The First Health® Network CALIFORNIA Payor Information Report

The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
66 FEDERAL CREDIT UNION
Affiliated With: SELECT BENEFIT
ADMINISTRATORS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
SELECT BENEFIT
ADMINISTRATORS, INC.
3001 Westown Pkwy.
WEST DES MOINES IA 50266
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SELECT BENEFIT
ADMINISTRATORS, INC.
UTILIZATION REVIEW
SELECT BENEFIT
ADMINISTRATORS, INC.
(800) 397-0427
(800) 397-0427
A & D MANAGEMENT CO INC
Affiliated With: SISCO/Cottingham &
Butler
Plan Type: Group Health
BUTLER BENEFIT SERVICES
BUTLER BENEFIT SERVICES
PO Box 3310
Davenport IA 52808-3310
(563) 327-2240
CHECK BENEFIT CARD
(563) 327-2240
A C HOUSTON LUMBER
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY PO Box 7011
Plan Type: Group Health
WYOMISSING PA 19610-6011
THE LOOMIS COMPANY
UM NOT APPLICABLE
(800) 346-1223
(800) 346-1223
A G ADMINISTRATORS
Affiliated With: A G ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
A L GILBERT COMPANY
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
1234 W OAK ST
STOCKTON CA 95201
(209) 939-3403
DELTA TEAM CARE
(800) 336-0123
AMERA-NET
AMERA-NET
DIRECT CARE AMERICA
CHECK BENEFIT CARD
A&G/AMERA-NET
Affiliated With: AMERA-NET
Plan Type: Group Health
(209) 939-3403
AMERA-NET
2805 Dallas Pkwy STE 140
PLANO TX 75093
A.R.E., INC
DIRECT CARE AMERICA
Affiliated With: THE CHANDLER GROUP PO Box 2090 C
Plan Type: Group Health
STOW OH 44224
(800) 266-5896
(800) 266-5896
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-1
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
A1 COPELAND INVESTMENTS
Affiliated With: AMERICAN
ADMINISTRATIVE GROUP
Plan Type: Group Health
CLAIMS SUBMISSION
American Administrative Group Inc.
PO Box 93670
LUBBOCK TX 79493-3670
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
American Administrative Group Inc.
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 221-4582
(800) 221-4582
ABACUS PROJECT MANAGEMENT
INC
Affiliated With: ADVANCED BENEFIT
SOLUTIONS LLC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ABETIC CORPORATION
Affiliated With: EMPLOYEE BENEFIT
MANAGEMENT CORP
Plan Type: Group Health
EBMC
EBMC
CHECK BENEFIT CARD
4789 Rings Rd
Dublin OH 43017-1599
(614) 766-5800
(614) 766-5800
ABFB CORPORATION DBA THE
WHITE MARKET
GROUP INSURANCE SERVICE
CENTER
GROUP INSURANCE SERVICE
CENTER
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
20 WINTER ST
PEMBROKE MA 02359
(800) 242-4472
GISC TOTALCARE
(866) 598-3973
(800) 242-4472
ABRAHAM BALDWIN AGRICULTURAL PEARCE ADMINISTRATION
COLLEGE AIH0057867
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
ABRAHAM BALDWIN AGRICULTURAL PEARCE ADMINISTRATION
COLLEGE AIH0057877
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-2
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
ABRAHAM BALDWIN AGRICULTURAL PEARCE ADMINISTRATION
COLLEGE UNDERGRAD MANDATORY Attn: WHIT WALTERS
Affiliated With: MAKSIN MANAGEMENT 419 S. COIT ST
CORP
FLORENCE SC 29501
Plan Type: Group Health
(800) 222-6491
ABTREX INDUSTRIES
Affiliated With: ASSURECARE
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 222-6491
ASSURECARE
ASSURECARE
4040 HUNSAKER STE 110
LANSING MI 38823
(800) 968-6616
CARELINE
(763) 383-4800
(800) 968-6616
ACADEMY OF ART COLLEGE
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ACCESS
Affiliated With: PREFERRED CARE
Plan Type: Group Health
PREFERRED CARE, INC.
PREFERRED CARE, INC.
PREFERRED CARE, INC.
6 Neshaminy Interplex #205
TREVOSE PA 19053
(215) 639-6208
(215) 639-6208
ACCESS ADMINISTRATORS , INC
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
ACCESS NURSES INC
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
NHBC
NHBC
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
CHECK BENEFIT CARD
(888) 621-7900
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
PO Box 80
Stockton CA 95201
(800) 807-0820
DELTA TEAM CARE
(800) 356-2395
(800) 807-0820
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-3
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Accident Fund Insurance Company of
America
Affiliated With: ACCIDENT FUND OF
AMERICA
Plan Type: Workers' Compensation
ACCO Management
Affiliated With: American Administrative
Group
Plan Type: Group Health
ACCOR NORTH AMERICA, INC.
