC.
Fund No:PlanType: Group Health
FISERV HEALTH INC FISERV HEALTH INCPO Box 375PUEBLO CO 81002
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.(800) 284-2273
POSAffiliated With: OSF HEALTHPLANS, INC.
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128
CHECK BENEFIT CARD CHECK BENEFIT CARDPOST REGISTERAffiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-309• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ZENITH ADMINISTRATORS C/O CCN
CHECK BENEFIT CARDPOUDRE VALLEY RURAL ELECTRIC ASSOCIATION INC.
Affiliated With: MOUNTAIN MEDICAL AFFILIATES (MMA)
Fund No:PlanType: Group Health
ZENITH ADMINISTRATORS C/O CCN
ZENITH ADMINISTRATORS C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295
CHECK BENEFIT CARDPOWER HOUSE GYMAffiliated With: CAROLINA BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295
CAROLINA BENEFIT ADMINISTRATORS333 SOUTH PINE STSPARTANBURG SC 29302
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
POWERWORKS INDUSTRIES, INCAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
UNITED BENEFITS(386) 239-4350
CHECK BENEFIT CARDPPI MOTORSPORTS LLCAffiliated With: UNITED BENEFITS DIVISION
Fund No:PlanType: Group Health
UNITED BENEFITS(386) 239-4350
UNITED BENEFITSPO Box 2480DAYTONA BEACH FL 32115-2480
Preferred Plus of Kansas, Inc(316) 609-2308
PREFERRED HEALTH SYSTEMS(800) 289-0345
PREFERRED BENEFIT ADMINISTRATORS
Affiliated With: PREFERRED PLUS OF KANSAS INC
Fund No:PlanType: Group Health
Preferred Plus of Kansas, Inc(316) 609-2308
Preferred Plus of Kansas, Inc8535 E 21st St NorthWichita KS 67206
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-310• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PREFERRED CARE PREFERRED CAREPREFERRED CAREAffiliated With: PREFERRED CARE
Fund No:PlanType: Group Health
PREFERRED CARE PREFERRED CARE6 Neshaminy Interplex #205TREVOSE PA 19053
PREFERRED HEALTH ALLIANCE(800) 722-8477
PREFERRED HEALTH ALLIANCE
PREFERRED HEALTH ALLIANCEAffiliated With: PREFERRED HEALTH ALLIANCE
Fund No:PlanType: Group Health
PREFERRED HEALTH ALLIANCE(800) 722-8477
PREFERRED HEALTH ALLIANCE300 Corporate Pkwy, #3BIRMINGHAM AL 35242
MERITAIN HEALTH(800) 824-8316
CHECK BENEFIT CARDPREFERRED SOURCINGAffiliated With: NORTH AMERICAN
Fund No:PlanType: Group Health
MERITAIN HEALTH(800) 824-8316
MERITAIN HEALTHPO Box 80884Indianapolis IN 46280
PREMIER ACCESS(888) 463-4137
CHECK BENEFIT CARDPREMIER ACCESS (OUT OF AREA)
Affiliated With: PREMIER ACCESS
Fund No:PlanType: Group Health
PREMIER ACCESS(888) 463-4137
PREMIER ACCESSPO Box 150275ARLINGTON TX 76015
MBA OF MARYLAND(410) 505-0507
STRATEGIC HEALTH DEVELOPMENT
PREMIER CLUB BENEFITS DBA BALD CREEK COLONY CLUB
Affiliated With: MBA OF MARYLAND
Fund No:PlanType: Group Health
MBA OF MARYLAND(410) 505-0507
MBA OF MARYLAND3103 EMMORTON RDABINGDON MD 21009
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-311• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
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UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MBA OF MARYLAND(410) 505-0507
STRATEGIC HEALTH DEVELOPMENT
PREMIER CLUB BENEFITS DBA BOCA LAGO COUNTRY CLUB, INC.
Affiliated With: MBA OF MARYLAND
Fund No:PlanType: Group Health
MBA OF MARYLAND(410) 505-0507
MBA OF MARYLAND3103 EMMORTON RDABINGDON MD 21009
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
PREMIER LABORATORY LLCAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
FMH BENEFIT SERVICES INC(800) 990-9058
HCM(800) 990-9058
PREMIUM STANDARD FARMSAffiliated With: FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURC
Fund No:PlanType: Group Health
FMH BENEFIT SERVICES INC(800) 990-9058
FMH BENEFIT SERVICES INCPO Box 25946OVERLAND PARK KS 66225-5946
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.
PRENT CORPORATIONAffiliated With: MIDWEST SECURITY ADMINISTRATORS INC
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.PO Box 574ONALASKA WI 54650
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-312• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882
PHYSICIAN CARE OF CALIFORNIA(714) 540-5882
PRESBYTERIAN INTERCOMMUNITY HOSPITAL
Affiliated With: PHYSICIANS CARE INSURANCE SERVICES
Fund No:PlanType: Group Health
PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882
PHYSICIANS CARE INSURANCE SERVICES, INC.PO Box 15165SANTA ANA CA 92735
PRESCOTT VAMC CHECK BENEFIT CARDPRESCOTT VAMC (N ARIZONA) 3175
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
PRESCOTT VAMC PRESCOTT VAMC
500 HWY 89 NORTHPRESCOTT AZ 86313
Attn: FEE - 144BF
ASSURECARE(800) 968-6616
CARELINE(763) 383-4800
PRESS SEAL GASKETAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823
CHECK BENEFIT CARD CHECK BENEFIT CARDPRETIUM PACKAGING LLCAffiliated With: THE EPOCH GROUP L C
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
America's TPA(952) 896-1255
CHECK BENEFIT CARDPRIDEAffiliated With: AMERICAS TPA
Fund No:PlanType: Group Health
America's TPA(952) 896-1255
America's TPAPO Box 398220Bloomington MN 55439
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-313• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PRIMARY PROVIDER MANAGEMENT COMPANY, INC.(619) 742-3223
PRIMARY PROVIDER MANAGEMENT COMPANY, INC.(909) 778-6118
PRIMARY PROVIDER MANAGEMENT COMPANY, INC.
Affiliated With: PRIMARY PROVIDER MANAGEMENT COMPANY, INC.
Fund No:PlanType: Group Health
PRIMARY PROVIDER MANAGEMENT COMPANY, INC.(619) 742-3223
PRIMARY PROVIDER MANAGEMENT COMPANY, INC.2525 Camino del Rio South Ste 300San Diego CA 92108
MSO, INC. OF SOUTHERN CALIFORNIA(626) 656-2370
CHECK BENEFIT CARDPRIMERA HEALTHCARE SERVICES, INC
Fund No:PlanType: Group Health
MSO, INC. OF SOUTHERN CALIFORNIA(626) 656-2370
MSO, INC. OF SOUTHERN CALIFORNIAPO Box 10355Scottsdale AZ 85271-0355
CONTACT EMPLOYER CONTACT EMPLOYERProcura
Fund No:PlanType: Workers' Compensation
Procura(610) 290-7202
Procura2435 Blvd of the Generals Ste 201Norristown PA 19403
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
PRODUCTION METAL FORMING, INC.
Affiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
HEALTH PLAN INC(508) 752-2480
CMS(866) 325-1550
PROFESIONAL ELECTRICAL CONTRACTORS OF CT, INC.
Affiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-314• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
RESOURCEONE ADMINSTRATORS(800) 967-2077
MEDCAREONE CORP(800) 816-1206
Professional Performance Development Corporation
Affiliated With: RESOURCEONE ADMINISTRATORS
*
Fund No:PlanType: Group Health
RESOURCEONE ADMINSTRATORS(918) 967-2077
RESOURCEONE ADMINSTRATORS
PO Box 489BUCKEYSTOWN MD 21717
Attn: Mary Shepherd
CHECK BENEFIT CARD CHECK BENEFIT CARDProgressive Insurance (Auto)Affiliated With: Mitchell Medical
Fund No:PlanType: Auto
Progressive: Administered by Mitchell Medical
CHECK BENEFIT CARD CHECK BENEFIT CARD
Accordia National(800) 428-1291
Accordia National(800) 428-1291
Progressive Insurance CompanyAffiliated With: Progressive Insurance Company
Fund No:PlanType: Group Health
Accordia National(800) 428-1291
Accordia NationalPO Box 3262CHARLESTON WV 25332
CHECK BENEFIT CARD CHECK BENEFIT CARDPROGRESSIVE INSURANCE COMPANY AUTO
Affiliated With: MITCHELL MEDICAL
Fund No:PlanType: Auto
Progressive: Administered by Mitchell MedicalExclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)
CHECK BENEFIT CARD CHECK BENEFIT CARD
HEALTH PLAN INC(508) 752-2480
CARE MANAGEMENT SERVICES(866) 325-1550
PROJECT ADVENTURESAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-315• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ASSURECARE(800) 759-1311
Careline UR(763) 383-4800
PROLOG SERVICESAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 759-1311
ASSURECARE340 Quadrangle DrBolingbrook IL 60440
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
PROVIDENCE AND WORCESTER RAILROAD
Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
PROVIDENCE VA MEDICAL CENTER
CHECK BENEFIT CARDPROVIDENCE VA MEDICAL CENTER 3114
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
PROVIDENCE VA MEDICAL CENTER
PROVIDENCE VA MEDICAL CENTER5504 HILL HEAVEN CTFRISCO TX 75035
PUGET SOUND VA HCS - AMIRICAN LAKE DIVISION
CHECK BENEFIT CARDPUGET SOUND VA HCS AMERICAN LAKE DIVISION 3179
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
PUGET SOUND VA HCS - AMIRICAN LAKE DIVISION
PUGET SOUND VA HCS - AMIRICAN LAKE DIVISION
9600 VETERANS DRTACOMA WA 98493
Attn: A-136-FEE
CHECK BENEFIT CARD CHECK BENEFIT CARDPYROMATION, INC.Affiliated With: NORTH AMERICAN ADMINISTRATOR - NY
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-316• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
QUAIL MOUNTAIN PEPSI COLAAffiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
DELTA HEALTH SYSTEMS(209) 939-3992
ARIZONA FOUNDATION FOR MEDICAL CARE(602) 417-2337
QUALITY PROJECT MANAGEMENT
Affiliated With: DELTA HEALTH SYSTEMS
Fund No:PlanType: Group Health
DELTA HEALTH SYSTEMS(209) 939-3992
DELTA HEALTH SYSTEMSPO Box 495Stockton CA 95201
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
QUALITY WOOD PRODUCTSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Gallagher Benefit Administrators Inc(800) 323-1726
IntraCorp(800) 535-5222
Quanta Services GroupAffiliated With: Gallagher Benefit Administrators, Inc.
Fund No:PlanType: Group Health
Gallagher Benefit Administrators Inc(800) 323-1726
Gallagher Benefit Administrators IncPO Box 34297San Antonio TX 78265
BAC(614) 863-8780
BAC(614) 863-8780
QUANTUM SERVICESAffiliated With: BUSINESS ADMINISTRATORS AND CONSULTANTS
Fund No:PlanType: Group Health
BAC(614) 863-8780
BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-317• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SRT ADMINISTRATORS(888) 690-2020
Action HealthCare(800) 433-6915
QUECHAN TRIBE - PARADISE CASINOS
Affiliated With: SRT ADMINISTRATORS
Fund No:PlanType: Group Health
SRT ADMINISTRATORS(888) 690-2020
SRT ADMINISTRATORSPO Box 25160SCOTTSDALE AZ 85255-0102
GROUP & PENSION ADMINISTRATORS(800) 827-7223
HEALTH WATCH(972) 238-7900
QUICKSILVER RESOURCES, INCAffiliated With: GROUP & PENSIONS ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223 Ext 2325
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
American Administrative Group Inc.(800) 323-1726
American Administrative Group Inc.(800) 538-5222
Quixote CorporationAffiliated With: American Administrative Group
Fund No:PlanType: Group Health
American Administrative Group Inc.(800) 323-1726
American Administrative Group Inc.PO Box 5227LISLE IL 60532
FISERV HEALTH KANSAS(800) 235-7160
AVIDYN HEALTH(866) 802-1328
R & B EXPRESSAffiliated With: FISERV HEALTH - KANSAS
Fund No:PlanType: Group Health
FISERV HEALTH KANSAS(800) 235-7160
FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520
CHECK BENEFIT CARD CHECK BENEFIT CARDR AND O CONSTRUCTIONAffiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-318• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD3129068080
CHECK BENEFIT CARDR G RAY CORPORATIONAffiliated With: ALLIED BENEFIT SYSTEMS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD3129068080
CHECK BENEFIT CARD
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
RADIO FREQUENCY COMPANYAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
CHECK BENEFIT CARD CHECK BENEFIT CARDRAIN FOR RENTAffiliated With: BENEFIT PLANNERS LTD
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYERRAMAffiliated With: Liberty
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
HCH ADMINISTRATION INC(800) 447-3227
CHECK BENEFIT CARDRAMAHA NAVAJO CHAPTERAffiliated With: EMPLOYEE BENEFIT CONSULTANTS INC
Fund No:PlanType: Group Health
HCH ADMINISTRATION INC(309) 673-7330
HCH ADMINISTRATION INCPO Box 285PEORIA IL 61650
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-319• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
RAMPART RESORT MANAGEMENT
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Western Health(605) 719-4600 or (888) 341-1766
Western Health(605) 719-4640 or (800) 229-0892
Rapid ChevroletAffiliated With: Rapid City Regional Hospital DBA Western Health
Fund No:PlanType: Group Health
Western Health(605) 719-4600 or (888) 341-1766
Western Health529 Kansas City St Ste 200Rapid City SD 57701
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.
RATH MANUFACTURINGAffiliated With: MIDWEST SECURITY ADMINISTRATORS INC
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.PO Box 574ONALASKA WI 54650
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMINISTRATION & MGMT
RAYPAK, INC.Affiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
NHBC(888) 621-7900
CHECK BENEFIT CARDRCIAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-320• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Mountain States Administrative Services(520) 722-7133
Hines and Associates(847) 214-2780
RDT EMPLOYEE BENEFIT TRUSTAffiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
Mountain States Administrative Services(520) 722-7133
Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710
SMITH ADMINISTRATORS(801) 261-5511
SERVICE ADVOCATES(877) 261-5511
RED INCAffiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
SMITH ADMINISTRATORS(801) 261-5511
SMITH ADMINISTRATORS428 E WINCHESTER ST, STE 200SALT LAKE CITY UT 84107
SRT ADMINISTRATORS, INC.(480) 505-0424
HINES AND ASSOCIATES(800) 528-2498
RED MESA UNIFIED SCHOOL DISTRICT - PEPM
Affiliated With: SRT ADMINISTRATORS, INC
Fund No:PlanType: Group Health
SRT ADMINISTRATORS, INC.(480) 505-0424
SRT ADMINISTRATORS, INC.14646 N. Kierland BlvdScottsdale AZ 85255-0102
ADVENTIST HEALTH SYSTEM/WEST C/O CCN
CHECK BENEFIT CARDREDBUD COMMUNITY HOSPITALAffiliated With: ADVENTIST HEALTH SYSTEM/WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM/WEST C/O CCN
ADVENTIST HEALTH SYSTEM/WEST C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDREED COLLEGEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-321• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Western Health(605) 719-4600 or (888) 341-1766
Western Health(605) 719-4640 or (800) 229-0892
Regional HealthAffiliated With: Western Health
Fund No:PlanType: Group Health
Western Health(605) 719-4600 or (888) 341-1766
Western Health529 Kansas City St Ste 200Rapid City SD 57701
GLOBALCARE, INC.8008601111
GLOBALCARE8008601111
REGIONAL MEDICAL ADMINISTRATORS
Affiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC.6783411722
GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
PRINCIPAL FINANCIAL GROUP(800) 533-5044
CHECK BENEFIT CARDRELIGIOUS COMP TRUST/HMSR-CHRISTIAN BROTHER SERVICES
Affiliated With: PRINCIPAL FINANCIAL GROUP
Fund No:PlanType: Group Health
PRINCIPAL FINANCIAL GROUP(800) 533-5044
PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319
RENO VAMC CHECK BENEFIT CARDRENO VAMC 3186Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
RENO VAMC RENO VAMC
1000 LOCUST STRENO NV 89502
Attn: FEE BASIS 04FB
CompIQ Corporation(800) 293-3131
CONTACT EMPLOYERRENY CompanyAffiliated With: CompIQ
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(800) 293-3131
CompIQ Corporation2 South PointeLake Forest CA 92630
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-322• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
RENY Company The(972) 250-0189
RENY Company The(972) 250-0189
RENY Company TheAffiliated With: RENY Company The
Fund No:PlanType: Workers' Compensation
RENY Company The(972) 250-0189
RENY Company The16610 Dallas Parkway Ste 2400Dallas TX 75248
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
REPUBLIC MORTGAGE TRAVEL PLAN
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
REPUBLIC MORTGAGE, LLCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
ACS BENEFIT SERVICES, INC.
CHECK BENEFIT CARDREPUBLIC PARKING SYSTEMS, INC.
Affiliated With: ACS BENEFIT SERVICES, INC.
Fund No:PlanType: Group Health
ACS BENEFIT SERVICES, INC.
ACS BENEFIT SERVICES, INC.PO Box 2000Winston-Salem SC 27102
CHECK BENEFIT CARD8007773575
CHECK BENEFIT CARDRESOURCE MANAGEMENT INCAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8007773575
CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-323• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CENBEN USA(614) 797-5204
CHECK BENEFIT CARDRETALIX USAAffiliated With: CENBEN USA INC / HEALTHSCOPE
Fund No:PlanType: Group Health
CENBEN USA(614) 797-5204
CENBEN USA
4079 Executive PkwyWesterville OH 43081
Attn: Melissa Joseph
Review Med(214) 696-3855
CHECK BENEFIT CARDREVIEW MED L.P.Affiliated With: CompIQ
Fund No:PlanType: Group Health
Review Med(214) 696-3855
Review Med10300 N Central Expressway Ste 450Dallas TX 75231
CHECK BENEFIT CARD CHECK BENEFIT CARDReview Works AUTOAffiliated With: Review Works
Fund No:PlanType: Auto
CHECK BENEFIT CARD
THE LOOMIS COMPANY(800) 346-1223
HINES & ASSOCIATES(888) 826-5769
RHODE & SCHWARZ, INCAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(800) 346-1223
THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011
EVEREST ADMINISTRATORS, INC.(800) 286-4160
CHECK BENEFIT CARDRHODES INTERNATIONAL INCAffiliated With: EVEREST ADMINISTRATORS INC
Fund No:PlanType: Group Health
EVEREST ADMINISTRATORS, INC.(800) 286-4160
EVEREST ADMINISTRATORS, INC.PO Box 19002PROVO UT 84605-9002
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-324• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN(800) 249-8440
HINES & ASSOCIATES(800) 528-2498
RHYTHM & HUES, INC.Affiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN(800) 249-8440
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
RICHMOND (H HOLMES MCGUIRE) VA
CHECK BENEFIT CARDRICHMOND (H HOLMES MCGUIRE) VA 3137
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
RICHMOND (H HOLMES MCGUIRE) VA
1201 BROAD ROCK BLVDRICHMOND VA 23249
Attn: FEE 04A
SMITH ADMINISTRATORS, INC.(801) 261-5511
SERVICE ADVOCATES(801) 261-5511
RIDLEYS SUPERMARKETS INCAffiliated With: SMITH ADMINISTRATORS INC
Fund No:PlanType: Group Health
SMITH ADMINISTRATORS, INC.(801) 261-5511
SMITH ADMINISTRATORS, INC.3761 S 700 E SUITE 202SALT LAKE CITY UT 84106
CONTACT EMPLOYER CONTACT EMPLOYERRIMCOAffiliated With: STRATACARE
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
RIO GRANDE EMPLOYEES HOSPITAL ASSOCIATION(303) 274-2312
RIO GRANDE EMPLOYEES HOSPITAL ASSOCIATION
RIO GRANDE ACTIVE EMPLOYEES HOSPITAL ASSOCIATION
Affiliated With: RIO GRANDE EMPLOYEES HOSPITAL ASSOCIATION
Fund No:PlanType: Group Health
RIO GRANDE EMPLOYEES HOSPITAL ASSOCIATION(303) 274-2312
RIO GRANDE EMPLOYEES HOSPITAL ASSOCIATION1675 Carr St. #200-SLAKEWOOD CO 80215
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-325• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Risk Administration Services, Inc.(605) 361-5701
CHECK BENEFIT CARDRisk Administration Services, Inc.Affiliated With: STRATACARE
Fund No:PlanType: Workers' Compensation
Risk Administration Services, Inc.(605) 361-5701
Risk Administration Services, Inc.3900 W 53rd StSioux Falls SD 57109-1008
CONTACT EMPLOYER CONTACT EMPLOYERRisk Enterprise ManagementAffiliated With: Risk Enterprise Management
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
NHBC(888) 621-7900
CHECK BENEFIT CARDRISK REDUCTIONAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798
AHH/EBC REVIEWRITE HITE HOLDING CORPORATION
Affiliated With: EMPLOYEE BENEFIT CONSULTANTS
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798
EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839
THE EPOCH GROUP, LC(800) 255-6065
UM NOT APPLICABLERITEMADE PAPER CONVERTERSAffiliated With: THE EPOCH GROUP
Fund No:PlanType: Group Health
THE EPOCH GROUP, LC(800) 255-6065
THE EPOCH GROUP, LCPO Box 12170OVERLAND PARK KS 66282
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-326• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
UNDERWRITERS SAFETY & CLAIMS(800) 678-1536
UNDERWRITERS SAFETY & CLAIMS
RITTAL CORP.Affiliated With: UNDERWRITERS SAFETY & CLAIMS, INC.
Fund No:PlanType: Group Health
UNDERWRITERS SAFETY & CLAIMS(800) 678-1536
UNDERWRITERS SAFETY & CLAIMSPO Box 23507LOUISVILLE KY 40223
RMSCO INC(315) 448-9000
RMSCO INC(315) 448-9000
RMSCOAffiliated With: RMSCO INC
Fund No:PlanType: Workers' Compensation
RMSCO INC(315) 448-9000
RMSCO INC115 CONTINUUM DRLIVEPOOL NY 13088
GLOBALCARE(678) 341-1811
CHECK BENEFIT CARDROBERT C BOUK-MERCANTILE BANCORP, INC
Affiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1811
GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005
CHECK BENEFIT CARD8003216607
CHECK BENEFIT CARDROBERT F KENNEDY MEDICAL PLAN
Affiliated With: ROBERT F KENNEDY MEDICAL PLAN
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8003216607
CHECK BENEFIT CARD
CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295
CHECK BENEFIT CARDROBERTS BROTHERS REALTORSAffiliated With: CAROLINA BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295
CAROLINA BENEFIT ADMINISTRATORS333 SOUTH PINE STSPARTANBURG SC 29302
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-327• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERRochesterAffiliated With: New York State Insurance Fund
*
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.
ROCK COUNTYAffiliated With: MIDWEST SECURITY ADMINISTRATORS INC
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.PO Box 574ONALASKA WI 54650
AMERIBEN SOLUTIONS(800) 953-1801
CHECK BENEFIT CARDROCKHURST UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 953-1801
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
ROCKWAY INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CHECK BENEFIT CARD CHECK BENEFIT CARDROCKY MOUNTAIN CAREAffiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-328• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
WAUSAU BENEFITS, INC.(715) 841-7802
CHECK BENEFIT CARDROCKY MOUNTAIN CHOCOLATE FACTORY, INC.
Affiliated With: WAUSAU BENEFITS
Fund No:PlanType: Group Health
WAUSAU BENEFITS, INC.(715) 841-7802
WAUSAU BENEFITS, INC.
PO Box 8046WAUSAU WI 54401-8046
Attn: LeAnn Fichtner
CHECK BENEFIT CARD CHECK BENEFIT CARDROCKY MOUNTAIN THERAPYAffiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CONSOLIDATED HEALTH PLANS(800) 633-7867
CHECK BENEFIT CARDROGER WILLIAMS UNIVERSITYAffiliated With: CONSOLIDATED HEALTH PLANS
Fund No:PlanType: Group Health
CONSOLIDATED HEALTH PLANS(800) 633-7867
CONSOLIDATED HEALTH PLANS195 STAFFORD STSPRINGFIELD MA 01104
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
RONNOCO SPECIALTY COFFEEAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
HEALTH NET FEDERAL SERVICES(916) 985-1259
CHECK BENEFIT CARDROSEBURG VA HCS 3180Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(916) 985-1259
HEALTH NET FEDERAL SERVICES2025 AEROJET RDRANCHO CORDOVA CA 95742
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-329• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SISCO(800) 457-4726
CHECK BENEFIT CARDROSENS DIVERSIFIED, INCAffiliated With: SELF INSURED SERVICES COMPANY SISCO
Fund No:PlanType: Group Health
SISCO(800) 457-4726
SISCOPO Box 389DUBUQUE IA 52004-0389
BENEFIT PLAN MANAGEMENT(781) 753-7559
CHECK BENEFIT CARDROYAL INSTITUTIONAL SERVICES PAWTUCKET ANGELICA
Affiliated With: BENEFIT PLAN MANAGEMENT
Fund No:PlanType: Group Health
BENEFIT PLAN MANAGEMENT(781) 753-7559
BENEFIT PLAN MANAGEMENTPO Box 536ROCKLAND MA 02370
GROUP & PENSION ADMINISTRATORS(800) 827-7223
HEALTH WATCHROYAL OAKSAffiliated With: GROUP & PENSION ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
BAC(614) 863-8780
BAC(614) 863-8780
RPM MANAGEMENT, INCAffiliated With: BUSINESS ADMINISTRATORS AND CONSULTANTS
Fund No:PlanType: Group Health
BAC(614) 863-8780
BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
CHECK BENEFIT CARDRS STAFFINGAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388
*
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-330• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERRSKCO Cunningham and Lindsey Channeling
Affiliated With: RSKCO Cunningham and Lindsey
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
RSVP TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
JOHN RILEY INSURANCE(800) 541-1101
HINES AND ASSOCIATES(800) 246-4127
RUSH UNIVERSITYAffiliated With: JOHN RILEY INSURANCE
Fund No:PlanType: Group Health
JOHN RILEY INSURANCE(800) 541-1101
JOHN RILEY INSURANCE
PO Box 356WEST BOYLSTON MA 01453
Attn: SUSAN RINDFLEISCH
ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259
CHECK BENEFIT CARDRYAN BUILDING GROUPAffiliated With: ALLIED BENEFIT SYSTEMS, INC.
Fund No:PlanType: Group Health
ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259
ALLIED BENEFIT SYSTEMS, INC208 S LASALLE ST STE 1300CHICAGO IL 60604
CHECK BENEFIT CARD CHECK BENEFIT CARDSABROSO COMPANYAffiliated With: ASSOCIATED ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-331• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ASSURECARE(800) 968-6616
CARELINE(763) 383-4800
SAC FINANCEAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDSADDLEBACK COLLEGEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
CHECK BENEFIT CARD8004427247 8005287936
CHECK BENEFIT CARDSADDLEBACK VALLEY COMMUNITY CHURCH
Affiliated With: HEALTHCOMP ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8004427247 8005287936
CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYERSafety Group Office 1Affiliated With: New York State Insurance Fund
*
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER New York State Insurance Fund199 Church StNew York NY 10007
CONTACT EMPLOYER CONTACT EMPLOYERSafety Group Office 2Affiliated With: New York State Insurance Fund
*
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER New York State Insurance Fund199 Church StNew York NY 10007
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-332• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
SAGEBRUSH - RHODES HOMESAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
SAGEBRUSH-TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
SAGINAW VA MEDICAL CENTER
CHECK BENEFIT CARDSAGINAW VA MEDICAL CENTER 3158
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
SAGINAW VA MEDICAL CENTER
SAGINAW VA MEDICAL CENTER
1500 WEISS STSAGINAW MI 48602
Attn: FEE BASIS 136F
ACORDIA NATIONAL(888) 685-7774
CHECK BENEFIT CARDSAIA BURGES AUTOMOTIVE CURATORS
Affiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR
*
Fund No:PlanType: Group Health
ACORDIA NATIONAL(888) 685-7774
ACORDIA NATIONAL
ADMINISTRATIVE CONCEPTS INC(888) 293-9229
UM NOT APPLICABLESAINT FRANCIS UNIVERSITYAffiliated With: ADMINISTRATIVE CONCEPTS INC
Fund No:PlanType: Group Health
ADMINISTRATIVE CONCEPTS INC(888) 293-9229
ADMINISTRATIVE CONCEPTS INC
997 Old Eagle School Rd. #215WAYNE PA 19087-1706
Attn: Customer Service Dept
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-333• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SUMMIT AMERICA INSURANCE SERVICES
SUMMIT AMERICA INSURANCE SERVICES
SAINT MARTIN'S COLLEGE ATHLETICS
Affiliated With: SUMMIT AMERICA INSURANCE SERVICES
Fund No:PlanType: Group Health
SUMMIT AMERICA INSURANCE SERVICES
SUMMIT AMERICA INSURANCE SERVICES5001 College Blvd., #216LEAWOOD KS 66211
SALEM VAMC CHECK BENEFIT CARDSALEM VAMC 3138Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
SALEM VAMC SALEM VAMC
1970 ROANOKE BLVDSALEM VA 24153
Attn: FEE BASIS 04H
GROUP & PENSION ADMINISTRATORS(800) 827-7223
CHECK BENEFIT CARDSales Partners Southwest (TRAVEL)Affiliated With: GROUP & PENSION ADMINISTRATORS
*
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
SALISBURY VAMC CHECK BENEFIT CARDSALISBURY VAMC 3139Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
SALISBURY VAMC SALISBURY VAMC
1601 BRENNER RDSALISBURY NC 28144
Attn: FEE BASIS (04J)
SALT LAKE CITY VAMC CHECK BENEFIT CARDSALT LAKE CITY VAMC 3535Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
SALT LAKE CITY VAMC SALT LAKE CITY VAMC500 FOOTHILL DRSALT LAKE CITY UT 84148
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-334• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
AMERIBEN SOLUTIONS(800) 786-7930 (800) 786-7930 Ext 9234
AMERIBEN SOLUTIONSSALT RIVER PIMA MARICOPA INDIAN COMMUNITY
Affiliated With: SALT RIVER PIMA MARICOPA INDIAN COMMUNITY
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930 (800) 786-7930 Ext 9234
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
CORESOURCE(866) 280-4120
CORESOURCE(866) 794-0770
SALT RIVER SAND & ROCKAffiliated With: CORESOURCE
Fund No:PlanType: Group Health
CORESOURCE(866) 280-4120
CORESOURCEPO Box 2920CLINTON OH 52733-2920
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
CHECK BENEFIT CARDSALVE REGINA UNIVERSITYAffiliated With: ADMINISTRATIVE CONCEPTS INC
Fund No:PlanType: Group Health
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDSAM HOUSTON STATE UNIVERSITY
Affiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
NHBC(888) 621-7900
CHECK BENEFIT CARDSAMARITAN HEALTH PLANSAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-335• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.(800) 284-2273
SAMCAffiliated With: OSF HEALTHPLANS, INC.
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128
GROUP & PENSION ADMINISTRATORS INC(800) 827-7223
HEALTH WATCH(972) 238-7900
SAN ANTONIO AEROSPACE - TRAVEL
Affiliated With: GROUP & PENSION ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS INC(972) 238-7900
GROUP & PENSION ADMINISTRATORS INC12770 MERIT DR STE 200DALLAS TX 75251
HEALTHCOMP THIRD PARTY ADMINISTRATORS INC(800) 442-7247
CHECK BENEFIT CARDSAN BENITO HEALTH CARE DISTRICT
Affiliated With: HEALTHCOMP THIRD PARTY ADMINISTRATORS
Fund No:PlanType: Group Health
HEALTHCOMP THIRD PARTY ADMINISTRATORS INC(800) 442-7247
HEALTHCOMP THIRD PARTY ADMINISTRATORS INCPO Box 45018Fresno CA 93718
ALLIED ADMINISTRATORS(619) 297-8235
ALLIED ADMINISTRATORS
SAN DIEGO CO. TEAMSTERS HEALTH & WELFARE TRUST
Affiliated With: SAN DIEGO CO. TEAMSTERS HEALTH & WELFARE TRUST
Fund No:PlanType: Group Health
ALLIED ADMINISTRATORS(619) 297-8235
ALLIED ADMINISTRATORS2831 Camino del Rio S STE 311SAN DIEGO CA 92108
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-336• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
THE PLAN HANDLERS INC(800) 538-5512
THE PLAN HANDLERS INC
SAN DIEGO FIREMAN RELIEF ASSOCIATION
Affiliated With: THE PLAN HANDLERS INC
Fund No:PlanType: Group Health
THE PLAN HANDLERS INC(800) 538-5512
THE PLAN HANDLERS, INC. C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
SAN DIEGO HCS CHECK BENEFIT CARDSAN DIEGO HCS 3192Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
SAN DIEGO HCS SAN DIEGO HCS
3350 LA JOLLA VILLAGE DRSAN DIEGO CA 92161
Attn: FEE BASIS 136B-SV
ALLIED ADMINISTRATORS(619) 574-1685
ALLIED ADMINISTRATORS
SAN DIEGO HOTEL & REST. EMPLOYEE HLTH & PENSION FUND
Affiliated With: SAN DIEGO HOTEL & REST. EMPLOYEE HLTH & PENS. FUND
Term Effective: 8/31/2007Fund No:PlanType: Group Health
ALLIED ADMINISTRATORS(619) 574-1685
ALLIED ADMINISTRATORS2831 Camino del Rio S STE 311SAN DIEGO CA 92108
EISB C/O HEALTH ASPEX, INC.
EISB C/O HEALTH ASPEX, INC.
SAN FRANCISCO ELECTRICAL WORKERS H&W TRUST
Affiliated With: SAN FRANCISCO ELECTRICAL WORKERS H&W TRUST
Fund No:PlanType: Group Health
EISB C/O HEALTH ASPEX, INC.
EISB C/O HEALTH ASPEX, INC.5301 Buckeystown Pike #455FREDERICK MD 21704
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-337• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SAN FRANSISCO VAMC CHECK BENEFIT CARDSAN FRANCISCO VAMC 3187Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
SAN FRANSISCO VAMC SAN FRANSISCO VAMC
4150 CLEMENT ST BLDG 6SAN FRANSISCO CA 94121
Attn: FEE BASIS 04F
ADVENTIST HEALTH SYSTEM WEST
CHECK BENEFIT CARDSAN JOAQUIN COMMUNITY HOSPITAL
Affiliated With: ADVENTIST HEALTH SYSTEM/WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002
ADVENTIST HEALTH SYSTEMS/WEST
CHECK BENEFIT CARDSAN JOAQUIN COMMUNITY HOSPITAL EXCLUSIVE
Affiliated With: ADVENTIST HEALTH SYSTEM/WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEMS/WEST
ADVENTIST HEALTH SYSTEMS/WESTPO Box 619031ROSEVILLE CA 95661-9002
CHECK BENEFIT CARD CHECK BENEFIT CARDSAN JUAN IPAAffiliated With: NATIONAL HEALTH BENEFIT CORPORATION (NHBC)
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
SAN JUAN VA MEDICAL CENTER
CHECK BENEFIT CARDSAN JUAN VA MEDICAL CENTER 3145
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
SAN JUAN VA MEDICAL CENTER
SAN JUAN VA MEDICAL CENTER
10 CASIA STSAN JUAN PR 00921
Attn: 672-B01D
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-338• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDSANDVIKAffiliated With: ALLIED BENEFIT SYSTEMS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
ASSOCIATED ADMINISTRATORS, INC.(800) 770-6672
CHECK BENEFIT CARDSANTA CLARA UNIVERSITYAffiliated With: ASSOCIATED ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
ASSOCIATED ADMINISTRATORS, INC.(800) 770-6672
ASSOCIATED ADMINISTRATORS, INC.PO Box 5096PORTLAND OR 97208
CHECK BENEFIT CARD CHECK BENEFIT CARDSANTA CRUZ MEDICAL CLINICAffiliated With: CAPITOL ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD CHECK BENEFIT CARDSANTA MONICA COLLEGEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
STAR HEALTHCARE NETWORK(212) 581-8228
CHECK BENEFIT CARDSANUS HEALTHAffiliated With: STAR HEALTHCARE NETWORK INC
*
Fund No:PlanType: Group Health
STAR HEALTHCARE NETWORK(212) 581-8228
STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-339• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SANUS HEALTH CORPORATION(469) 417-1755
SANUS HEALTH CORPORATION(469) 417-1755
SANUS HEALTHAffiliated With: SANUS HEALTH CORPORATION
Fund No:PlanType: Group Health
SANUS HEALTH CORPORATION(469) 417-1755
SANUS HEALTH CORPORATION12501 KENDALL DR STE 2MIAMI FL 33186
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
SAPAUGH MOTORS, INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
EBPA(802) 846-8060
CHECK BENEFIT CARDSARGENT CORP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDSAVANNAH STATE UNIV AIH0058417
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLESAVANNAH STATE UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-340• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERSCHAFFER COMPANIES GHAffiliated With: STRATACARE
Fund No:PlanType: Group Health
CONTACT EMPLOYER CONTACT EMPLOYER
CONTACT EMPLOYER CONTACT EMPLOYERSCHAFFER COMPANIES WCAffiliated With: STRATACARE
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
NORTH AMERICA ADMINISTRATORS, L.P.(615) 255-6654
MED-CERT(800) 356-7126
SCHMIEDESKAMP, ROBERTSON, NEW & MITCHELL
Affiliated With: NORTH AMERICAN ADMINISTRATORS
Fund No:PlanType: Group Health
(615) 255-6654 NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202
(800) 220-2600 CHECK BENEFIT CARDSCHMITT, SUSSMAN, ENTERPRISES dba PFP
Affiliated With: BROKERAGE CONCEPTS INC
Fund No:PlanType: Group Health
CLAIMS MANAGER(610) 337-2600
CLAIMS MANAGERPO Box 61553KING OF PRUSSIA PA 19406
PROFESSIONAL CLAIMS MGMT(800) 590-6500
CHECK BENEFIT CARDSCHOOL CITY OF EAST CHICAGOAffiliated With: PROFESIONAL CLAIMS MANAGEMENT
Fund No:PlanType: Group Health
PROFESSIONAL CLAIMS MGMT(800) 590-6500
PROFESSIONAL CLAIMS MGMT16 W 455 S FRONTGATE RD STE 216BURR RIDGE IL 60527
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-341• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.
SCHOOL DISTRICT OF JANESVILLE
Affiliated With: MIDWEST SECURITY ADMINISTRATORS INC
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.PO Box 574ONALASKA WI 54650
NGS AMERICAN, INC.8005211555
UM NOT APPLICABLESCHWARZ PARTNERS-PACKAGING
Affiliated With: NGS AMERICAN INC
Fund No:PlanType: Group Health
NGS AMERICAN, INC.8005211555
NGS AMERICAN, INC.PO Box 7676DETROIT MI 48080
CHECK BENEFIT CARD CHECK BENEFIT CARDSCOTIABANKAffiliated With: COLONIAL GROUP INTERNATIONAL LTD
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
SCOTLAND YARD SECURITY SERVICES LTD
Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
SCHALLER ANDERSON HEALTHCARE LLC(888) 897-4988
SCHALLER ANDERSON HEALTHCARE LLC
SCRIPPS HEALTH INC EPOAffiliated With: SCHALLER ANDERSON HEALTHCARE LLC
Fund No:PlanType: Group Health
SCHALLER ANDERSON HEALTHCARE LLC(888) 897-4988
SCHALLER ANDERSON HEALTHCARE LLCPO Box 63065PHOENIX AZ 85082-3065
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-342• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SCHALLER ANDERSON HEALTHCARE LLC
SCHALLER ANDERSON HEALTHCARE LLC
SCRIPPS HEALTH INC PPO AND OUT OF AREA
Affiliated With: SCHALLER ANDERSON HEALTHCARE LLC
Fund No:PlanType: Group Health
SCHALLER ANDERSON HEALTHCARE LLC
SCHALLER ANDERSON HEALTHCARE LLCPO Box 63065PHOENIX AZ 85082-3065
ALLIED ADMINISTRATORS(619) 297-8235
CHECK BENEFIT CARDSD CEMENT MASONS TRUSTAffiliated With: SD CEMENT MASONS TRUST
Fund No:PlanType: Group Health
ALLIED ADMINISTRATORS(619) 297-8235
ALLIED ADMINISTRATORS2831 Camino del Rio S STE 311SAN DIEGO CA 92108
ALLIED ADMINISTRATORS(619) 297-8235
CHECK BENEFIT CARDSD COUNTY TEAMSTER TRUSTAffiliated With: SD COUNTY TEAMSTER TRUST
Fund No:PlanType: Group Health
ALLIED ADMINISTRATORS(619) 297-8235
ALLIED ADMINISTRATORS2831 Camino del Rio S STE 311SAN DIEGO CA 92108
CBA(800) 525-8788
UM NOT APPLICABLESD IRELAND CONCRETEAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
CBA(800) 525-8788
CBAPO Box 2365SOUTH BURLINGTON VT 05407
ENTRUST INC(281) 368-7878
MEDICAL HELPLINE(877) 463-3435
SEABOARD INTERNATIONALAffiliated With: ENTRUST INC
Fund No:PlanType: Group Health
ENTRUST INC(281) 368-7878
ENTRUST INC14701 ST MARY'S LN STE 150HOUSTON TX 77079
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-343• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDSEALMASTER EPT HOURLYAffiliated With: SEALMASTER EPT HOURLY
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
America's TPA(952) 896-1255
CHECK BENEFIT CARDSEASONAL CONCEPTS INCAffiliated With: AMERICAS TPA
Fund No:PlanType: Group Health
America's TPA(952) 896-1255
America's TPAPO Box 398220Bloomington MN 55439
EBMS(800) 777-3575
CHECK BENEFIT CARDSEATTLE FINANCIAL GROUPAffiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES, INC.
Fund No:PlanType: Group Health
EBMS(800) 777-3575
EBMSPO Box 21367BILLINGS MT 59104-1367
HEALTH PLAN INC(508) 752-2480
CARE MANAGEMENT SERVICES(866) 325-1550
SECURE CARE PRODUCTS INCAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INCPO Box 5199WESTBOROUGH MA 01581
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
CHECK BENEFIT CARDSECURIGUARDAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388
*
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-344• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDSECURITIES AMERICA FINANCIAL CORPORATION
Affiliated With: AMERICAN HEALTHCARE ALLIANCE
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
KHS(800) 822-1274
UM NOT APPLICABLESecurity ForcesAffiliated With: KANAWHA HEALTHCARE
*
Fund No:PlanType: Group Health
KHS(800) 822-1274
KHSPO Box 1000LANCASTER SC 29720
CONTACT EMPLOYER CONTACT EMPLOYERSedgwick Claims Management Services
Affiliated With: Genex Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER CONTACT EMPLOYERSedgwick CMS
Fund No:PlanType: Workers' Compensation
Refer to Intercorp
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Selective Insurance Agency(973) 948-1638
CHECK BENEFIT CARDSelective Insurance AgencyAffiliated With: Fair Isaac Corporation
Fund No:PlanType: Workers' Compensation
Selective Insurance Agency(973) 948-1638
Selective Insurance Agency40 Wantage AveBranchville NJ 07890
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-345• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTHCOMP ADMINISTRATORS INC(800) 755-7247
HEALTHCOMP ADMINISTRATORS INC(800) 755-7247
SENECA CENTERAffiliated With: HEALTHCOMP
Fund No:PlanType: Group Health
HEALTHCOMP ADMINISTRATORS INC(800) 755-7247
HEALTHCOMP ADMINISTRATORS INC621 SANTA FEFRESNO CA 93703
JEANNE SHIMODA(800) 442-7247
CHECK BENEFIT CARDSENENET, INCAffiliated With: HEALTHCOMP TPA #10473
Fund No:PlanType: Group Health
JEANNE SHIMODA(800) 442-7247
JEANNE SHIMODAPO Box 45018FRESNO CA 93721
QUALIFIED BENEFIT SERVICES LLC(800) 853-3234
UM NOT APPLICABLE(801) 269-8723
SENIOR MANAGEMENT CONCEPTS
Affiliated With: QUALIFIED BENEFIT SERVICES
Fund No:PlanType: Group Health
QUALIFIED BENEFIT SERVICES LLC(800) 853-3234
QUALIFIED BENEFIT SERVICES LLC75 S 500 WBOUNTIFUL UT 84010
CHECK BENEFIT CARD CHECK BENEFIT CARDSENTRY INSURANCEAffiliated With: MITCHELL MEDICAL
Fund No:PlanType: Auto
Sentry: Administered by Mitchell MedicalExclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)
CHECK BENEFIT CARD CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYERSentry InsuranceAffiliated With: Sentry Insurance A Mutual Company
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-346• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
THE LOOMIS COMPANY(866) 425-7244
HINES & ASSOCIATES(888) 826-5769
SEQUEL YOUTH AND FAMILYAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(866) 425-7244
THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011
HEALTH NETWORK AMERICA(888) 200-8537
HEALTH NETWORK AMERICA(732) 676-2637
SEQUEL YOUTH SERVICES - CLARINDA ACADEMY
Affiliated With: HEALTH NETWORK AMERICA
Fund No:PlanType: Group Health
HEALTH NETWORK AMERICA(888) 200-8537
HEALTH NETWORK AMERICAPO Box 607W LONG BRANCH NJ 07764
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.(800) 284-2273
SFIAffiliated With: OSF HEALTHPLANS, INC.
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.(800) 284-2273
SFMCAffiliated With: OSF HEALTHPLANS, INC.
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128
BAC(800) 521-2654
UM NOT APPLICABLESHAMROCK MANAGEMENT LLCAffiliated With: BUSINESS ADMINISTRATORS & CONSULTANTS, INC.
Fund No:PlanType: Group Health
BAC(614) 863-2120 Ext 3102
BACPO Box 107REYNOLDSBURG OH 43068
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-347• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711
QUANTUM CARE(866) 412-8252
SHEBESTER-BECHTELAffiliated With: THE KEMPTON GROUP INC
Fund No:PlanType: Group Health
KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711
KEMPTON GROUP ADMINISTRATORS INCPO Box 54889OKLAHOMA CITY OK 73154
WILLIAM C. EARHART CO. INC.
WILLIAM C. EARHART CO. INC.
SHEET METAL WORKERS #16 HEALTH PLAN
Affiliated With: SHEET METAL WORKERS #16 HEALTH PLAN
Fund No:PlanType: Group Health
WILLIAM C. EARHART CO. INC.
WILLIAM C. EARHART CO. INC.PO Box 4148PORTLAND OR 97208
BENESYS(248) 822-4200
HEALTH CARE EVALUATION(209) 951-6711
SHEET METAL WORKERS DBA"LOCAL 104" HEALTH CARE PLAN
Affiliated With: SHEET METAL WORKERS LOCAL 104 HEALTH CARE PLAN
Fund No:PlanType: Group Health
BENESYS(248) 822-4200
BENESYSPO Box 1618SAN RAMON CA 94583
CHECK BENEFIT CARD CHECK BENEFIT CARDSHEET METAL WORKERS' HEALTH AND WELFARE FUND OF NORTHERN CAROLINA
Affiliated With: SOUTHERN BENEFIT ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-348• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7345
SHELBY AUTOMOTIVEAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
AMERICA'S CHOICE HEALTHPLANS, LLC(877) 224-3627
AMERICAN HEALTH HOLDINGS INC(888) 578-1812
SHEPLEY WOOD PRODUCTS INCAffiliated With: BENEFIRST LLC
Fund No:PlanType: Group Health
AMERICA'S CHOICE HEALTHPLANS, LLC(877) 224-3627
AMERICA'S CHOICE HEALTHPLANS, LLC13111 Northwest Fwy, Ste 510Houston TX 77040
SHERIDAN VAMC CHECK BENEFIT CARDSHERIDAN VAMC 3536Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
SHERIDAN VAMC SHERIDAN VAMC1898 FORT RDSHERIDAN WY 82801
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMINISTRATION & MGMT
SHIMADZU MEDICAL SYSTEMSAffiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
JSL ADMINISTRATORS, INC.(910) 480-3100
DOCTORS DIRECT(800) 443-9178
SHOOK BUILDER SUPPLY COAffiliated With: JSL ADMINISTRATORS, INC
Fund No:PlanType: Group Health
JSL ADMINISTRATORS, INC.(910) 480-3100
JSL ADMINISTRATORS, INC.201 HAY STREET, STE 302FAYETTEVILLE NC 28301
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-349• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
SIERRA ALUMINUM COMPANYAffiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
SUMMIT AMERICA INSURANCE SERVICES
SUMMIT AMERICA INSURANCE SERVICES
SIERRA COLLEGE ATHLETIC INSURANCE
Affiliated With: SUMMIT AMERICA INSURANCE SERVICES
Fund No:PlanType: Group Health
SUMMIT AMERICA INSURANCE SERVICES
SUMMIT AMERICA INSURANCE SERVICES5001 College Blvd. #216LEAWOOD KS 66211
GLOBALCARE, INC. GLOBALCARE, INC.SIERRA HEALTH & LIFE INSURANCE
Affiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC. GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
SIERRA HEALTH SERVICESAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Sierra Heatlh Services(818) 846-5297
Sierra Heatlh Services(800) 373-3054
Sierra Health Services
Fund No:PlanType: Workers' Compensation
Sierra Heatlh Services(818) 846-5297
Sierra Heatlh ServicesPO Box 7858Burbank CA 91510-7858
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-350• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GLOBALCARE, INC. GLOBALCARE, INC.SIERRA HEALTH-CARE OPTIONS, INC.
Affiliated With: GLOBALCARE, INC.
Fund No:PlanType: Group Health
GLOBALCARE, INC. GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
SIGNATURE LABELAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
SILVER STATE BANKAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
SILVER STATE FORD-TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
SILVERTON CASINO LLCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-351• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ADVENTIST HEALTH SYSTEM WEST
CHECK BENEFIT CARDSIMI VALLEY HOSPITAL - EPOAffiliated With: ADVENTIST HEALTH SYSTEM/WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002
SUMMIT AMERICA INSURANCE SERVICES
SUMMIT AMERICA INSURANCE SERVICES
SIMPSON COLLEGE ATHLETIC INSURANCE
Affiliated With: SUMMIT AMERICA INSURANCE SERVICES
Fund No:PlanType: Group Health
SUMMIT AMERICA INSURANCE SERVICES
SUMMIT AMERICA INSURANCE SERVICES5001 College Blvd. #216LEAWOOD KS 66211
GROUP BENEFIT SERVICES, INC.(800) 995-3569
GROUP BENEFIT SERVICES, INC.(800) 995-3569
SIOUX MANUFACTURINGAffiliated With: GROUP BENEFIT SERVICES, INC
Fund No:PlanType: Group Health
GROUP BENEFIT SERVICES, INC.(800) 995-3569
GROUP BENEFIT SERVICES, INC.1736 E. Sunshine Ste 200Springfield MO 65804
NHBC(888) 621-7900
CHECK BENEFIT CARDSIS IMPERIAL PALACEAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
SISCO(800) 457-4726
SISCO(800) 457-4726
SISCOAffiliated With: SISCO/Cottingham & Butler
Fund No:PlanType: Group Health
SISCO(800) 457-4726
SISCOPO Box 389DUBUQUE IA 52004-0389
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-352• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMINISTRATION & MGMT
SIZZLER, USAAffiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.(800) 284-2273
SJHAffiliated With: OSF HEALTHPLANS, INC.
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128
OSF HealthPlans, Inc. OSF HealthPlans, Inc.SJMCAffiliated With: OSF HEALTHPLANS, INC.
Fund No:PlanType: Group Health
OSF HealthPlans, Inc. OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128
RISK REDUCTION INC GENEX SERVICES, INC.(800) 477-3502
SKILSTAF INCAffiliated With: SKILSTAF INC
Fund No:PlanType: Group Health
RISK REDUCTION INC RISK REDUCTION INCPO Box 729ALEXANDER CITY AL 35011
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
SKY RIVER MANAGEMENT, LLC TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-353• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GISC, INC(800) 242-4472
TOTALCARE W / APS HEALTHCARE(866) 598-3973
Smart Management IncAffiliated With: GROUP INSURANCE SERVICE CENTER
Fund No:PlanType: Group Health
GISC, INC(800) 242-4472
GISC, INCPO Box 9120MARSHFIELD MA 02050
PIONEER MANAGEMENT SYSTEMS(877) 868-9060
CHECK BENEFIT CARDSMITH COLLEGEAffiliated With: PIONEER MANAGEMENT SYSTEMS
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(877) 868-9060
PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01090
CORESOURCE INC(800) 624-7143
CORESOURCE INC(800) 480-6658
SMITH MEDIAAffiliated With: CORESOURCE, INC.
Fund No:PlanType: Group Health
CORESOURCE INC(800) 624-7143
CORESOURCE INCPO Box 2920CLINTON OH 52733-2920
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.(800) 284-2273
SMMCAffiliated With: OSF HEALTHPLANS, INC.
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128
AFFORDABLE BENEFIT ADMINISTRATORS, INC.(800) 350-0148 (800) 350-0148 Ext 240
CHECK BENEFIT CARDSN SERVICING CORPORATIONAffiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC. (ABA)
Fund No:PlanType: Group Health
AFFORDABLE BENEFIT ADMINISTRATORS, INC.(800) 350-0148 (800) 350-0148 Ext 240
AFFORDABLE BENEFIT ADMINISTRATORS, INC.PO Box 10787BURBANK CA 91510
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-354• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
CHECK BENEFIT CARDSODEXHO MANAGEMENTAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388
*
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218
AFFORDABLE BENEFIT ADMINISTRATORS INC(800) 350-0148
AFFORDABLE BENEFIT ADMINISTRATORS, INC.
SOKA UNIVERSITY OF AMERICAAffiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC. (ABA)
Fund No:PlanType: Group Health
AFFORDABLE BENEFIT ADMINISTRATORS INC(800) 350-0148
AFFORDABLE BENEFIT ADMINISTRATORS, INC.PO Box 10787BURBANK CA 91510
CHECK BENEFIT CARD ADVANCED BENEFIT SOLUTIONS
SOLAR INDUSTRIESAffiliated With: ADVANCED BENEFIT SOLUTIONS LLC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYERSolin USA
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(800) 293-3131
Solin USA520 N Semoran Blvd Ste 220Orlando FL 32807
CONTACT EMPLOYER CONTACT EMPLOYERSOLUTIONS 4Affiliated With: MCMC LLC
Fund No:PlanType: Workers' Compensation
Includes Exclusive Preferred Providers (OCN ONLY)
MCMC LLC(888) 350-1150 Ext 228
MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-355• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MCMC LLC(888) 350-1150 Ext 228
MCMC LLC(888) 350-1150 Ext 228
Solutions4 - Nashvile AutoAffiliated With: MCMC LLC
Fund No:PlanType: Auto
MCMC LLC(888) 350-1150 Ext 228
MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317
CHECK BENEFIT CARD CHECK BENEFIT CARDSOLUTIONS4 AUTOAffiliated With: MCMC LLC
Fund No:PlanType: Auto
CHECK BENEFIT CARD MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDSOMA - STUDENT OSTEOPATHIC MEDICAL ASSOC 1
Affiliated With: UnitedHealthcare StudentResources #11689
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDSOMA - STUDENT OSTEOPATHIC MEDICAL ASSOC 2
Affiliated With: UnitedHealthcare StudentResources #11689
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDSOMA HIGH DEDUCTIBLE PLANAffiliated With: UnitedHealthcare StudentResources #11689
Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-356• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ADVENTIST HEALTH SYSTEM WEST
CHECK BENEFIT CARDSONORA COMMUNITY HOSPITALAffiliated With: ADVENTIST HEALTH SYSTEM/WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002
KLAIS & COMPANY INC(330) 867-8443
CHECK BENEFIT CARDSOPREMA, INCAffiliated With: KLAIS & COMPANY
Fund No:PlanType: Group Health
KLAIS & COMPANY INC(330) 867-8443
KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313
CNIC HEALTH SOLUTIONS(800) 426-7453
CNIC HEALTH SOLUTIONS(800) 426-7453
SOS STAFFING SERVICES, INC. (COLORADE EEs-TRAVEL)
Affiliated With: CNIC HEALTH SOLUTIONS
Fund No:PlanType: Group Health
CNIC HEALTH SOLUTIONS(800) 426-7453
CNIC HEALTH SOLUTIONSPO Box 3559ENGLEWOOD CO 80155-3559
ADVENTIST HEALTH SYSTEM WEST(800) 441-2524
CHECK BENEFIT CARDSOUTH COAST MEDICAL CENTERAffiliated With: ADVENTIST HEALTH SYSTEM WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM WEST(800) 441-2524
ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDSOUTH GEORGIA COLLEGE AIH0058437
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-357• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDSOUTH GEORGIA COLLEGE AIH0058447
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLESOUTH GEORGIA COLLEGE UNDERGRAD UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PIONEER MANAGEMENT SYSTEMS(413) 534-8658
UM NOT APPLICABLESouth Maine Community CollegeAffiliated With: PIONEER MANAGEMENT SYSTEMS
*
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(413) 534-8658
PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01089
ECOM PPO ADVISORS, INC(828) 281-9000
CHECK BENEFIT CARDSOUTH VALLEY BANKAffiliated With: ECOM PPO ADVISORS INC
Fund No:PlanType: Group Health
ECOM PPO ADVISORS, INC(828) 281-9000
ECOM PPO ADVISORS, INC
8350 N. CENTRAL EXPWY, STE 600DALLAS TX 75206
Attn: ACCOUNTING
SOUTHERN BENEFIT ADMINISTRATORS INC(800) 831-4914
UM NOT APPLICABLESOUTHEASTERN CARPENTERS AND MILLWRIGHTS HEALTH TRUST
Affiliated With: SOUTHERN BENEFIT ADMINISTRATORS, INC
Fund No:PlanType: Group Health
SOUTHERN BENEFIT ADMINISTRATORS INC(800) 831-4914
SOUTHERN BENEFIT ADMINISTRATORS INC907 TWO MILE PKWY STE C-5GOODLETTSVILLE TN 37072
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-358• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERSoutheastern Claims Services IncAffiliated With: Genex Services, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CHECK BENEFIT CARD CHECK BENEFIT CARDSOUTHEASTERN LOUISIANA UNIVERSITY
Affiliated With: STUDENT ASSURANCE SERVICES INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
SOUTHERN CALIFORNIA PIPE TRADES ADMIN(800) 595-7473
SOUTHERN CALIFORNIA PIPE TRADES ADMIN(213) 385-6161 Ext 268
SOUTHERN CALIFORNIA PIPE TRADES ADMIN CORP
Affiliated With: SOUTHERN CALIFORNIA PIPE TRADES ADMIN CORP
Fund No:PlanType: Group Health
SOUTHERN CALIFORNIA PIPE TRADES ADMIN(800) 595-7473
SOUTHERN CALIFORNIA PIPE TRADES ADMIN501 SHATTO PLACE 5TH FLOORLOS ANGELES CA 90020
MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540
CHECK BENEFIT CARDSOUTHERN NAZARENE UNIVERSITY - FACILITY AND EMPLOYEES
Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540
MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096
SOUTHERN NEVADA HCS CHECK BENEFIT CARDSOUTHERN NEVADA HCS 3193Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
SOUTHERN NEVADA HCS SOUTHERN NEVADA HCS
2455 W CHEYENNENORTH LAS VEGAS NV 89032
Attn: FEE 136C
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-359• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDSOUTHERN NEW ENGLAND SCHOOL OF LAW
Affiliated With: UnitedHealthcare StudentResources #11689
Term Effective: 8/31/2007Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
QVI RISK SOLUTIONS INC(541) 312-8512
INNOVATIVE CARE MANAGEMENT(800) 862-3338
SOUTHERN OREGON HEAD START
Affiliated With: QVI RISK SOLUTIONS INC
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
SOUTHERN OREGON REHAB CTR & CLINICS
CHECK BENEFIT CARDSOUTHERN OREGON REHAB CENTER & CLINICS 3117
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
SOUTHERN OREGON REHAB CTR & CLINICS
SOUTHERN OREGON REHAB CTR & CLINICS
8495 CRATER LAKE HWYWHITE CITY OR 97503
Attn: FEE 136C-7
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONS(800) 786-7930
SOUTHERN OREGON UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
USI ADMINISTRATORS(877) 277-5718
USI ADMINISTRATORSSOUTHERN OREGON UNIVERSITYAffiliated With: FIRST UNDERWRITERS INC
Fund No:PlanType: Group Health
USI ADMINISTRATORS(877) 277-5718
USI ADMINISTRATORSPO Box 3357FORT WORTH TX 76113
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-360• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDSOUTHERN PAINTERS WELFARE FUND
Affiliated With: SOUTHERN PAINTERS WELFARE FUND
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDSOUTHERN POLYTECHNIC STATE UNIV AIH0058457
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLESOUTHERN POLYTECHNIC STATE UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDSOUTHWEST BAPTIST UNIVERSITY
Affiliated With: UnitedHealthcare StudentResources #11689
Term Effective: 8/31/2007Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-361• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDSOUTHWEST CARPENTERS TRUST FUNDS
Affiliated With: SOUTHWEST CARPENTERS TRUST FUNDS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
RESOURCEONE ADMINSTRATORS(800) 967-2077
MEDCAREONE CORP(800) 816-1206
SOUTHWEST ORTHOPAEDIC SPECIALIST PLLC
Affiliated With: RESOURCEONE ADMINISTRATORS
Fund No:PlanType: Group Health
RESOURCEONE ADMINSTRATORS(800) 967-2077
RESOURCEONE ADMINSTRATORS
PO Box 489BUCKEYSTOWN MD 21717
Attn: Mary Shepherd
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
SOUTHWEST SERVICES (TRAVEL)Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777
PREFERRED BENEFIT ADMINISTRATORS INC
SOUTHWEST SIGNAL ENGINEERING COMPANY
Affiliated With: PREFERRED BENEFIT ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777
PREFERRED BENEFIT ADMINISTRATORS INCPO Box 916188LONGWOOD FL 32791-6188
CHECK BENEFIT CARD CHECK BENEFIT CARDSouthwestern BenefitsAffiliated With: Amalgamated Life Insurance Co.
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-362• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
TRUE CHOICE(800) 251-9665
UM NOT APPLICABLESouthwestern Oklahoma StateAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE(800) 251-9665
TRUE CHOICEPO Box 700307DALLAS TX 75370
MERITAIN HEALTH(800) 844-7979
UM NOT APPLICABLESOUTHWESTERN VERMONT HEALTH CARE CORP.
Affiliated With: MERITAIN HEALTH
Fund No:PlanType: Group Health
MERITAIN HEALTH(800) 844-7979
MERITAIN HEALTH
PO Box 853921Richardson TX 75085-3921
Attn: Claims Dept
MIDWEST SECURITY ADMINISTRATORS INC(888) 672-4342
CHECK BENEFIT CARDSPACESAVER CORPORATIONAffiliated With: MIDWEST SECURITY ADMINISTRATORS INC
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS INC(888) 672-4342
MIDWEST SECURITY ADMINISTRATORS INC2700 Midwest Dr.ONALASKA WI 54650
First Health(800) 638-6589
CHECK BENEFIT CARDSpecial Agents Mutual Benefits Association (SAMBA)
Affiliated With: Special Agents Mutual Benefit Association (SAMBA)
Fund No:PlanType: Group Health
First Health(800) 638-6589
First HealthPO Box 8600London KY 40742
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
SPECIAL MARKETSAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-363• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARD(800) 525-8788
SPECIALIZED TECHNOLOGY RESOURCES JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
EBPA(802) 846-8060
CHECK BENEFIT CARDSPECIALIZED TECHNOLOGY RESOURCES WRAP JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
CHECK BENEFIT CARDSpecialty Accident SicknessAffiliated With: International Medical Group, Inc.
Fund No:PlanType: Group Health
International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US
International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684
Mountain States Administrative Services(520) 722-7133
Hines and Associates(847) 214-2780
SPELLMAN HARDWOODSAffiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
Mountain States Administrative Services(520) 722-7133
Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-364• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH NET FEDERAL SERVICES(916) 985-1259
CHECK BENEFIT CARDSPOKANE VAMC 3181Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(916) 985-1259
HEALTH NET FEDERAL SERVICES2025 AEROJET RDRANCHO CORDOVA CA 95742
RESOURCEONE ADMINSTRATORS(800) 967-2077
MEDCAREONE CORP(800) 816-1206
Springdale Liquor AssociationAffiliated With: RESOURCEONE ADMINISTRATORS
*
Fund No:PlanType: Group Health
RESOURCEONE ADMINSTRATORS(918) 967-2077
RESOURCEONE ADMINSTRATORS
PO Box 489BUCKEYSTOWN MD 21717
Attn: Mary Shepherd
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDST EDWARDS UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
ADVENTIST HEALTH SYSTEM/WEST(800) 441-2524
CHECK BENEFIT CARDST HELENAL HOSPITAL EXCLUSIVE
Affiliated With: ADVENTIST HEALTH SYSTEM/WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM/WEST(800) 441-2524
ADVENTIST HEALTH SYSTEM/WEST2100 DOUGLASROSEVILLE CA 95661
GISC, INC(800) 242-4472
TOTALCARE W / APS HEALTHCARE(866) 598-3973
ST JOHNSBURY ACADEMYAffiliated With: GROUP INSURANCE SERVICE CENTER
Fund No:PlanType: Group Health
GISC, INC(800) 242-4472
GISC, INCPO Box 9120MARSHFIELD MA 02050
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-365• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
ST JOSEPH CATHOLIC ORPHANAGE
Affiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(800) 832-8212
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
ST LOUIS VA MEDICAL CENTER
CHECK BENEFIT CARDST LOUIS VAMEDICAL CENTER 3528
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
ST LOUIS VA MEDICAL CENTER
ST LOUIS VA MEDICAL CENTER
ONE JEFFERSON BARRACKS DRST LOUIS MO 63125
Attn: FEE BASIS 04FJB
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDST MARY'S UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
ADVENTIST HEALTH SYSTEM WEST
CHECK BENEFIT CARDST. HELENA HOSPITAL PPOAffiliated With: ADVENTIST HEALTH SYSTEM/WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMINISTRATION & MGMT
STA TRAVELAffiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-366• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PRIMARY PHYSICIANCARE, INC.(800) 446-5439
CHECK BENEFIT CARDSTABILUS, INCAffiliated With: PRIMARY PHYSICIANSCARE INC
Fund No:PlanType: Group Health
PRIMARY PHYSICIANCARE, INC.(800) 446-5439
PRIMARY PHYSICIANCARE, INC.PO Box 11088CHARLOTTE NC 28220
SOVEREIGN SOLUTIONS, LLC(229) 382-1360
MedWatch(800) 432-8421
STAFFORD DEVELOPMENTAffiliated With: SOVEREIGN SOLUTIONS LLC
Term Effective: 3/31/2008Fund No:PlanType: Group Health
SOVEREIGN SOLUTIONS, LLC(229) 382-1360
SOVEREIGN SOLUTIONS, LLC1805 U.S. HIGHWAY 82 WESTTIFTON GA 31794
Benefits/Eligibility(800) 843-3106
CHECK BENEFIT CARD(800) 522-2161
Standard Security Life Insurance Company of New York
Affiliated With: Insurers Administrative Corporation #962500302
Fund No:PlanType: Group Health
Benefits/Eligibility(800) 843-3106
Benefits/EligibilityPO Box 828Park Ridge IL 60068-0828
CHECK BENEFIT CARD CHECK BENEFIT CARDSTAR AFFORDABLE HEALTH BENEFITS
Affiliated With: STAR HEALTHCARE NETWORK INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
STAR HEALTHCARE NETWORK(212) 581-8228
UM NOT APPLICABLESTAR HEALTHCARE NETWORK INC
Affiliated With: STAR HEALTHCARE NETWORK INC
*
Fund No:PlanType: Group Health
STAR HEALTHCARE NETWORK(212) 581-8228
STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-367• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDSTAR RELIABLE LIFEAffiliated With: STAR HEALTHCARE NETWORK INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(800) 877-3727
CRITIQUE(800) 666-5551
STAR VALLEY MEDICAL CENTERAffiliated With: MANAGED BENEFITS ADMIN. & INSURANCE CONSULTANTS
Fund No:PlanType: Group Health
MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(800) 877-3727
MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS3625 S WEST TEMPLE STE 200SALT LAKE CITY UT 84115
CompIQ Corporation(800) 293-3131
UM NOT APPLICABLESTARR COMPREHENSIVE SOLUTIONS, INC
Affiliated With: COMP IQ
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(800) 293-3131
CompIQ Corporation35 Tesla Way #100Irvine CA 92618
CHECK BENEFIT CARD CHECK BENEFIT CARDSTATE AUTO INSURANCE COMPANIES
Affiliated With: STATE AUTO INSURANCE COMPANIES
Fund No:PlanType: Auto
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD CHECK BENEFIT CARDState Auto Insurance CompanyAffiliated With: State Auto Insurance Company
Fund No:PlanType: Auto
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-368• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
State Farm California(818) 707-5317
State Farm California(818) 707-5317
State Farm CaliforniaAffiliated With: State Farm Fire and Casualty Company
Fund No:PlanType: Workers' Compensation
State Farm California(818) 707-5317
State Farm Fire and Casualty Company31303 Agoura RdWestlake Village CA 91363-4635
State Farm Workers' Compensation Claim Department(309) 763-0126
State Farm Workers' Compensation Claim Department(309) 763-0126
State Farm Fire and Casualty Company
Affiliated With: State Farm Fire and Casualty Company
Fund No:PlanType: Workers' Compensation
State Farm Workers' Compensation Claim Department(309) 763-0126
CONTACT EMPLOYER
Attn:
State Farm Fire and Casualty Company(863) 318-3563
State Farm Fire and Casualty Company(863) 318-3563
State Farm FloridaAffiliated With: State Farm Fire and Casualty Company
Fund No:PlanType: Workers' Compensation
State Farm Fire and Casualty Company(863) 318-3563
State Farm Fire and Casualty Company7401 Cypress Gardens BlvdWinter Haven FL 33888
State Farm Hawaii(512) 918-5608
State Farm Hawaii(512) 918-5608
State Farm HawaiiAffiliated With: State Farm Fire and Casualty Company
Fund No:PlanType: Workers' Compensation
State Farm Fire and Casualty Company(512) 918-5608
State Farm Fire and Casualty Company8900 Amberglen BlvdAustin TX 78729-1110
State Farm Health Insurance - Policy #05(707) 584-6688
CHECK BENEFIT CARDState Farm Individual Policy HoldersAffiliated With: State Farm Individual Policy Holders
Fund No:PlanType: Group Health
State Farm Health Insurance - Policy #05(707) 584-6672 (800) 845-6592 ECS Help Desk
State Farm Health Insurance - Policy #05PO Box 8629Scottsdale AZ 85252-8629
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-369• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
State Farm Fire and Casualty Company(800) 427-1160
CONTACT EMPLOYERState Farm LouisianaAffiliated With: State Farm Fire and Casualty Company
Fund No:PlanType: Workers' Compensation
State Farm Fire and Casualty Company(800) 427-1160
State Farm Fire and Casualty CompanyPO Box 11980Monroe LA 71211-1980
CONTACT EMPLOYER CONTACT EMPLOYERState Farm New JerseyAffiliated With: State Farm Fire and Casualty Company
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
State Farm Fire and Casualty Company(512) 918-5608
State Farm Fire and Casualty Company(512) 918-5608
State Farm TexasAffiliated With: State Farm Fire and Casualty Company
Fund No:PlanType: Workers' Compensation
State Farm Fire and Casualty Company(512) 918-5608
State Farm Fire and Casualty Company8900 Amberglen BlvdAustin TX 78729-1110
GLOBALHEALTH(405) 280-5600
GLOBALHEALTH(405) 230-8781
State of OklahomaAffiliated With: GLOBALHEALTH AND GENERATION HEALTHCARE
Fund No:PlanType: Group Health
GLOBALHEALTH(405) 280-5600
GLOBALHEALTH7001 NE 10th StOklahoma City OK 73104
FairPay Solutions(972) 715-8000
FairPay Solutions(972) 715-8000
State of VermontAffiliated With: FairPay Solutions, Inc.
Fund No:PlanType: Workers' Compensation
FairPay Solutions(972) 715-8000
FairPay Solutions
14295 Midway Rd Ste 300Addison TX 75001
Attn: Jon Peebles
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-370• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
AMERICAN INSURANCE ADMINISTRATORS(800) 654-7900
CHECK BENEFIT CARDSTATER BROS. MARKETSAffiliated With: AMERICAN INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
AMERICAN INSURANCE ADMINISTRATORS(800) 654-7900
AMERICAN INSURANCE ADMINISTRATORS13191 CROSSROADS PARK NORTH STE 205CITY OF INDUSTRY CA 91746-3434
STAR HEALTHCARE NETWORK(212) 581-8228
CHECK BENEFIT CARDSTAYWELL HEALTH PLANAffiliated With: STAR HEALTHCARE NETWORK INC
*
Fund No:PlanType: Group Health
STAR HEALTHCARE NETWORK(212) 581-8228
STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019
SRT ADMINISTRATORS, INC.
CHECK BENEFIT CARDSTEPHENS MEDIA GROUPAffiliated With: SRT ADMINISTRATORS, INC.
Fund No:PlanType: Group Health
SRT ADMINISTRATORS, INC.
SRT ADMINISTRATORS, INC.PO Box 25160SCOTTSDALE AZ 85255-0102
THE LOOMIS COMPANY(877) 634-9814
CHECK BENEFIT CARDSTERLING MEDICAL CORPORATION
Affiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(877) 634-9814
THE LOOMIS COMPANYPO Box 7045WYOMISSING PA 19610
PREFERRED CARE, INC.(215) 639-6208
PREFERRED CARE, INC.STOCK CAR CLUB OF AMERICAAffiliated With: PREFERRED CARE
Fund No:PlanType: Group Health
PREFERRED CARE, INC.(215) 639-6208
PREFERRED CARE, INC.6 Neshaminy Interplex #205TREVOSE PA 19053
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-371• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
STOCKYARD BANKAffiliated With: PREFERRED HEALTH PLAN INC 962550088
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(502) 992-4535
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
KLAIS & COMPANY INC(800) 331-1096
CHECK BENEFIT CARDSTONEHILL UNIVERSITYAffiliated With: KLAIS & COMPANY
Fund No:PlanType: Group Health
KLAIS & COMPANY INC(800) 331-1096
KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313
StrataCare Inc StrataCare IncSTRATACAREAffiliated With: STRATACARE
Fund No:PlanType: Workers' Compensation
Some service groups include, Interplan and/or MPN Select or MPN Primary in CA,
StrataCare Inc StrataCare Inc16800 Aston 2nd FloorIrvine CA 92606
THE LOOMIS COMPANY(866) 340-7182
UM NOT APPLICABLESTRINE PRINTINGAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(866) 340-7182
THE LOOMIS COMPANY850 N PARK RDWYOMISSING PA 19610
AMERICA'S CHOICE HEALTHPLANS, LLC(713) 895-3900
CHECK BENEFIT CARDSTURNER AND KLEINAffiliated With: AMERICA'S CHOICE HEALTHPLANS, LLC
Fund No:PlanType: Group Health
AMERICA'S CHOICE HEALTHPLANS, LLC(713) 895-3900
AMERICA'S CHOICE HEALTHPLANS, LLC13111 Northwest Fwy, Ste 510Houston TX 77040
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-372• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERSuffolkAffiliated With: New York State Insurance Fund
*
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
PREFERRED BENEFIT ADMINISTRATORS(407) 786-2777
CHECK BENEFIT CARDSun Coast Media GroupAffiliated With: PREFERRED BENEFIT ADMINISTRATORS INC
*
Fund No:PlanType: Group Health
PREFERRED BENEFIT ADMINISTRATORS(407) 786-2777
PREFERRED BENEFIT ADMINISTRATORSPO Box 916188LONGWOOD FL 32791-6188
America's TPA(952) 896-4888
CHECK BENEFIT CARDSUN COUNTY AIRLINESAffiliated With: AMERICA'S TPA
Fund No:PlanType: Group Health
America's TPA(952) 896-4888
America's TPAPO Box 398220Bloomington MN 55439
SCHALLER ANDERSON HEALTHCARE LLC(866) 479-1130
SCHALLER ANDERSON HEALTHCARE LLC(866) 479-1130
SUN HEALTHAffiliated With: SCHALLER ANDERSON HEALTHCARE
Fund No:PlanType: Group Health
SCHALLER ANDERSON HEALTHCARE LLC(866) 479-1130
SCHALLER ANDERSON HEALTHCARE LLCPO Box 60850Phoenix AZ 85082
DELTA HEALTH SYSTEMS(800) 422-6099
UM NOT APPLICABLESUN PACIFICAffiliated With: DELTA HEALTH SYSTEMS
Fund No:PlanType: Group Health
DELTA HEALTH SYSTEMS(800) 422-6099
DELTA HEALTH SYSTEMS555 W Benjamin Holt DrStockton CA 95207
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-373• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PINNACLE CLAIMS MANAGEMENT
CHECK BENEFIT CARDSUN PACIFIC FARMINGAffiliated With: PINNACLE CLAIMS MANAGEMENT
Fund No:PlanType: Group Health
PINNACLE CLAIMS MANAGEMENT
PINNACLE CLAIMS MANAGEMENT17620 FITCH STIRVINE CA 92614
TRIDENT PLAN ADMINISTRATORS(602) 240-2404
CHECK BENEFIT CARDSUN VALLEY MASONRY, INC.Affiliated With: UNITED CLAIMS SOLUTIONS
Fund No:PlanType: Group Health
TRIDENT PLAN ADMINISTRATORS(602) 240-2404
TRIDENT PLAN ADMINISTRATORS5045 N 12TH St Ste APhoenix AZ 85014
PPC(800) 446-5439
PRIMARY PHYSICIANCARE, INC.7045232758
SUNBELT RENTALSAffiliated With: PRIMARY PHYSICIANSCARE INC
Fund No:PlanType: Group Health
PPC(800) 446-5439
PPCPO Box 11088CHARLOTTE NC 28220
CHECK BENEFIT CARD CHECK BENEFIT CARDSUNMEDAffiliated With: STAR HEALTHCARE NETWORK INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD CHECK BENEFIT CARDSUNRISE CREATIVE GROUP INCAffiliated With: BENESIGHT
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-374• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
SUPERIOR FEDERAL CREDIT UNION (SFCU)
Affiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
CHECK BENEFIT CARDSUPERIOR JANITORIALAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388
*
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218
BENEFIT CONCEPTS, INC.(610) 337-2600
CHECK BENEFIT CARDSURGICAL MONITORING SERVICES INC
Affiliated With: BENEFIT CONCEPTS INC
Fund No:PlanType: Group Health
BENEFIT CONCEPTS, INC.(610) 337-2600
BENEFIT CONCEPTS, INC.PO Box 61553KING OF PRUSSIA PA 19406
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
SW RESOURCES INCAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
Broadspire(860) 282-4960
CONTACT EMPLOYERSwiss ReAffiliated With: Swiss Re
Fund No:PlanType: Workers' Compensation
Broadspire(860) 282-4960
First HealthPO Box 5318Tampa FL 33675-5318
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-375• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERSyracuseAffiliated With: New York State Insurance Fund
*
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
SYRACUSE CHINA - ACTIVEAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
SYRACUSE CHINA - RETIREDAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
HEALTH NET FEDERAL SERVICES(972) 550-2836
UM NOT APPLICABLESYRACUSE FEE BASISAffiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
HEALTH NET FEDERAL SERVICES(972) 550-2836
SYRACUSE FEE BASIS
113 HOLLAND AVEALBANY NY 12208
Attn: FEE BASIS 136E
SYRACUSE VAMC CHECK BENEFIT CARDSYRACUSE VAMC 3199Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
SYRACUSE VAMC SYRACUSE VAMC
800 IRVING AVESYRACUSE NY 13210
Attn: FEE BASIS 04
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-376• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FLORIDA HEALTH ADMINISTRATORS(954) 366-0111
DELPHI(727) 573-5737
SYSTEMAX, INCAffiliated With: FLORIDA HEALTH ADMINISTRATORS (FHA)
Fund No:PlanType: Group Health
FLORIDA HEALTH ADMINISTRATORS(954) 366-0111
FLORIDA HEALTH ADMINISTRATORSPO Box 327810Fort Lauderdale FL 33332
America's TPA(866) 478-6268
CHECK BENEFIT CARDTAHERAffiliated With: AMERICAS TPA
Fund No:PlanType: Group Health
America's TPA(866) 478-6268
America's TPAPO Box 398220Bloomington MN 55439
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
TAHOE BILTMORE LODGE & CASINO % OF SAVINGS - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
TAHOE BILTMORE LODGE & CASINO PEPM
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
CHECK BENEFIT CARD CHECK BENEFIT CARDTAHOE TRUCKEE SIERRA DISPOSAL COMPANY
Affiliated With: CAPITOL ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-377• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
STAR HEALTHCARE NETWORK(212) 581-8228
UM NOT APPLICABLETAKECARE INSURANCE COMPANY
Affiliated With: STAR HEALTHCARE NETWORK INC
Fund No:PlanType: Group Health
STAR HEALTHCARE NETWORK(212) 581-8228
STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019
CHECK BENEFIT CARD4194233823
CHECK BENEFIT CARDTALBOT AGENCY INCAffiliated With: ADVANCED BENEFIT RESOURCES CORP
Fund No:PlanType: Group Health
CHECK BENEFIT CARD4194233823
CHECK BENEFIT CARD
TAMPA VAMC CHECK BENEFIT CARDTAMPA VAMC 3141Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
TAMPA VAMC TAMPA VAMC10770 NORTH 46TH STTAMPA FL 33617
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
TATE & SNYDER ARCHITECTSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
EBA&M(800) 776-1545
HINES & ASSOCIATES(800) 528-2498
TBP ARCHITECTUREAffiliated With: EBA&M #10160
Fund No:PlanType: Group Health
EBA&M(800) 776-1545
EBA&MPO Box 5079WESTLAKE VILLAGE CA 91359
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-378• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CENBEN USA(614) 797-5204
CHECK BENEFIT CARDTC CONSTRUCTIONAffiliated With: CENBEN USA INC
Fund No:PlanType: Group Health
CENBEN USA(614) 797-5204
CENBEN USA
4079 Executive PkwyWesterville OH 43081
Attn: Melissa Joseph
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
TED WIENS TIRE & AUTO CENTERS TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
TEMPLE VAMC CHECK BENEFIT CARDTEMPLE VAMC 3167Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
TEMPLE VAMC TEMPLE VAMC
1901 VETERANS MEMORIAL DRTEMPLE TX 76504
Attn: MED ACCT MGT SECT
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
CHECK BENEFIT CARDTERO TEK INTERNATIONAL INCAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388
*
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
TERRA CONTRACTINGAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-379• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
TERRIBLE HERBSTAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
THE LOOMIS COMPANY(800) 346-1223
SIERRA HEALTH OPTIONS(800) 873-5791
TERRIBLE HERBSTAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(800) 346-1223
THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011
Zenith Administrators(602) 200-3934
Zenith AdministratorsTESSENDERLO KERLEY, INC.Affiliated With: ZENITH ADMINISTRATORS INC PHOENIX OFFICE
Fund No:PlanType: Group Health
Zenith Administrators(602) 200-3934
Zenith Administrators2001 CAMELBACKPHOENIX AZ 85014
BOON CHAPMAN(800) 252-9653
CHECK BENEFIT CARDTETRA Technologies Inc.Affiliated With: BOON CHAMPMAN
*
Term Effective: 12/31/2007Fund No:PlanType: Group Health
BOON CHAPMAN(800) 252-9653
BOON CHAPMANPO Box 9201AUSTIN TX 78766
American Administrative Group(800) 658-9777
American Administrative Group(877) 202-6379 Ext 2530
TEXAS AGRICULTURAL COOPERATIVE TRUST
Affiliated With: AMERICAN ADMINISTRATIVE GROUP
Fund No:PlanType: Group Health
American Administrative Group(800) 658-9777
American Administrative GroupPO Box 53070LUBBOCK TX 79453
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-380• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDTEXAS WESLEYAN UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDTEXAS WOMAN'S UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
CHECK BENEFIT CARD CHECK BENEFIT CARDTextile Staff FundAffiliated With: Amalgamated Life Insurance Co.
Fund No:PlanType: Group Health
CHECK BENEFIT CARD ALICOPO Box 1449New York NY 10116-1449ECS Payor ID 13550
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 742-7345
THE ASTORIA CORPORATION - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
FISERV HEALTH INC(866) 868-8230
FISERV HEALTH INC(866) 868-8230
THE BAMA COMPANIESAffiliated With: FISERV HEALTH
Fund No:PlanType: Group Health
FISERV HEALTH INC(866) 868-8230
FISERV HEALTH INCPO Box 690450SAN ANTONIO TX 78269
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-381• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650
MED-CERT(800) 356-7126
THE BRINK GROUPAffiliated With: NORTH AMERICA ADMINISTRATORS LP TENNESSEE
Fund No:PlanType: Group Health
NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650
NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202
PRIMARY PHYSICIANCARE, INC.(800) 446-5439
PRIMARY PHYSICIANCARE, INC.(800) 446-5439
THE CATO CORPORATIONAffiliated With: RRIMARY PHYSICIANCARE INC
Fund No:PlanType: Group Health
PRIMARY PHYSICIANCARE, INC.(800) 446-5439
PRIMARY PHYSICIANCARE, INC.PO Box 11088CHARLOTTE NC 28220
EPOCH GROUP LC(800) 255-6065
UM NOT APPLICABLETHE CBE GROUPAffiliated With: THE EPOCH GROUP
Fund No:PlanType: Group Health
EPOCH GROUP LC(800) 255-6065
EPOCH GROUP LCPO Box 12170OVERLAND PARK KS 66282
PEARCE ADMINISTRATION(888) 722-1668
CHECK BENEFIT CARDTHE CITADELAffiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 722-1668
PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437
PROFESSIONAL CLAIMS MGMT(800) 590-6500
CHECK BENEFIT CARDTHE CITY OF EAST CHICAGOAffiliated With: PROFESSIONAL CLAIMS MANAGEMENT
Fund No:PlanType: Group Health
PROFESSIONAL CLAIMS MGMT(800) 590-6500
PROFESSIONAL CLAIMS MGMT16 W 455 S FRONTGATE RD STE 216BURR RIDGE IL 60527
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-382• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PROFESSIONAL CLAIMS MGMT(800) 590-6500
CHECK BENEFIT CARDTHE CITY OF HAMMONDAffiliated With: PROFESSIONAL CLAIMS MANAGEMENT
Fund No:PlanType: Group Health
PROFESSIONAL CLAIMS MGMT(800) 590-6500
PROFESSIONAL CLAIMS MGMT16 W 455 S FRONTGATE RD STE 216BURR RIDGE IL 60527
ACS BENEFIT SERVICES, INC.(800) 255-6065
CHECK BENEFIT CARDTHE ENCORE GROUPAffiliated With: ACS BENEFIT SERVICES, INC
Fund No:PlanType: Group Health
ACS BENEFIT SERVICES, INC.(800) 849-5370
ACS BENEFIT SERVICES, INC.PO Box 2000Winston-Salem SC 27102
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
THE GREENSPUN CORPORATIONAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
THE LOOMIS COMPANY(800) 346-1223
UM NOT APPLICABLETHE HERBST GAMING MIDWEST CASINOS
Affiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(800) 346-1223
THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
THE KEENEY MANUFACTURING COMPANY
Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION
Fund No:PlanType: Group Health
DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524
DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-383• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDTHE KEMPTON CO ADVANTAGE HEALTH PLANS
Affiliated With: NATIONAL HEALTH BENEFIT CORPORATION (NHBC)
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD CHECK BENEFIT CARDTHE LAYTON COMPANIESAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
THE LIFELINE HEALTH GROUPAffiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(502) 992-4535
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
Health Design Plus(877) 286-3559
Health Design Plus(800) 385-7085
THE LONGABERGER COMPANY - PRIMARY
Affiliated With: HEALTH DESIGN PLUS
Fund No:PlanType: Group Health
Health Design Plus(330) 463-1181
Health Design Plus1755 GEORGETOWN ROADHUDSON OH 44236
Health Design Plus(877) 286-3559
Health Design Plus(800) 385-7085
THE LONGABERGER COMPANY - WRAP
Affiliated With: HEALTH DESIGN PLUS
Fund No:PlanType: Group Health
Health Design Plus(330) 463-1181
Health Design Plus1755 GEORGETOWN ROADHUDSON OH 44236
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-384• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Health Design Plus(800) 893-0777
Health Design Plus(888) 463-3737
THE LUBRIZOL CORPORATIONAffiliated With: HEALTH DESIGN PLUS
Fund No:PlanType: Group Health
Health Design Plus(800) 893-0777
Health Design PlusPO Box 2581HUDSON OH 44236
THE LOOMIS COMPANY(866) 473-6615
CHECK BENEFIT CARDThe Medical TeamAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(866) 473-6615
THE LOOMIS COMPANY850 N PARK RDWYOMISSING PA 19610
Health Design Plus(877) 286-3559
Health Design Plus(800) 385-7085
THE MIDLAND GUARDIAN COMPAN - PRIMARY
Affiliated With: HEALTH DESIGN PLUS
Fund No:PlanType: Group Health
Health Design Plus(877) 286-3559
Health Design Plus1755 GEORGETOWN ROADHUDSON OH 44236
Health Design Plus(877) 286-3559
Health Design Plus(800) 385-7085
THE MIDLAND GUARDIAN COMPANY TRAVEL
Affiliated With: HEALTH DESIGN PLUS
Fund No:PlanType: Group Health
Health Design Plus(877) 286-3559
Health Design Plus1755 GEORGETOWN ROADHUDSON OH 44236
TRUSTMARK INSURANCE CO(800) 544-7312
PHS(800) 253-4417
THE PAPER TIGERSAffiliated With: TRUSTMARK INS CO #962500650
Fund No:PlanType: Group Health
TRUSTMARK INSURANCE CO
TRUSTMARK INSURANCE COPO Box 2942CLINTON IA 52733
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-385• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
American Administrative Group(877) 782-6828
American Administrative Group(877) 202-6379 Ext 2530
The Parker GroupAffiliated With: American Administrative Group
Fund No:PlanType: Group Health
American Administrative Group(877) 782-6828
American Administrative GroupPO Box 33159San Antonio TX 78265-3159
ULTRABENEFITS INC(866) 858-7223
CHECK BENEFIT CARDTHE PATRON SPIRITS COMPANYAffiliated With: ULTRABENEFITS
Fund No:PlanType: Group Health
ULTRABENEFITS INC(866) 858-7223
ULTRABENEFITS INCPO Box 763WESTBOROUGH MA 01581
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
THE PENN TRAFFIC COMPANYAffiliated With: NORTH AMERICAN ADMINISTRATORS - NY
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226
CBCA Administrators Inc(866) 510-8782
CBCA Administrators IncTHE PERMANENTE MEDICAL GROUP, INC.
Affiliated With: CBCA Administrators, Inc.
Fund No:PlanType: Group Health
CBCA Administrators Inc(866) 510-8782
CBCA Administrators IncPO Box 1339Minneapolis MN 55440-1339
CHECK BENEFIT CARD5094734074
CHECK BENEFIT CARDTHE PHYSICIAN HOSP COMMUNITY ORGANIZATION PHCO
Affiliated With: THE PHYSICIAN HOSP COMMUNITY ORGANIZATION PHCO
Fund No:PlanType: Group Health
CHECK BENEFIT CARD5094734074
CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-386• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CNIC HEALTH SOLUTIONS(800) 426-7453
CNIC HEALTH SOLUTIONS
THE POINT ORLANDO RESORTAffiliated With: CNIC HEALTH SOLUTIONS
Fund No:PlanType: Group Health
CNIC HEALTH SOLUTIONS(800) 426-7453
CNIC HEALTH SOLUTIONSPO Box 3559ENGLEWOOD CO 80155-3559
ADMINONE CORPORATION(800) 967-2077
MEDCAREONE CORP(800) 816-1206
THE PRICE COMPANYAffiliated With: ADMINONE CORPORATION
Fund No:PlanType: Group Health
ADMINONE CORPORATION(800) 967-2077
RESOURCEONE ADMINSTRATORS
PO Box 489BUCKEYSTOWN MD 21717
Attn: Mary Shepherd
Mountain States Administrative Services(520) 722-7133
CHECK BENEFIT CARDTHE SUNDT COMPANIESAffiliated With: MT STATES ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
Mountain States Administrative Services(520) 722-7133
Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710
SCHALLER ANDERSON HEALTHCARE LLC(602) 659-1418
SCHALLER ANDERSON HEALTHCARE LLC(602) 659-1488
THE SUNDT COMPANIES INCAffiliated With: SCHALLER ANDERSON HEALTHCARE
Fund No:PlanType: Group Health
SCHALLER ANDERSON HEALTHCARE LLC(602) 659-1418
SCHALLER ANDERSON HEALTHCARE LLC4645 E. COTTON CENTER BLVD BLDG 1 #200PHOENIX AZ 85040
THE TERTELIN COMPANY, INC.
CHECK BENEFIT CARDTHE TERTELING COMPANY INCAffiliated With: THE TERTELING COMPANY INC
Fund No:PlanType: Group Health
THE TERTELIN COMPANY, INC.
THE TERTELIN COMPANY, INC.1665 Hill RdBoise ID 83702
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-387• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750
PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750
THE TILE SHOPAffiliated With: PREFERREDONE ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750
PREFERREDONE ADMINISTRATIVE SERVICESPO Box 59212MINNEAPOLIS MN 55459
TR Paul Inc(203) 426-8161
HINES & ASSOCIATESTHE VANTAGE GROUP, INCAffiliated With: TR PAUL INC
Fund No:PlanType: Group Health
TR Paul Inc(203) 426-8161
TR Paul IncPO Box 5508NEWTOWN CT 06470-5508
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
THE VERMONT TEDDY BEAR COAffiliated With: NORTH AMERICAN ADMINISTRATORS - NY
Fund No:PlanType: Group Health
NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922
NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
THE WALTERS GROUPAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CHECK BENEFIT CARD8007773575
CHECK BENEFIT CARDTHE WINE GROUPAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8007773575
CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-388• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259
CHECK BENEFIT CARDTHOMAS & SKINNER INCAffiliated With: ALLIED BENEFIT SYSTEMS INC
Fund No:PlanType: Group Health
ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259
ALLIED BENEFIT SYSTEMS, INC208 S LASALLE ST STE 1300CHICAGO IL 60604
ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259
CHECK BENEFIT CARDTHOMAS AND SKINNER INCAffiliated With: ALLIED BENEFIT SYSTEMS
Fund No:PlanType: Group Health
ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259
ALLIED BENEFIT SYSTEMS, INC208 S LASALLE ST STE 1300CHICAGO IL 60604
HUDSON VALLEY VA HEALTHCARE SYSTEM(702) 242-7345
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
THORNDAL ARMSTRONG AND DELK - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
TALL TREE ADMINISTRATORS(801) 274-8100
CORVEL(801) 269-8723
THORNWOOD FUNITUREAffiliated With: TALL TREE ADMINISTRATORS
Fund No:PlanType: Group Health
TALL TREE ADMINISTRATORS(801) 274-8100
TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107
PREFERRED CARE, INC.(215) 639-6208
PREFERRED CARE, INC.THOROUGHBRED RACING ASSOCIATION OF NORTH AMERICA INC
Affiliated With: PREFERRED CARE
Fund No:PlanType: Group Health
PREFERRED CARE, INC.(215) 639-6208
PREFERRED CARE, INC.6 Neshaminy Interplex #205TREVOSE PA 19053
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-389• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDTIC AGENCIESAffiliated With: STAR HEALTHCARE NETWORK INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
EBMS(800) 777-3575
EBMS(800) 777-3575
TIDEWATER BARGED LINES, INCAffiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES INC (EBMS)
Fund No:PlanType: Group Health
EBMS(800) 777-3575
EBMSPO Box 21367BILLINGS MT 59104-1367
International Claims Services(877) 916-7920
International Claims Services(877) 916-7920
TieCare International IncAffiliated With: TieCare International Inc
Fund No:PlanType: Group Health
-Network participation is contingent upon proper member identification. The First Health® Network Logo must be on the benefit card.
International Claims Services(877) 916-7920
International Claims Services27092 BurbankFoothill Ranch CA 92610
BENEFIRST LLC7818374402
CHECK BENEFIT CARDTIGHEWAREHOUSING AND DISTRIBUTION INC
Affiliated With: BENEFIRST LLC
Term Effective: 8/31/2007Fund No:PlanType: Group Health
BENEFIRST LLC7818374402
BENEFIRST LLC1020 PLAINMARSHFIELD CENTER MA 02050
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-390• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDTILLAMOOK COUNTY GENERAL HOSPITAL
Affiliated With: ADVENTIST HEALTH SYSTEM / WEST
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
KEY BENEFIT ADMINISTRATORS(866) 387-0489
FORTIS BENEFITS INSURANCE COMPANY(866) 387-3407
TIME HEALTHY VENTURESAffiliated With: ASSURANT HEALTH
Fund No:PlanType: Group Health
KEY BENEFIT ADMINISTRATORS(317) 284-7649
KEY BENEFIT ADMINISTRATORS8330 ALLISON POINT TRAILINDIANAPOLIS IL 46250
MERITAIN HEALTH(800) 842-3216
CHECK BENEFIT CARDTIPPMAN GROUPAffiliated With: MERITAIN HEALTH
Fund No:PlanType: Group Health
MERITAIN HEALTH(800) 842-3216
MERITAIN HEALTH
PO Box 853921Richardson TX 75085-3921
Attn: Claims Dept
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 742-7345
TITAN STAIRS & TRIM TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CHECK BENEFIT CARD CHECK BENEFIT CARDTMCAAffiliated With: STAR HEALTHCARE NETWORK INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-391• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
TOGUS VA MEDICAL CENTER
CHECK BENEFIT CARDTOGUS VA MEDICAL CENTER 3115
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
TOGUS VA MEDICAL CENTER
TOGUS VA MEDICAL CENTER
ONE VA CENTER - RT 17AUGUSTA ME 04330
Attn: FEE BASIS (BSL4)
CHECK BENEFIT CARD CHECK BENEFIT CARDTOKIO MARINE - CHANNELINGAffiliated With: Tokio Marine Management, Inc.
Fund No:PlanType: Workers' Compensation
Includes Exclusive Preferred Providers (OCN ONLY)
CHECK BENEFIT CARD CHECK BENEFIT CARD
CONTACT EMPLOYER CONTACT EMPLOYERTokio Marine ManagementAffiliated With: Tokio Marine Management, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
CHECK BENEFIT CARD CHECK BENEFIT CARDTokio Marine Management AutoAffiliated With: Tokio Marine Management Auto
Fund No:PlanType: Auto
CHECK BENEFIT CARD CHECK BENEFIT CARD
Attn:
EMPLOYER GROUP EMPLOYER GROUPTokio Marine Management BR4 WCAffiliated With: Tokio Marine Management
Fund No:PlanType: Workers' Compensation
EMPLOYER GROUP EMPLOYER GROUP
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-392• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERTokio Marine Management, Inc.Affiliated With: Genex Services, Inc.
Fund No:PlanType: Workers' Compensation
-Formerly accessed through GENEX Services, Inc.
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
TOMAH VAMC CHECK BENEFIT CARDTOMAH VAMC 3166Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
TOMAH VAMC TOMAH VAMC
500 E VETERANS STTOMAH WI 54660
Attn: FEE 136B2
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
UM NOT APPLICABLETOP FLIGHT BUILDING SERVICES, INC
Affiliated With: FCE BENEFIT ADMINISTRATORS INC #10388
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218
MEDICAL CLAIMS SERVICES, INC.(888) 225-0522
AMERICAN HEALTH HOLDINGS INC(800) 592-9858
TOP LINE EXPRESS INCAffiliated With: MEDICAL CLAIMS SERVICE INC
Fund No:PlanType: Group Health
MEDICAL CLAIMS SERVICES, INC.(888) 225-0522
MEDICAL CLAIMS SERVICES, INC.1 WALL ST STE 2ARAVENSWOOD WV 26164
TOPEKA VA MEDICAL CENTER
CHECK BENEFIT CARDTOPEKA VA MEDICAL CENTER 3529
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
TOPEKA VA MEDICAL CENTER
TOPEKA VA MEDICAL CENTER
2200 S W GAGE BLVDTOPEKA KS 66622
Attn: FEE BASIS
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-393• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PINNACLE CLAIMS MANAGEMENT
CHECK BENEFIT CARDTORRANCE UNIFIED SCHOOL DISTRICT (RETIREES)
Affiliated With: PINNACLE CLAIMS MANAGEMENT
Fund No:PlanType: Group Health
PINNACLE CLAIMS MANAGEMENT
PINNACLE CLAIMS MANAGEMENT17620 FITCH STIRVINE CA 92614
PINNACLE CLAIMS MANAGEMENT
CHECK BENEFIT CARDTORRANCE UNIFIED SCHOOL DISTRICT (WRAP)
Affiliated With: PINNACLE CLAIMS MANAGEMENT
Fund No:PlanType: Group Health
PINNACLE CLAIMS MANAGEMENT
PINNACLE CLAIMS MANAGEMENT17620 FITCH STIRVINE CA 92614
HERITAGE CONSULTANTS INC8639674139
HEALTHCHOICE8639674139
TORWESTAffiliated With: HERITAGE CONSULTANTS INC
Fund No:PlanType: Group Health
HERITAGE CONSULTANTS INC8639674139
HERITAGE CONSULTANTS INC
CompIQ Corporation(800) 293-3131
CompIQ Corporation(800) 293-3131
Total Managed Care (TMC)Affiliated With: CompIQ
Fund No:PlanType: Workers' Compensation
CompIQ Corporation(800) 293-3131
CompIQ Corporation2 South PointeLake Forest CA 92630
CHECK BENEFIT CARD CHECK BENEFIT CARDTOUR MEDAffiliated With: STAR HEALTHCARE NETWORK INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-394• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MMSI(866) 222-3914
MMSI(866) 222-3914
TOWN OF GILBERTAffiliated With: MMSI
Fund No:PlanType: Group Health
MMSI(866) 222-3914
MMSI4001 41ST STREET NWROCHESTER MN 55901
EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002
UM NOT APPLICABLE(800) 367-9939
TOWN OF SCHERERVILLEAffiliated With: EMPLOYEE BENEFIT CONSULTANTS INC
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002
EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGTOWN OF THERMOPOLISAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGPO Box 98WORLAND WY 82401
TRUSTEED PLANS SERVICE GROUP(800) 426-9786
TRUSTEED PLANS SERVICE GROUP(800) 426-9786
TPSC WRAPAffiliated With: TRUSTEED PLANS SERVICE CORPORATION
Fund No:PlanType: Group Health
TRUSTEED PLANS SERVICE GROUP(800) 426-9786
TRUSTEED PLANS SERVICE GROUPPO Box 1894TACOMA WA 98401-1894
NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650
MED-CERT(800) 356-7126
TRANSITIONS OF WESTERN ILAffiliated With: NORTH AMERICA ADMINISTRATORS LP TENNESSEE
Fund No:PlanType: Group Health
NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650
NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-395• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
BENEFIT PROGRAM ADMINISTRATOR(562) 463-5070
CHECK BENEFIT CARDTRANSPORTATION COMMUNICATIONS UNION
Affiliated With: TRANSPORTATION COMMUNICATIONS UNION
Fund No:PlanType: Group Health
BENEFIT PROGRAM ADMINISTRATOR(562) 463-5070
BENEFIT PROGRAM ADMINISTRATOR13191 CROSSROADS PARK NORTH STE 205CITY OF INDUSTRY CA 91746-3434
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
UM NOT APPLICABLETRANSPORTATION EMPLOYEEAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218
BENEFIT COORDINATORS CORP.(800) 685-6100
CHECK BENEFIT CARDTRANSWESTERN PUBLISHING COMPANY LLC
Affiliated With: BENEFIT COORDINATORS CORP.
Fund No:PlanType: Group Health
BENEFIT COORDINATORS CORP.(800) 685-6100
BENEFIT COORDINATORS CORP.111 RYANPITTSBURGH PA 15205-1324
CHECK BENEFIT CARD CHECK BENEFIT CARDTRAVEL GUARD CANADAAffiliated With: STAR HEALTHCARE NETWORK INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CONTACT EMPLOYER Travelers Property Casualty(800) 842-6569
TravelersAffiliated With: Travelers
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-396• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
TRENDCOAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
DELTA HEALTH SYSTEMS DELTA HEALTH SYSTEMS
TRI COUNTY SCHOOLS INSURANCE GROUP
Affiliated With: DELTA HEALTH SYSTEMS
Fund No:PlanType: Group Health
DELTA HEALTH SYSTEMS DELTA TEAM CAREPO Box 1147STOCKTON CA 95201
CBCA CHECK BENEFIT CARDTRIAD HOSPITALS, INC.Affiliated With: TRIAD HOSPITALS, INC.
Fund No:PlanType: Group Health
CBCA CBCAPO Box 1181MINNEAPOLIS MN 55440-1181
KLAIS & COMPANY INC(330) 867-8443
CHECK BENEFIT CARDTRINITY COLLEGE SPORTS PLANAffiliated With: KLAIS & COMPANY
Fund No:PlanType: Group Health
KLAIS & COMPANY INC(330) 867-8443
KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313
ADMINONE CORPORATION(800) 967-2077
MEDCAREONE CORP(800) 816-1206
TRINITY HOSPICE INCAffiliated With: ADMINONE CORPORATION
Fund No:PlanType: Group Health
ADMINONE CORPORATION(800) 967-2077
RESOURCEONE ADMINSTRATORS
PO Box 489BUCKEYSTOWN MD 21717
Attn: Mary Shepherd
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-397• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ADMINONE CORPORATION(800) 967-2077
MEDCAREONE CORP(800) 816-1206
Trinity Hospice Inc. (KS)Affiliated With: ADMINONE CORPORATION
Fund No:PlanType: Group Health
ADMINONE CORPORATION(800) 967-2077
RESOURCEONE ADMINSTRATORS
PO Box 489BUCKEYSTOWN MD 21717
Attn: Mary Shepherd
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
TRINITY SALES & LEASING, INC.Affiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDTRINITY UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
TRISTAR Managed Care(714) 245-4813
UM NOT APPLICABLETRISTAR Managed CareAffiliated With: CompIQ #13910
Fund No:PlanType: Workers' Compensation
TRISTAR Managed Care(714) 245-4813
TRISTAR Managed Care203 N Golden Circle Dr Ste 310Santa Ana CA 92705
HEALTHSCOPE BENEFITS INC(866) 885-4944
HEALTHSCOPE BENEFITS INC(501) 218-7691
TRMI/TRAMAffiliated With: HEALTHSCOPE BENEFITS, INC
Fund No:PlanType: Group Health
HEALTHSCOPE BENEFITS INC(800) 560-4664
HEALTHSCOPE BENEFITS INC27 CORPORATE HILL DRLITTLE ROCK AR 72205
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-398• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Professional Benefit Administrators, Inc.(630) 655-3755
CHECK BENEFIT CARD(714) 668-8920
Troy Community School Dist, 30-CAffiliated With: Troy Community School Dist, 30-C
Fund No:PlanType: Group Health
Professional Benefit Administrators, Inc.(630) 655-3755
Professional Benefit Administrators, Inc.900 Jorie Blvd Ste 250Oakbrook IL 60523
UNDERWRITERS SAFETY & CLAIMS(502) 244-1343
UNDERWRITERS SAFETY & CLAIMS
TRUCHECK, INC.Affiliated With: UNDERWRITERS SAFETY & CLAIMS, INC.
Fund No:PlanType: Group Health
UNDERWRITERS SAFETY & CLAIMS(502) 244-1343
UNDERWRITERS SAFETY & CLAIMSPO Box 23790LOUISVILLE KY 40223
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 240-8931
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
TRUMP RUFFIN TOWER I - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 240-8931
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA2720 N. Tenaya Way, Room 507Las Vegas NV 89128
CONTACT EMPLOYER CONTACT EMPLOYERTTC Inc
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Total Claims Solution(800) 376-0110
Total Claims Solution(800) 376-0110
TTX CompanyAffiliated With: TTX Company
*
Term Effective: 12/31/2007Fund No:PlanType: Group Health
Total Claims Solution(800) 376-0110
Total Claims SolutionPO Box 10888Green Bay WI 54307-0888
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-399• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
TUCSON VAMC CHECK BENEFIT CARDTUCSON VAMC 3176Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
TUCSON VAMC TUCSON VAMC
3601S 6TH AVETUCSON AZ 85723
Attn: 9-13E
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
CHECK BENEFIT CARDTUFTS UNIVERSITY - ACIAffiliated With: ADMINISTRATIVE CONCEPTS INC
Fund No:PlanType: Group Health
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706
TUSCALOOSA VAMC CHECK BENEFIT CARDTUSCALOOSA VAMC 3541Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
TUSCALOOSA VAMC TUSCALOOSA VAMC
3701 LOOP RD EASTTUSCALOOSA AL 35404
Attn: FEE BASIS BMS/FB
TUSKEGEE VAMC (CENTRAL ALABAMA HCS)
CHECK BENEFIT CARDTUSKEGEE VAMC (CENTRAL ALABAMA HCS) 3544
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
TUSKEGEE VAMC (CENTRAL ALABAMA HCS)
TUSKEGEE VAMC (CENTRAL ALABAMA HCS)
2400 HOSPITAL RDTUSKEGEE AL 36083
Attn: FEE BASIS 136F
NATIVE PLUS(800) 811-0119
CHECK BENEFIT CARDTWENTY-NINE PALMS BAND OF MISSION INDIANS
Affiliated With: NATIVE PLUS
Fund No:PlanType: Group Health
NATIVE PLUS(800) 811-0119
NATIVE PLUS100 SUNRISE WAY PMB 355PALM SPRINGS CA 92262
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-400• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
DIRECT CARE AMERICA(800) 266-5896
CHECK BENEFIT CARDTWIN OAKS JUVENILE DEVELOPMENTS INC
Affiliated With: THE CHANDLER GROUP #13352
Fund No:PlanType: Group Health
DIRECT CARE AMERICA(800) 266-5896
DIRECT CARE AMERICAPO Box 2090 CSTOW OH 44224
COVENANT ADMINISTRATORS(800) 680-8728
MEDICOR(678) 258-8412
TY COBB HEALTHCARE SYSTEM, INC
Affiliated With: COVENANT ADMINISTRATORS INC
Fund No:PlanType: Group Health
COVENANT ADMINISTRATORS(800) 680-8728
COVENANT ADMINISTRATORS1745 N Brown Rd Ste 400Lawrenceville GA 30043
QVI RISK SOLUTIONS INC(541) 312-8512
CASCADE COMPREHENSIVE CARE(541) 883-2947
TYRHOLM BIG R STORES, INC.Affiliated With: QVI RISK SOLUTIONS, INC.
Fund No:PlanType: Group Health
QVI RISK SOLUTIONS INC(541) 312-8512
QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
CHECK BENEFIT CARDUC EXTENSINS - UC SANTA CRUZAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
CHECK BENEFIT CARDUC EXTENSION - UC BERKLEYAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-401• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
CHECK BENEFIT CARDUC EXTENSION - UC DAVISAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
CHECK BENEFIT CARDUC EXTENSION - UC IRVINEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
CHECK BENEFIT CARDUC EXTENSION - UC LOS ANGELES
Affiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
CHECK BENEFIT CARDUC EXTENSION - UC RIVERSIDEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
CHECK BENEFIT CARDUC EXTENSION - UC SAN DIEGOAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-402• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
CHECK BENEFIT CARDUC EXTENSION - UC SANTA BARBARA
Affiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376
AMERIBEN SOLUTIONS(800) 953-1801
CHECK BENEFIT CARDUCDHSC-HEALTH SCIENCES CAMPUSES
Affiliated With: AMERIBEN SOLUTIONS
Term Effective: 8/31/2007Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 953-1801
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
AMERICAN INSURANCE ADMINISTRATORS/ROSA MONOSTORI(800) 654-7900
CHECK BENEFIT CARDUCLAAffiliated With: AMERICAN INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
AMERICAN INSURANCE ADMINISTRATORS/ROSA MONOSTORI(800) 654-7900
AMERICAN INSURANCE ADMINISTRATORS/ROSA MONOSTORI3415 S. Sepulveda Blvd #200LOS ANGELES CA 90034-6035
CONSUMER HEALTH SOLUTIONS(877) 573-9541
CHECK BENEFIT CARDUHAULAffiliated With: CONSUMER HEALTH SOLUTION
Fund No:PlanType: Group Health
CONSUMER HEALTH SOLUTIONS(877) 573-9541
CONSUMER HEALTH SOLUTIONS333 SOUTH PINE STSPARTANBURG SC 29302
CHECK BENEFIT CARD CHECK BENEFIT CARDUICI THE INSURANCE CENTERAffiliated With: MEGA LIFE AND HEALTH INSURANCE COMPANY
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-403• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDUKIAH VALLEY MEDICAL CENTER EXCLUSIVE
Affiliated With: ADVENTIST HEALTH SYSTEM WEST
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
ADVENTIST HEALTH SYSTEM WEST
CHECK BENEFIT CARDUKIAH VALLEY MEDICAL CENTER PPO
Affiliated With: ADVENTIST HEALTH SYSTEM WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002
JSL ADMINISTRATORS, INC.(910) 480-3100
DOCTORS DIRECT HEALTHCARE(910) 485-0510
Ultimate Textile Inc.Affiliated With: JSL ADMINISTRATORS INC
*
Fund No:PlanType: Group Health
JSL ADMINISTRATORS, INC.(910) 480-3100
JSL ADMINISTRATORS, INC.PO Box 2857FAYETTEVILLE NC 28302
UNARCO COMMERCIAL PRODUCTS INC(800) 749-2631
CHECK BENEFIT CARDUNARCO COMMERCIAL PRODUCTS INC
Affiliated With: EQUITABLE PLAN SERVICES
Fund No:PlanType: Group Health
UNARCO COMMERCIAL PRODUCTS INC(800) 749-2631
UNARCO COMMERCIAL PRODUCTS INCPO Box 720460OKLAHOMA CITY OK 73172
ADVANCED BENEFIT SOLUTIONS LLC(888) 419-1094
AZ Foundation(602) 417-2337
UNI- TEKAffiliated With: ADVANCED BENEFIT SOLUTIONS LLC
Fund No:PlanType: Group Health
ADVANCED BENEFIT SOLUTIONS LLC(888) 419-1094
ADVANCED BENEFIT SOLUTIONS LLC
2222 W Pinnacle Peak Rd Ste 190Phoenix AZ 85027
Attn: Michele Terzich
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-404• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GLOBALCARE(678) 341-1811
UM NOT APPLICABLEUNIFIED GROUP SERVICES - INTEGRAL TECHNOLOGIES
Affiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1811
GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005
GLOBALCARE(678) 341-1811
UM NOT APPLICABLEUNIFIED GROUP SERVICES - WORLD GOSPEL MISSION
Affiliated With: GLOBALCARE INC
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1811
GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005
GLOBALCARE(678) 341-1811
UM NOT APPLICABLEUNILIANCEHEALTH - THE HUGHSTON CLINIC
Affiliated With: GLOBALCARE
Fund No:PlanType: Group Health
GLOBALCARE(678) 341-1811
GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005
THE LOOMIS COMPANY(866) 452-4054
AMERICAN HEALTH HOLDINGS(866) 245-8131
UNION DRILLING COMPANYAffiliated With: THE LOOMIS COMPANY
Fund No:PlanType: Group Health
THE LOOMIS COMPANY(866) 452-4054
THE LOOMIS COMPANY850 N PARK RDWYOMISSING PA 19610
UNION PACIFIC(800) 547-0421
UNION PACIFIC(800) 547-0421
UNION PACIFIC EARLY RETIREE PROGRAM FUND V5017
Affiliated With: UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS
Fund No:PlanType: Group Health
UNION PACIFIC(800) 547-0421
UNION PACIFICPO Box 161020SALT LAKE CITY UT 84116
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-405• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Mountain States Administrative Services(520) 722-7133
Hines and Associates(847) 214-2780
UNISOURCE ENERGY / TUCSON POWER
Affiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
Mountain States Administrative Services(520) 722-7133
Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710
ALICARE, Inc(800) 332-5426
ALICARE, Inc(800) 332-5426
Unite Staff Health Benefit PlanAffiliated With: Amalgamated Life Insurance Co.
Fund No:PlanType: Group Health
ALICARE, Inc(800) 888-5554
For electronic claims submission ID, refer to Benefit Card. Mail all other claims to: ALICARE, Inc.PO Box 1435New York NY 10116-1435ECS Payor ID 13550
UNITED AGRICULTURAL BENEFIT TRUST C/O CCN
CHECK BENEFIT CARDUNITED AGRICULTURAL BENEFIT TRUST
Affiliated With: UNITED AGRICULTURAL BENEFIT TRUST
Fund No:PlanType: Group Health
UNITED AGRICULTURAL BENEFIT TRUST C/O CCN
UNITED AGRICULTURAL BENEFIT TRUST C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
PINNACLE CLAIMS MANAGEMENT INC(800) 649-9121
CHECK BENEFIT CARDUNITED CHURCH OF GODAffiliated With: PINNACLE CLAIMS MANAGEMENT
Fund No:PlanType: Group Health
PINNACLE CLAIMS MANAGEMENT INC(800) 649-9121
PINNACLE CLAIMS MANAGEMENT INCPO Box 2220NEWPORT BEACH CA 92658
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
UNITED COIN & MACHINE COMPANY
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-406• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GROUP & PENSION ADMINISTRATORS(800) 827-7223
HEALTH WATCH(972) 238-7900
UNITED FASHIONS OF TEXAS TRAVEL
Affiliated With: GROUP & PENSION ADMINISTRATORS
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
NATIONAL EMPLOYEE BENEFIT ADMINISTRATORS(800) 842-5899
UM NOT APPLICABLEUnited Food and Commercial Workers Allied Trades Trust Fund
Affiliated With: UNITED FOOD AND COMMERCIAL WORKERS ALLIED TRADES
*
Fund No:PlanType: Group Health
NATIONAL EMPLOYEE BENEFIT ADMINISTRATORS(800) 842-5899
NATIONAL EMPLOYEE BENEFIT ADMINISTRATORS
2010 N W 150th Ave Ste 100Pembroke Pines FL 33028
Attn: Claims Dept
UnitedHealthCare(952) 992-6063
CHECK BENEFIT CARDUnited Health Care (Shared Savings Program)
Affiliated With: United Health Care
Fund No:PlanType: Group Health
UnitedHealthCare(952) 992-6063
UnitedHealthCare5901 Lincoln DrEdina MN 55436
BENEFIT CONCEPTS, INC.(610) 337-2600
BENEFIT CONCEPTS, INC.(800) 883-2000
UNITED OIL RECOVERYAffiliated With: BROKERAGE CONCEPTS #15074
Fund No:PlanType: Group Health
BENEFIT CONCEPTS, INC.(610) 337-2600
BENEFIT CONCEPTS, INC.1021 W 8TH AVEKING OF PRUSSIA PA 19406
Benefit Planners(800) 292-5386
CHECK BENEFIT CARDUNITED STATES BEEF CORPORATION
Affiliated With: BENEFIT PLANNERS
Fund No:PlanType: Group Health
Benefit Planners(800) 292-5386
Benefit PlannersPO Box 690450SAN ANTONIO TX 78269
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-407• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERUnited States Postal ServiceAffiliated With: United States Postal Service
Fund No:PlanType: Workers' Compensation
Hospital Outpatient Bills are not part of the USPS WC Program as of 12/1/2001.
First Health(800) 571-4501
USPS Workers' CompensationPO Box 23808Tucson AZ 85734-3808
ALTERNATIVE INSURANCE RESOURCES(202) 871-3229
CHECK BENEFIT CARDUNITED SURGICAL ASSISTANTS INC
Affiliated With: ALTERNATIVE INSURANCE RESOURCES
Fund No:PlanType: Group Health
ALTERNATIVE INSURANCE RESOURCES(202) 871-3229
ALTERNATIVE INSURANCE RESOURCESPO Box 660787BIRMINGHAM AL 35266
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
UNITED TRIBES TECHNICAL COLLEGE
Affiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
UnitedHealthcare (for the Shared Savings Program).(952) 992-6063
CHECK BENEFIT CARDUnitedHealthcare (for the Shared Savings Program).
Affiliated With: UnitedHealthcare
Fund No:PlanType: Group Health
For provider services inquires please contact 800-774-4339.
UnitedHealthcare (for the Shared Savings Program).(952) 992-6063
UnitedHealthcare (for the Shared Savings Program).5901 Lincoln DrEdina MN 55436
ALLIED ADMINISTRATORS(619) 297-8235
CHECK BENEFIT CARDUNITE-HERE ALLIEDAffiliated With: SAN DIEGO HOTEL & RESTAURANT EMPLOYEE
Fund No:PlanType: Group Health
ALLIED ADMINISTRATORS(619) 297-8235
ALLIED ADMINISTRATORS2831 Camino del Rio S STE 311SAN DIEGO CA 92108
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-408• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
BAC(614) 863-8780
BAC(614) 863-8780
UNITRANSAffiliated With: BUSINES ADMINISTRATORS & CONSULTANTS INC
*
Term Effective: 8/31/2007Fund No:PlanType: Group Health
BAC(614) 863-8780
BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068
CHECK BENEFIT CARD CHECK BENEFIT CARDUNITRINAffiliated With: MITCHELL MEDICAL
Fund No:PlanType: Auto
Unitrin: Administered by Mitchell MedicalExclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD CHECK BENEFIT CARDUnitrin (Auto)Affiliated With: Mitchell Medical
Fund No:PlanType: Auto
Unitrin: Administered by Mitchell Medical
CHECK BENEFIT CARD CHECK BENEFIT CARD
MT STATES ADMINISTRATION CO(520) 722-7133
HINES & ASSOCIATES(847) 214-2780
UNIVERSAL AVIONICSAffiliated With: MT STATES ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
MT STATES ADMINISTRATION CO(520) 722-7133
MT STATES ADMINISTRATION CO7202 E ROSEWOOD STE 200TUCSON AZ 85710
ADMINISTRATIVE SOLUTIONS INC(678) 339-0211
CHECK BENEFIT CARDUNIVERSAL ENVIRONMENTAL CORPORATION
Affiliated With: ADMINISTRATIVE SOLUTIONS, INC.
Fund No:PlanType: Group Health
ADMINISTRATIVE SOLUTIONS INC(678) 339-0211
ADMINISTRATIVE SOLUTIONS INCPO Box 2490ALPHARETTA GA 30023
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-409• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMINISTRATION & MGMT
UNIVERSAL SPACE LINEAffiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
TRUE CHOICE(800) 251-9665
UM NOT APPLICABLEUNIVERSITY CENTRAL OF OKLAHOMA
Affiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE(800) 251-9665
TRUE CHOICEPO Box 700307DALLAS TX 75370
UNIVERSITY HEALTH ALLIANCE
UNIVERSITY HEALTH ALLIANCE
UNIVERSITY HEALTH ALLIANCEAffiliated With: UNIVERSITY HEALTH ALLIANCE
Fund No:PlanType: Group Health
UNIVERSITY HEALTH ALLIANCE
UNIVERSITY HEALTH ALLIANCE700 BISHOP STREETHONOLULU HI 96813
PEARCE ADMINISTRATION(888) 722-1668
CHECK BENEFIT CARDUNIVERSITY NORTH CAROLINA AT PEMBROKE
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(888) 722-1668
PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408
PEARCE ADMINISTRATION(888) 722-1668
CHECK BENEFIT CARDUNIVERSITY NORTH CAROLINA WILMINGTON
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(888) 722-1668
PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-410• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
TRUE CHOICE(800) 251-9665
UM NOT APPLICABLEUNIVERSITY OF ARKANSAS FOR MEDICAL SERVICES
Affiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE(800) 251-9665
TRUE CHOICEPO Box 700307DALLAS TX 75370
AMERIBEN SOLUTIONS(800) 953-1801
CHECK BENEFIT CARDUNIVERSITY OF COLORADO AT DENVER - DOWNTOWN CAMPUS
Affiliated With: AMERIBEN SOLUTIONS #15255
Term Effective: 8/31/2007Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 953-1801
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDUNIVERSITY OF DALLASAffiliated With: ACADEMIC RISK MANAGEMENT
Term Effective: 8/31/2007Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDUNIVERSITY OF GEORGIA AIH0058507
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
MAKSIN MANAGEMENT CORP(800) 285-8133
CHECK BENEFIT CARDUNIVERSITY OF HOUSTON MAINAffiliated With: MAKSIN MANAGEMENT CORPORATION
Fund No:PlanType: Group Health
MACORI ADMINISTRATION(281) 651-8787
MACORI ADMINISTRATION19609 WIEDSPRING TX 77388
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-411• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
STUDENT INSURANCE A DIVISION OF UICI
CHECK BENEFIT CARDUNIVERSITY OF JUDAISMAffiliated With: UnitedHealthcare StudentResources #11689
Term Effective: 8/31/2007Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDUNIVERSITY OF MASSACHUSETTS SCHOLARS
Affiliated With: UnitedHealthcare StudentResources #11689
Term Effective: 8/31/2007Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
STUDENT ASSURANCE SERVICES INC(800) 328-2739
CHECK BENEFIT CARDUNIVERSITY OF NEW ORLEANSAffiliated With: STUDENT ASSURANCE SERVICES INC
Fund No:PlanType: Group Health
STUDENT ASSURANCE SERVICES INC(800) 328-2739
STUDENT ASSURANCE SERVICES INC333 N. MAIN STREETSTILLWATER MN 55082
MAKSIN MANAGEMENT CORP(888) 722-1668
CHECK BENEFIT CARDUNIVERSITY OF NORTH CAROLINA - CHARLOTTE
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
MACORI ADMINISTRATION(888) 722-1668
MACORI ADMINISTRATIONPO Box 2408Florence SC 29503-2408
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDUNIVERSITY OF PHOENIXAffiliated With: UnitedHealthcare StudentResources #11689
Term Effective: 8/31/2007Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-412• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDUNIVERSITY OF PORTLANDAffiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDUNIVERSITY OF SOUTH CAROLINA - MMH0000136
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437
STUDENT ASSURANCE SERVICES(800) 328-2739
CHECK BENEFIT CARDUNIVERSITY OF SOUTHERN INDIANA
Affiliated With: STUDENT ASSURANCE SERVICES
Fund No:PlanType: Group Health
STUDENT ASSURANCE SERVICES(651) 439-7098
STUDENT ASSURANCE SERVICES333 N. MAIN STREETSTILLWATER MN 55082
MAKSIN MANAGEMENT CORP(877) 775-5430
UM NOT APPLICABLEUNIVERSITY OF THE CUMBERLANDS
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
MAKSIN MANAGEMENT CORP(877) 775-5430
MAKSIN MANAGEMENT CORP2500 McClellan AvePennsauken NJ 08109
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
CHECK BENEFIT CARDUNIVERSITY OF VERMONT - ACIAffiliated With: ADMINISTRATIVE CONCEPTS INC
Fund No:PlanType: Group Health
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-413• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDUNIVERSITY OF WEST GEORGIA AIH0058477
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDUNIVERSITY OF WEST GEORGIA AIH0058487
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEUNIVERSITY OF WEST GEORGIA UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
PEARCE ADMINISTRATION(800) 722-1668
CHECK BENEFIT CARDUNIVERSITY OK - NORMAN CAMPUS STUDENTS
Affiliated With: MAKSIN MANAGEMENT CORPORATION
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 722-1668
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
GROUP & PENSION ADMINISTRATORS(800) 827-7223
CHECK BENEFIT CARDUpshur County TravelAffiliated With: GROUP & PENSION ADMINISTRATORS
*
Fund No:PlanType: Group Health
GROUP & PENSION ADMINISTRATORS(800) 827-7223
GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-414• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
NGS AMERICAN8005211555
UM NOT APPLICABLEURBAN SCIENCEAffiliated With: NGS AMERICAN INC
*
Term Effective: 12/31/2007Fund No:PlanType: Group Health
NGS AMERICAN8005211555
NGS AMERICANPO Box 7676DETROIT MI 48080
NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650
MED-CERT(800) 356-7126
URSA FARMERS CO-OPAffiliated With: NORTH AMERICA ADMINISTRATORS LP TENNESSEE
Fund No:PlanType: Group Health
NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650
NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202
CONTACT EMPLOYER CONTACT EMPLOYERUS ConcreteAffiliated With: US Concrete
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
CHECK BENEFIT CARD9166692468
CHECK BENEFIT CARDUS MARSHALL SERVICES PREFERRED PRICING PLAN
Affiliated With: CAPITOL ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD9166692468
CHECK BENEFIT CARD
AMERIHEALTH ADMINISTRATORS2158302596
AMERIHEALTH ADMINISTRATORS2158302596
US VISIONAffiliated With: AMERIHEALTH ADMINISTRATORS
Fund No:PlanType: Group Health
AMERIHEALTH ADMINISTRATORS2158302596
AMERIHEALTH ADMINISTRATORS720 BLAIR MILL RDHORSHAM PA 19044
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-415• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
Health Net USELECT(866) 813-5300
Health Net USELECT(800) 978-3424
USELECT ArizonaAffiliated With: Health Net, Inc.
Fund No:PlanType: Group Health
The First Health® Network is not used for Behavioral Health services.
Health Net USELECT(866) 813-5300
Health Net USELECTPO Box 4225Lexington KY 40512-4225
Health Net USELECT(866) 813-5300
Health Net USELECT(800) 978-3424
USELECT Arizona Travel Member Benefit
Affiliated With: Health Net, Inc.
Fund No:PlanType: Group Health
The First Health® Network is not used for Behavioral Health services.
Health Net USELECT(866) 813-5300
Health Net USELECTPO Box 4225Lexington KY 40512-4225
COMPUSYS OF UTAH, INC.(801) 954-8010
CHECK BENEFIT CARDUTAH CARPENTERS & CEMENT MASONS
Affiliated With: UTAH CARPENTERS AND CEMENT MASONS HEALTH AND WELFA
Fund No:PlanType: Group Health
COMPUSYS OF UTAH, INC.(801) 954-8010
COMPUSYS OF UTAH, INC.PO Box 30021SALT LAKE CITY UT 84130-0101
CHECK BENEFIT CARD CHECK BENEFIT CARDUTAH IDAHO TEAMSTERS SECURITY FUND
Affiliated With: UTAH IDAHO TEAMSTERS SECURITY FUND
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
COMPUSYS(800) 628-6562
UM NOT APPLICABLEUTAH LABORERS HEALTH & WELFARE FUND TRUST / ID
Affiliated With: UTAH PIPE TRADES WELFARE TRUST FUND
Fund No:PlanType: Group Health
COMPUSYS(800) 628-6562
COMPUSYS2156 W 2200 SSALT LAKE CITY UT 84119-1326
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-416• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
COMPUSYS(800) 628-6562
UM NOT APPLICABLEUTAH LABORERS HEALTH & WELFARE ID
Affiliated With: UTAH LABORERS HEALTH & WELFARE
Fund No:PlanType: Group Health
COMPUSYS(800) 628-6562
COMPUSYS2156 W 2200 SSALT LAKE CITY UT 84119-1326
COMPUSYS(800) 628-6562
UM NOT APPLICABLEUTAH PIPE TRADES WELFARE TRUST FUND / ID
Affiliated With: UTAH PIPE TRADES WELFARE TRUST FUND
Fund No:PlanType: Group Health
COMPUSYS(800) 628-6562
COMPUSYS2156 W 2200 SSALT LAKE CITY UT 84119-1326
COMPUSYS(800) 628-6562
UM NOT APPLICABLEUTAH PIPE TRADES WELFARE TRUST FUND/ID
Affiliated With: UTAH PIPE TRADES WELFARE TRUST FUND
Fund No:PlanType: Group Health
COMPUSYS(800) 628-6562
COMPUSYS2156 W 2200 SSALT LAKE CITY UT 84119-1326
CHECK BENEFIT CARD CHECK BENEFIT CARDVACo Risk Management Programs.Affiliated With: VACo Risk Management Programs.
Fund No:PlanType: Workers' Compensation
CHECK BENEFIT CARD VACo Risk Management Programs104 Church Ave SERoanoke VA 24011
WAUSAU BENEFITS, INC.(715) 841-7802
CHECK BENEFIT CARDVAIL RESORTSAffiliated With: WAUSAU BENEFITS INC
Fund No:PlanType: Group Health
WAUSAU BENEFITS, INC.(715) 841-7802
WAUSAU BENEFITS, INC.
PO Box 8046WAUSAU WI 54401-8046
Attn: LeAnn Fichtner
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-417• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDVALDOSTA STATE UNIV AIH0058517
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDVALDOSTA STATE UNIV AIH0058527
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEVALDOSTA STATE UNIVERSITY UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDVALENCIA COMMUNITY COLLEGE DISTRICT
Affiliated With: UnitedHealthcare StudentResources #11689
Term Effective: 8/31/2007Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
Valley Oak Systems(925) 242-4659
CHECK BENEFIT CARDValley Oak SystemsAffiliated With: Valley Oak Systems
Fund No:PlanType: Workers' Compensation
Valley Oak Systems(925) 242-4659
Valley Oak SystemsBishop Ranch 8 - 5000 Executive Pkwy Ste 340San Ramon CA 94583
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-418• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
VALLEY SERVICE CONNECTIONAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002
UM NOT APPLICABLE(800) 367-9939
VALPARAISO COMMUNITY SCHOOL CORPORATION
Affiliated With: EMPLOYEE BENEFIT CONSULTANTS INC
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002
EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839
PRINCIPAL FINANCIAL GROUP(800) 533-5044
CHECK BENEFIT CARDVALPARAISO UNIVERSITYAffiliated With: PRINCIPAL FINANCIAL GROUP
*
Fund No:PlanType: Group Health
PRINCIPAL FINANCIAL GROUP(800) 533-5044
PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319
INTERNATIONAL BENNEFITS ADMINISTRATOR(800) 422-7617
CHECK BENEFIT CARDVAN WAGNER COMMUNICATIONSAffiliated With: HEALTHDATAINSIGHTS DBA MVPPO
Fund No:PlanType: Group Health
INTERNATIONAL BENNEFITS ADMINISTRATOR(800) 422-7617
INTERNATIONAL BENNEFITS ADMINISTRATOR100 GARDEN CITY PLAZA #102GARDEN CITY NY 11530
GREAT WEST LIFE(800) 795-6610
CHECK BENEFIT CARDVARCO INTERNATIONAL INCAffiliated With: GREAT WEST LIFE
Fund No:PlanType: Group Health
GREAT WEST LIFE(800) 795-6610
GREAT WEST LIFE1000 GREAT-WEST DR.KENNETT MO 63857
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-419• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FISERV HEALTH INC FISERV HEALTH INCVARIAN MEDICAL SYSTEMSAffiliated With: BENESIGHT, INC.
Fund No:PlanType: Group Health
FISERV HEALTH INC FISERV HEALTH INCPO Box 399PUEBLO CO 81002
SELF INSURED PLANS LLC(239) 403-7884
CHECK BENEFIT CARDVCBO ARCHITECTURE LLCAffiliated With: SELF INSURED PLANS, LLC
Fund No:PlanType: Group Health
SELF INSURED PLANS LLC(239) 403-7884
SELF INSURED PLANS LLC1016 COLLIER CENTER WAY STE 200NAPLES FL 34110
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
VEGAS GENERALAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
VEGAS GENERAL - TRAVELAffiliated With: SIERRA HEALTH AND LIFE HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
CHECK BENEFIT CARD CHECK BENEFIT CARDVERICLAIMAffiliated With: STAR HEALTHCARE NETWORK INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-420• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EBPA(800) 846-8060
CHECK BENEFIT CARDVERMONT CTR FOR THE DEAF & HARD OF HEARING - WRAP % JMS
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATOR INC
Fund No:PlanType: Group Health
EBPA(800) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05407
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788
CHECK BENEFIT CARDVERMONT LEGAL AID WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060
COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403
EBPA(802) 846-8060
CHECK BENEFIT CARDVERMONT MECHANICALAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATOR, INC.
Fund No:PlanType: Group Health
EBPA(802) 846-8060
EBPAPO Box 2365SOUTH BURLINGTON VT 05403
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
VERNON SHELTERED WORKSHOP
Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS
Fund No:PlanType: Group Health
HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927
HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018
GISC, INC(800) 242-4472
GISC TOTALCARE(800) 999-1077
VERTEX DISTRIBUTIONAffiliated With: GROUP INSURANCE SERVICE CENTER
Fund No:PlanType: Group Health
GISC, INC(800) 242-4472
GISC, INC20 WINTER STPEMBROKE MA 02359
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-421• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
HEALTH PLAN INC(800) 532-7575
CARE MANAGEMENT SERVICES(866) 325-1550
VESCOMAffiliated With: HEASLTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
UM NOT APPLICABLEVGS INCAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388
*
Fund No:PlanType: Group Health
FCE BENEFIT ADMINISTRATORS INC(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218
ASSURECARE(800) 759-1311
Careline UR(763) 383-4800
VILLAGE OF ALSIPAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 759-1311
ASSURECARE340 Quadrangle DrBolingbrook IL 60440
ASSURECARE(800) 759-1311
Careline UR(763) 383-4800
VILLAGE OF BOLINGBROOKAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 759-1311
ASSURECARE340 Quadrangle DrBolingbrook IL 60440
Western Health(605) 719-4600 or (888) 341-1766
Western Health(605) 719-4640 or (800) 229-0892
Village/Clarkson MT ViewAffiliated With: Rapid City Regional Hospital DBA Western Health
Fund No:PlanType: Group Health
Western Health(605) 719-4600 or (888) 341-1766
Western Health529 Kansas City St Ste 200Rapid City SD 57701
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-422• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
NATIONAL CLAIMS ADMINISTRATIVE SERVICES, INC
NATIONAL CLAIMS ADMINISTRATIVE SERVICES, INC
VIRGINIA WESLEYAN COLLEGEAffiliated With: MARKEL INSURANCE COMPANY
Fund No:PlanType: Group Health
NATIONAL CLAIMS ADMINISTRATIVE SERVICES, INC
NATIONAL CLAIMS ADMINISTRATIVE SERVICES, INCPO Box 3426FAIRFAX VA 22038
TRUE CHOICE(800) 251-9665
UM NOT APPLICABLEVIRGINIA WESLEYAN COLLEGEAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE(800) 251-9665
TRUE CHOICEPO Box 700307DALLAS TX 75370
CONTACT EMPLOYER CONTACT EMPLOYERVirtueMedAffiliated With: VirtueMed, Inc.
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
THE PLAN HANDLERS, INC.(800) 538-5512
THE PLAN HANDLERS, INC.
VISTA UNIFIED SCHOOL DISTRICTAffiliated With: CBIZ/SCEET
Fund No:PlanType: Group Health
THE PLAN HANDLERS, INC.(800) 538-5512
THE PLAN HANDLERS, INC.930 Canterbury Pl.ESCONDIDO CA 92025
Mountain States Administrative Services(520) 722-7133
Hines and Associates(847) 214-2780
VOCATIONAL TRAINING INSTITUTE INC
Affiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES
Fund No:PlanType: Group Health
Mountain States Administrative Services(520) 722-7133
Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-423• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDVOLCANO THERAPEUTICS INCAffiliated With: HEALTHCOMP ADMINISTRATORS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
VSR LOCKAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
HEALTHSCOPE BENEFITS(877) 883-5352
AMERICAN HEALTH HOLDINGS8009723025
W C BRADLEY COAffiliated With: HEALTHSCOPE BENEFITS
Fund No:PlanType: Group Health
HEALTHSCOPE BENEFITS5012187702
HEALTHSCOPE BENEFITS27 CORPORATE HILL DRLITTLE ROCK AR 72205
ULTRABENEFITS INC(866) 858-7223
CHECK BENEFIT CARDW E MANAGEMENT LLCAffiliated With: ULTRABENEFITS, INC.
Fund No:PlanType: Group Health
ULTRABENEFITS INC(508) 438-0007
ULTRABENEFITS INC29 EAST MOUNTAIN STWORCESTER MA 01606
MANAGED BENEFITS ADMINISTRATOR AND INSURANCE CONSULTANTS(800) 877-3727
CRITIQUE(800) 666-5551
WADA FARMS POTATOES INCAffiliated With: MANAGED BENEFITS ADMINISTRATORS AND INSURANCE CONS
Fund No:PlanType: Group Health
MANAGED BENEFITS ADMINISTRATOR AND INSURANCE CONSULTANTS(800) 877-3727
MANAGED BENEFITS ADMINISTRATOR AND INSURANCE CONSULTANTSPO Box 651109SALT LAKE CITY UT 84165-1109
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-424• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CORESOURCE INC(800) 274-6965
CORESOURCE INC(866) 794-0770
WAGNER AND BROWNAffiliated With: CORESOURCE, INC.
Fund No:PlanType: Group Health
CORESOURCE INC(800) 274-6965
CORESOURCE INC7830 E. BroadwayTUCSON AZ 85710
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
WAKO ELECTRONICS (USA) INCAffiliated With: PREFERRED HEALTH PLAN INC 962550088
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(502) 992-4535
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
NGS AMERICAN8005211555
NGS AMERICAN8005211555
WALBRO ENGINE MANAGEMENTAffiliated With: NGS AMERICAN INC
Fund No:PlanType: Group Health
NGS AMERICAN8005211555
NGS AMERICANPO Box 7676DETROIT MI 48080
EMPLOYEE BENEFIT ADMINISTRATORS(626) 294-2800
CHECK BENEFIT CARDWALKER ZANGERAffiliated With: EMPLOYEE BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
EMPLOYEE BENEFIT ADMINISTRATORS(626) 294-2800
EMPLOYEE BENEFIT ADMINISTRATORS424 N. First Ave.ARCADIA CA 91006-2804
ASSURECARE(800) 328-0927
CHECK BENEFIT CARDWALL COLMONOYAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 328-0927
ASSURECARE13700 WATERTOWER CIRCLE STE DPLYMOUTH MN 55441-3705
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-425• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ADVENTIST RISK MANAGEMENT, INC.(909) 353-6800
CHECK BENEFIT CARDWALLA WALLA COLLEGEAffiliated With: ADVENTIST RISK MANAGEMENT, INC.
Fund No:PlanType: Group Health
ADVENTIST RISK MANAGEMENT, INC.(909) 353-6800
ADVENTIST RISK MANAGEMENT, INC.11291 Pierce St.RIVERSIDE CA 92515-8007
WALLA WALLA VAMC CHECK BENEFIT CARDWALLA WALLA VAMC 3182Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
WALLA WALLA VAMC WALLA WALLA VAMC
77 WAINWRIGHT DRWALLA WALLA WA 99362-3994
Attn: FEE 208
CONTACT EMPLOYER CONTACT EMPLOYERWalmart
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
AFFORDABLE BENEFIT ADMINISTRATORS INC(800) 350-0148
AFFORDABLE BENEFIT ADMINISTRATORS, INC.
WALONG MARKETAffiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC. (ABA)
Fund No:PlanType: Group Health
AFFORDABLE BENEFIT ADMINISTRATORS INC(800) 350-0148
AFFORDABLE BENEFIT ADMINISTRATORS, INC.PO Box 10787BURBANK CA 91510
CONTACT EMPLOYER CONTACT EMPLOYERWalt Disney CompanyAffiliated With: StratacareYTD NOAS102 Report
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-426• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
GREAT WEST LIFE(800) 795-6610
CHECK BENEFIT CARDWARD PETROLEUMAffiliated With: GREAT WEST LIFE
Fund No:PlanType: Group Health
GREAT WEST LIFE(800) 795-6610
GREAT WEST LIFE1000 GREAT-WEST DR.KENNETT MO 63857
AMERICAN INSURANCE ADMINISTRATORS
WARD BENEFITSWARNER PACIFICAffiliated With: FIRST UNDERWRITERS INC
Fund No:PlanType: Group Health
AMERICAN INSURANCE ADMINISTRATORS
AMERICAN INSURANCE ADMINISTRATORS3415 S. Sepulveda Blvd #200LOS ANGELES CA 90034-6035
STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700
CHECK BENEFIT CARDWARNER PACIFIC COLLEGEAffiliated With: UnitedHealthcare StudentResources #11689
Term Effective: 8/31/2007Fund No:PlanType: Group Health
STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075
ASSURECARE(800) 422-2026
Careline UR(763) 383-4800
WARREN FABRICATIONAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 422-2026
ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGWASHAKIE COUNTY SCHOOL DISTRICT 2
Affiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGPO Box 98WORLAND WY 82401
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-427• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
WASHINGTON DC VA MEDICAL CENTER
CHECK BENEFIT CARDWASHINGTON DC VA MEDICAL CENTER 3132
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
WASHINGTON DC VA MEDICAL CENTER
WASHINGTON DC VA MEDICAL CENTER
50 IRVING STATION WESTWASHINGTON DC 20422
Attn: FEE BASIS 122
WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 816-6049
UM NOT APPLICABLEWATERSTONE BENEFIT ADMINISTRATORS
Affiliated With: WATERSTONE BENEFIT ADMINISTRATORS
Fund No:PlanType: Group Health
WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 816-6049
WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116
CENBEN USA(614) 797-5204
CHECK BENEFIT CARDWATKINS MANUFACTURINGAffiliated With: CENBEN USA INC
Fund No:PlanType: Group Health
CENBEN USA(614) 797-5204
CENBEN USA
4079 Executive PkwyWesterville OH 43081
Attn: Melissa Joseph
CENBEN USA(614) 797-5204
CHECK BENEFIT CARDWATKINS MANUFACTURING % TRAVEL
Affiliated With: CENBEN USA INC
Fund No:PlanType: Group Health
CENBEN USA(614) 797-5204
CENBEN USA
4079 Executive PkwyWesterville OH 43081
Attn: Melissa Joseph
SISCO(800) 547-4726
CHECK BENEFIT CARDWAUPACA NORTHWOODSAffiliated With: SISCO/Cottingham & Butler
Fund No:PlanType: Group Health
SISCO(800) 547-4726
SISCOPO Box 389DUBUQUE IA 52004-0389
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-428• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERWausau InsuranceAffiliated With: Liberty Mutual Insurance Group
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDWAYCROSS COLLEGE AIH0058537
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDWAYCROSS COLLEGE AIH0058547
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503
PEARCE ADMINISTRATION(800) 222-6491
UM NOT APPLICABLEWAYCROSS COLLEGE UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(800) 222-6491
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
CHECK BENEFIT CARD CHECK BENEFIT CARDWAYNE AUTOMATIC FIRE SPRINKLER INC
Affiliated With: HERITAGE CONSULTANTS INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-429• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
TRUE CHOICE USA(800) 785-2446
CHECK BENEFIT CARDWEATHERFORD COLLEGEAffiliated With: ACADEMIC RISK MANAGEMENT
Term Effective: 8/31/2007Fund No:PlanType: Group Health
TRUE CHOICE USA(800) 785-2446
TRUE CHOICE USAPO Box 700307DALLAS TX 75370
MCMC LLC(888) 350-1150 Ext 228
MCMC LLC(888) 350-1150 Ext 228
WEBSTER AUTOAffiliated With: MCMC LLC
Fund No:PlanType: Auto
MCMC LLC(888) 350-1150 Ext 228
MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317
HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 668-6004
AMERICAN BENEFIT COMPANY, INC.(425) 289-5142
WELCO LUMBER COMPANY USAAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC
Fund No:PlanType: Group Health
HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 668-6004
HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.PO Box 85008BELLEVUE WA 98015
AFFORDABLE BENEFIT ADMINISTRATORS INC(800) 350-0148
AFFORDABLE BENEFIT ADMINISTRATORS INC
WELCOME MARKETAffiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC. (ABA)
Fund No:PlanType: Group Health
AFFORDABLE BENEFIT ADMINISTRATORS INC(800) 350-0148
AFFORDABLE BENEFIT ADMINISTRATORS INCPO Box 10787BURBANK CA 91510
CHECK BENEFIT CARD CHECK BENEFIT CARDWELLINGTON INVESTMENT CORPORATION
Affiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-430• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PITTMAN & ASSOCIATES, INC.(800) 238-1344
VALUECHECK(888) 545-6687
WENCOAST RESTAURANTSAffiliated With: PITTMAN AND ASSOCIATES
Fund No:PlanType: Group Health
PITTMAN & ASSOCIATES, INC.(800) 238-1344
PITTMAN & ASSOCIATES, INC.ONE PRESCOTT SOUTHMEMPHIS TN 38111
PEARCE ADMINISTRATION(843) 622-6001
UM NOT APPLICABLEWESLEYAN COLLEGEAffiliated With: MAKSIN MANAGEMENT CORP
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATION
419 S. COIT STFLORENCE SC 29501
Attn: WHIT WALTERS
KLAIS & COMPANY INC(330) 867-8443
CHECK BENEFIT CARDWESLEYAN UNIV BASIC PLAN & WESLEYAN UNIV ENHANCHED PLAN
Affiliated With: KLAIS & COMPANY
Fund No:PlanType: Group Health
KLAIS & COMPANY INC(330) 867-8443
KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
WEST BROTHERS CHRYSLER, INC
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
WEST PALM BEACH VAMC CHECK BENEFIT CARDWEST PALM BEACH VA MEDICAL CENTER 3142
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
WEST PALM BEACH VAMC WEST PALM BEACH VAMC
7305 N MILITARY TRAILWEST PALM BEACH FL 33410
Attn: 136-FEE BASIS
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-431• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
FMH / HCM FMH / HCM(800) 990-9058
WESTAR ENERGY - NATIONALAffiliated With: FMH BENEFIT SERVICES INC
Fund No:PlanType: Group Health
FMH / HCM FMH / HCM
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
WESTCOR CONSTRUCTIONAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
WESTCOR CONSTRUCTION TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
PEARCE ADMINISTRATION(888) 722-1668
CHECK BENEFIT CARDWESTERN CAROLINA UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(888) 722-1668
PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408
PINNACLE CLAIMS MANAGEMENT INC(800) 777-7898
Blue Cross of California(800) 274-7767
WESTERN GROWERS ASSURANCE TRUST
Affiliated With: WESTERN GROWERS ASSURANCE TRUST
Fund No:PlanType: Group Health
PINNACLE CLAIMS MANAGEMENT INC(800) 777-7898
PINNACLE CLAIMS MANAGEMENT INCPO Box 2130Newport Beach CA 92658
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-432• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
ADVENTIST HEALTH SYSTEM/WEST(800) 441-2524
UM NOT APPLICABLEWESTERN HEALTH RESOURCEAffiliated With: ADVENTIST HEALTH SYSTEMS/WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEM/WEST(800) 441-2524
ADVENTIST HEALTH SYSTEM/WEST2100 DOUGLASROSEVILLE CA 95661
TRUE CHOICE(800) 251-9665
UM NOT APPLICABLEWESTERN KENTUCKY UNIVERSITY
Affiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE(800) 251-9665
TRUE CHOICEPO Box 700307DALLAS TX 75370
PIONEER MANAGEMENT SYSTEMS(877) 868-9060
CHECK BENEFIT CARDWESTERN NEW ENGLAND COLLEGE
Affiliated With: PIONEER MANAGEMENT SYSTEMS
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(877) 868-9060
PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01090
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONS(800) 786-7930
WESTERN OREGON UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 786-7930
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
USI ADMINISTRATORS(877) 277-5718
USI ADMINISTRATORSWESTERN OREGON UNIVERSITYAffiliated With: FIRST UNDERWRITERS INC
Fund No:PlanType: Group Health
USI ADMINISTRATORS(877) 277-5718
USI ADMINISTRATORSPO Box 3357FORT WORTH TX 76113
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-433• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGWESTERN RESEARCH INSTITUTEAffiliated With: MBA OF WYOMING/MERRILL BOSTROM ASSOCIATES
Fund No:PlanType: Group Health
MBA OF WYOMING(972) 250-0189
MBA OF WYOMINGPO Box 98WORLAND WY 82401
CHECK BENEFIT CARD CHECK BENEFIT CARDWESTERN STATE UNIVERSITYAffiliated With: STUDENT ASSURANCE SERVICES INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
USI ADMINISTRATORS(800) 759-0101 8007590101 Ext 1749
USI ADMINISTRATORSWESTERN STATE UNIVERSITYAffiliated With: FIRST UNDERWRITERS INC
Fund No:PlanType: Group Health
USI ADMINISTRATORS(800) 759-0101 8007590101 Ext 1749
USI ADMINISTRATORSPO Box 3357FORT WORTH TX 76113
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDWESTERN STATES CHIROPRACTIC COLLEGE
Affiliated With: PERSONAL INSURANCE ADMINISTRATORS
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
WESTERN STATES CONTRACTING - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-434• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CHECK BENEFIT CARD CHECK BENEFIT CARDWESTERN TOOL SUPPLYAffiliated With: TRUSTEED PLANS SERVICE CORPORATION
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
WESTERN UNIVERSITY OF HEALTH SCIENCE
Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376
W HAVEN VA MEDICAL VENTER
CHECK BENEFIT CARDWESTHAVEN VA MEDICAL CENTER 3716
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
W HAVEN VA MEDICAL VENTER
W HAVEN VA MEDICAL VENTER
950 Campbell AveWest Haven CT 06516
Attn: Ian Kauffman - Dept 118
THE PLAN HANDLERS, INC. C/O CCN(800) 538-5512
CHECK BENEFIT CARDWESTMINSTER SCHOOL DISTRICT
Affiliated With: CBIZ/SCEET
Fund No:PlanType: Group Health
THE PLAN HANDLERS, INC. C/O CCN(800) 538-5512
THE PLAN HANDLERS, INC. C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
WESTSTAR CREDIT UNIONAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-435• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
WEYCO INC(517) 349-7010 Ext 6059
CHECK BENEFIT CARDWEYCO, INCAffiliated With: WEYCO, INC
Fund No:PlanType: Group Health
WEYCO INC(517) 349-7010 Ext 6059
WEYCO INCPO Box 30132OKEMOS MI 48864
CORPORATE BENEFITS SERVICE, INC.(800) 277-9476
ALLIANCE REVIEW SERVICES(800) 373-4454
WHALEY FOOD SERVICE REPAIRS
Affiliated With: CORPORATE BENEFIT SERVICES, INC.
Fund No:PlanType: Group Health
CORPORATE BENEFITS SERVICE, INC.(800) 277-9476
CORPORATE BENEFITS SERVICE, INC.145 Scaleybark Rd. Ste BCHARLOTTE NC 28209
HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(425) 482-1000
HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(425) 482-1000
WHATCOM COUNTYAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS
Fund No:PlanType: Group Health
HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(425) 482-1000
HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.220 120th Ave Ste D200Bellevue WA 98005
NATIONAL CLAIMS ADMINISTRATIVE SERVICES, INC.
NATIONAL CLAIMS ADMINISTRATIVE SERVICES, INC.
WHEATON COLLEGEAffiliated With: MARKEL INSURANCE COMPANY
Fund No:PlanType: Group Health
NATIONAL CLAIMS ADMINISTRATIVE SERVICES, INC.
NATIONAL CLAIMS ADMINISTRATIVE SERVICES, INC.PO Box 3426FAIRFAX VA 22030
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
CHECK BENEFIT CARDWHEATON COLLEGE - ACIAffiliated With: ADMINISTRATIVE CONCEPTS INC
Fund No:PlanType: Group Health
ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229
ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-436• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
KLAIS & COMPANY INC(330) 867-8443
CHECK BENEFIT CARDWHEATON COLLEGE ACCIDENT AND SICKNESS PLAN AND WHEATON COLLEGE ACCIDENT ONLY
Affiliated With: KLAIS & COMPANY
Fund No:PlanType: Group Health
KLAIS & COMPANY INC(330) 867-8443
KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
CHECK BENEFIT CARDWHEATON COLLEGE ILLINOISAffiliated With: PIONEER MANAGEMENT SERVICES
Fund No:PlanType: Group Health
PIONEER MANAGEMENT SYSTEMS(413) 539-9900
PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090
PREFERRED HEALTH PLANS INC.(800) 832-8212
PHCS Utilization Management(888) 551-7427
WHITE COUNTY MEMORIAL HOSPITAL
Affiliated With: PREFERRED HEALTH PLANS, INC.
Fund No:PlanType: Group Health
PREFERRED HEALTH PLANS INC.(800) 832-8212
PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223
ADVENTIST HEALTH SYSTEMS/WEST
CHECK BENEFIT CARDWHITE MEMORIAL MEDICAL CENTER EPO PLAN
Affiliated With: ADVENTIST HEALTH SYSTEMS/WEST
Fund No:PlanType: Group Health
ADVENTIST HEALTH SYSTEMS/WEST
ADVENTIST HEALTH SYSTEMS/WESTPO Box 619031ROSEVILLE CA 95661-9002
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
White Pine County - TravelAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-437• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERWhite PlainsAffiliated With: New York State Insurance Fund
*
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
WHITE RIVER JUNCTION VAMC & REG OFFICE
CHECK BENEFIT CARDWHITE RIVER JUNCTION VAMC & REG OFFICE 3116
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
WHITE RIVER JUNCTION VAMC & REG OFFICE
WHITE RIVER JUNCTION VAMC & REG OFFICE
215 N MAIN STWHITE RIVER JUNCTION VT 05009
Attn: FEE BASIS 136F
AMERIBEN SOLUTIONS(800) 953-1801
CHECK BENEFIT CARDWHITTIER COLLEGEAffiliated With: AMERIBEN SOLUTIONS
Fund No:PlanType: Group Health
AMERIBEN SOLUTIONS(800) 953-1801
AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707
DIRECTOR OF CLAIM OPERATION(800) 288-2078
MEDWATCH, INC.(800) 432-8421
WHITWORTH TOOL INCAffiliated With: ALLIED BENEFITS SYSTEMS, INC.
Fund No:PlanType: Group Health
DIRECTOR OF CLAIM OPERATION(800) 288-2078
DIRECTOR OF CLAIM OPERATION208 S LASALLE ST STE 1300CHICAGO IL 60604
WICHITA VA MEDICAL CENTER
CHECK BENEFIT CARDWICHITA VA MEDICAL CENTER 3530
Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
WICHITA VA MEDICAL CENTER
WICHITA VA MEDICAL CENTER
5500 E KELLOGGWICHITA KS 67218
Attn: FEE BASIS
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-438• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
WILKES-BARRE VAMC CHECK BENEFIT CARDWILKES-BARRE VAMC 3128Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
WILKES-BARRE VAMC WILKES-BARRE VAMC
1111 E END BLVDWILKES-BARRE PA 08711
Attn: FEE BASIS 16D
CHECK BENEFIT CARD CHECK BENEFIT CARDWILLIAM F FENTON INC TOYOTA VOLVO OF KEENE
Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD CHECK BENEFIT CARDWILLIAM RUSSELLAffiliated With: STAR HEALTHCARE NETWORK INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(307) 347-6151
MOUNTAIN STATES REVIEW(307) 347-7979
WILLIAM, PORTER, DAY & NEVILLE, PC
Affiliated With: MANAGED BENEFITS ADMINISTRATORS & INS CONSULTANTS
Fund No:PlanType: Group Health
MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(307) 347-6151
MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTSPO Box 98WORLAND WY 82401
KLAIS & COMPANY INC(330) 867-8443
CHECK BENEFIT CARDWILLIAMS COLLEGEAffiliated With: KLAIS & COMPANY
Fund No:PlanType: Group Health
KLAIS & COMPANY INC(330) 867-8443
KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-439• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
WILMINGTON VAMC CHECK BENEFIT CARDWILMINGTON VAMC 3129Affiliated With: HEALTH NET FEDERAL SERVICES
Fund No:PlanType: Group Health
WILMINGTON VAMC WILMINGTON VAMC
1601 KIRKWOOD HWYWILMINGTON DE 19805
Attn: FEE BASIS 600
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.(800) 284-2273
WINNAffiliated With: OSF HEALTHPLANS, INC.
Fund No:PlanType: Group Health
OSF HealthPlans, Inc.(800) 673-5222
OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128
PEARCE ADMINISTRATION(843) 622-6001
CHECK BENEFIT CARDWINTHROP UNIVERSITYAffiliated With: MAKSIN MANAGEMENT CORP #14005
Fund No:PlanType: Group Health
PEARCE ADMINISTRATION(843) 622-6001
PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437
HEALTH PLAN INC(508) 752-2480
CARE MANAGEMENT SERVICES(866) 325-1550
WOLLASTON ALLYOYS INCAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
ASSURECARE(800) 968-6616
CARELINE(763) 383-4800
WOLVERINEAffiliated With: ASSURECARE
Fund No:PlanType: Group Health
ASSURECARE(800) 968-6616
ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-440• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
CHECK BENEFIT CARDWOODBURY UNIVERSITYAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA #10491
Fund No:PlanType: Group Health
PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343
PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376
CHECK BENEFIT CARD CHECK BENEFIT CARDWOODGRAIN MILLWORK INCAffiliated With: SOVEREIGN SOLUTIONS
Term Effective: 3/31/2008Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD CHECK BENEFIT CARDWOODLAND FURNITURE HARKER DESIGN
Affiliated With: SMITH ADMINISTRATORS
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.
WOODMAN'S FOOD MARKETAffiliated With: MIDWEST SECURITY ADMINISTRATORS INC
Fund No:PlanType: Group Health
MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819
MIDWEST SECURITY ADMINISTRATORS, INC.PO Box 574ONALASKA WI 54650
TAYLOR BENEFIT RESOURCE, INC.(229) 225-9795
TAYLOR BENEFIT RESOURCE, INC.(888) 352-5246
WORKSTAFFAffiliated With: TAYLORE BENEFIT RESOURCES
Fund No:PlanType: Group Health
TAYLOR BENEFIT RESOURCE, INC.(229) 225-9795
TAYLOR BENEFIT RESOURCE, INC.PO Box 6580THOMASVILLE GA 31758
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-441• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
WORLD INSURANCE COMPANY(800) 786-7557
CHECK BENEFIT CARDWORLD INSURANCE COMPANYAffiliated With: AMERICAN REPUBLIC INSURANCE COMPANY
Fund No:PlanType: Group Health
WORLD INSURANCE COMPANY(402) 496-8044
WORLD INSURANCE COMPANYPO Box 2558OMAHA NE 68103-2558
CHECK BENEFIT CARD CHECK BENEFIT CARDWORLD LEARNINGAffiliated With: AIG CLAIMS SERVICES INC
Fund No:PlanType: Group Health
CHECK BENEFIT CARD CHECK BENEFIT CARD
CHECK BENEFIT CARD8007773575
CHECK BENEFIT CARDWORLD MINERALS INCAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES
Fund No:PlanType: Group Health
CHECK BENEFIT CARD8007773575
CHECK BENEFIT CARD
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
WRIGHT ENGINEERSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114
SUPERIEN HEALTH NETWORK(800) 266-5896
CHECK BENEFIT CARDWW WILLIAMSAffiliated With: INTERPLAN HEALTH GROUP
Fund No:PlanType: Group Health
SUPERIEN HEALTH NETWORK(800) 266-5896
SUPERIEN HEALTH NETWORK
PO Box 2388 CSTOW OH 44224
Attn: Supervisor of the Claims Dept
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-442• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272
COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272
WYMAN GORDAN COMPANYAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272
COMPREHENSIVE BENEFITS ADMINISTRATORS INCPO Box 2365SOUTH BURLINGTON VT 05407-2365
COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272
COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272
WYMAN GORDON COMPANYAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)
Fund No:PlanType: Group Health
COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272
COMPREHENSIVE BENEFITS ADMINISTRATORS INCPO Box 2365SOUTH BURLINGTON VT 05407-2365
MBA OF WYOMING,INC./MERRILL BOSTROM ASSOC. C/O CCN(972) 250-0189
CHECK BENEFIT CARDWYOMING TECHNICAL INSTITUTEAffiliated With: MANAGED BENEFITS ADMINISTRATOR AND INS. CONSUTANTS
Fund No:PlanType: Group Health
MBA OF WYOMING,INC./MERRILL BOSTROM ASSOC. C/O CCN(972) 250-0189
MBA OF WYOMING,INC./MERRILL BOSTROM ASSOC. C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000
INSURANCE ADMINISTRATORS OF AMERICA INC8885991515
HEALTHCARE STRATEGIES8885991515
X-RAY ASSOCIATESAffiliated With: INSURANCE ADMINISTRATORS OF AMERICA INC
Fund No:PlanType: Group Health
INSURANCE ADMINISTRATORS OF AMERICA INC8885991515
INSURANCE ADMINISTRATORS OF AMERICA INC9841 BROKEN LANE PKWYCOLUMBIA MD 21046
Benefit Planners(800) 292-5386
CHECK BENEFIT CARDXTO ENERGYAffiliated With: BENEFIT PLANNERS
Fund No:PlanType: Group Health
Benefit Planners(800) 292-5386
Benefit PlannersPO Box 690450SAN ANTONIO TX 78269
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-443• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345
XYIENCE INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA
Fund No:PlanType: Group Health
SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114
GILSBAR(985) 871-1863
CHECK BENEFIT CARDYAVAPAI-PRESCOTT INDIAN TRIBE
Affiliated With: GILSBAR, INC.
Fund No:PlanType: Group Health
GILSBAR(985) 871-1863
GILSBARPO Box 2947COVINGTON LA 70434
PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777
HINES & ASSOCIATES(888) 819-3775
YENMAN ENTERPRISES LTDAffiliated With: PREFERRED BENEFIT ADMINISTRATORS, INC
Fund No:PlanType: Group Health
PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777
PREFERRED BENEFIT ADMINISTRATORS INCPO Box 916188LONGWOOD FL 32791-6188
TRUE CHOICE(800) 251-9665
UM NOT APPLICABLEYESHIVA UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT
Fund No:PlanType: Group Health
TRUE CHOICE(800) 251-9665
TRUE CHOICEPO Box 700307DALLAS TX 75370
HEALTH PLAN INC(508) 752-2480
CMS(866) 325-1550
YESTERDAY'S CHILDREN, INCAffiliated With: HEALTH PLANS INC
Fund No:PlanType: Group Health
HEALTH PLAN INC(508) 752-2480
HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-444• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
EBPA(800) 578-3272
CHECK BENEFIT CARDYORK HOSPITAL JMSAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS
Fund No:PlanType: Group Health
EBPA(800) 578-3272
EBPA
PO Box 2000Exeter NH 03833
Attn: Denise Oberg
ECOM PPO ADVISORS, INC(719) 381-1950
CHECK BENEFIT CARDYOUNG LIFEAffiliated With: ECOM PPO ADVISORS INC
Fund No:PlanType: Group Health
ECOM PPO ADVISORS, INC(719) 381-1950
ECOM PPO ADVISORS, INC
8350 N. CENTRAL EXPWY, STE 600DALLAS TX 75206
Attn: ACCOUNTING
CONTACT EMPLOYER CONTACT EMPLOYERZenithAffiliated With: Zenith Insurance Company
Fund No:PlanType: Workers' Compensation
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
NHBC(888) 621-7900
CHECK BENEFIT CARDZENITH ADMINISTRATORS WRAPAffiliated With: NATIONAL HEALTH BENEFIT CORPORATION NHBC #12717
Fund No:PlanType: Group Health
NHBC(888) 621-7900
NHBC8990 E. Raintree Dr.Scottsdale AZ 85260
CENBEN USA(614) 797-5204
CHECK BENEFIT CARDZODIAC DBA POLARIS POOL SYSTEMS
Affiliated With: CENBEN USA INC
Fund No:PlanType: Group Health
CENBEN USA(614) 797-5204
CENBEN USA
4079 Executive PkwyWesterville OH 43081
Attn: Melissa Joseph
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-445• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PAYOR NAME
ALASKA Comprehensive Client List
Billing / Claims Submission
Eligibility/ Benefits/ Compensability
UM/Pre-Certification and/or Referral Management Billing/Claims
The First Health® Network Outpatient Care Network
CONTACT EMPLOYER CONTACT EMPLOYERZURICH AUTOAffiliated With: ZURICH NORTH AMERICAN
Fund No:PlanType: Auto
CONTACT EMPLOYER CONTACT EMPLOYER
Attn:
Info as of 12/27/2007
www.firsthealth.com
For further information, contact Provider Relations at (800) 937-6824
Page CCL AK-446• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.