Affiliated With: P5 E HEALTH SVCS,
INC. (MOTEL 6 & RED ROOF INNS)
Plan Type: Group Health
ACE DISPOSAL COMPANY
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
ACE INTERNATIONAL UNIVERSITY
OF NORTH TEXAS
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
Term Effective: 8/31/2007
CLAIMS SUBMISSION
Accident Fund Insurance Company of
America
232 S Capitol Ave
Lansing MI 48901-7990
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Accident Fund Insurance Company of
America
(517) 367-1771
UTILIZATION REVIEW
Accident Fund Insurance
Company of America
(517) 367-1771
(517) 367-1771
American Administrative Group
American Administrative Group
PO Box 93670
LUBBOCK TX 79493-3670
(800) 877-7474
First Health
(800) 346-3220
(800) 877-7474
P5 E HEALTH SERVICES, INC.
P5 E HEALTH SERVICES, INC.
2455 E. Parleys Way #300
Salt Lake City UT 84109
(800) 397-3685
P5 PROVIDER REVIEW
(200) 633-1988
(800) 397-3685
TALL TREE ADMINISTRATORS
TALL TREE ADMINISTRATORS
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
(801) 274-8100
CORVEL
(801) 269-8723
TRUE CHOICE USA
TRUE CHOICE USA
CHECK BENEFIT CARD
PO Box 700307
DALLAS TX 75370
(800) 785-2446
(801) 274-8100
(800) 785-2446
ACE USA
ACE USA
ACE USA
Plan Type: Workers' Compensation
950 Cottage Grove Road (North
Building)
Bloomfield CT 06002
(860) 731-6868
ACE USA
(860) 731-6868
(860) 731-6868
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-4
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ACKERMAN MCQUEEN
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MUTUAL ASSURANCE
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 825-3540
(800) 825-3540
ACMG
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
GLOBALCARE, INC.
ACROM PUBLISHING
Affiliated With: ASSURECARE
Plan Type: Group Health
GLOBALCARE, INC.
GLOBALCARE, INC.
ASSURECARE
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
Careline UR
(763) 383-4800
6875 Shiloh Rd E
ALPHARETTA GA 30005
(800) 422-2026
ACS BENEFIT SERVICES INC
Affiliated With: NATIONAL HEALTH
BENEFITS COUNCIL
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ACS HEALTH ADVANTAGE PLAN
REWARDS ADMINISTRATION
CENTER
HEALTH INTERNATIONAL
HEALTH INTERNATIONAL
Plan Type: Group Health
PO Box 10219
SCOTTSDALE AZ 85271
ACTARIS
Affiliated With: CORPORATE
BENEFITS SERVICE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Acterna Corp Administrators, Inc.
Affiliated With: Gallagher Benefit
Administrators, Inc.
Plan Type: Group Health
CHECK BENEFIT CARD
8002779476
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-5
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* ADA S MCKINLEY
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
ADAMS-REMCO
Affiliated With: ASSURECARE
Plan Type: Group Health
CLAIMS SUBMISSION
FCE BENEFIT ADMINISTRATORS INC
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
FCE BENEFIT ADMINISTRATORS INC
(800) 899-9355
(800) 899-9355
ASSURECARE
ASSURECARE
4040 HUNSAKER STE 110
LANSING MI 38823
(800) 968-6616
CARELINE
(763) 383-4800
(800) 968-6616
ADCO PRODUCTS
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
ADKNOWLEDGE, INC
Affiliated With: FMH BENEFIT
SERVICES, A DIVISION OF
CORESOURCE
Plan Type: Group Health
ADVANCE AMERICA CASH ADVANCE
Affiliated With: MARSH ADVANTAGE
AMERICA
Plan Type: Group Health
Term Effective: 9/30/2007
ADVANCE MANUFACTURING
COMPANY WRAP JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
(800) 832-8212
FMH BENEFIT SERVICES INC
FMH BENEFIT SERVICES INC
PO Box 25946
OVERLAND PARK KS 66225-5946
(800) 990-9058
HCM
(800) 990-9058
MARSH ADVANTAGE AMERICA
MARSH ADVANTAGE AMERICA
CHECK BENEFIT CARD
ONE W. THIRD ST #900
TULSA OK 74103
(800) 426-9786
(800) 990-9058
(800) 949-5945
EBPA
EBPA
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
CHECK BENEFIT CARD
(802) 846-8060
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-6
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
ADVANCED FINANCIAL TECHNOLOGY MUTUAL ASSURANCE
ADMINISTRATORS
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Plan Type: Group Health
Oklahoma City OK 73123-3096
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MUTUAL ASSURANCE
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 825-3540
(800) 825-3540
ADVANCED SERVICES, INC.
Affiliated With: PITTMAN &
ASSOCIATES, INC.
Plan Type: Group Health
PITTMAN & ASSOCIATES, INC.
ADVANCED SYSTEMS TECHNOLOGY
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
PITTMAN & ASSOCIATES, INC.
PITTMAN & ASSOCIATES, INC.
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
CHECK BENEFIT CARD
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
PO Box 111047
MEMPHIS TN 38111
(800) 825-3540
ADVANSTAFF
Affiliated With: SIERRA HEALTH &
LIFE / HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
ADVANSTAFF TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
Advantage
Affiliated With: ADVANTAGE
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
Participates in California Select Network
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-7
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Advantage Consulting Services
Affiliated With: ADVANTAGE
CONSULTING SERVICES
Plan Type: Group Health
ADVANTAGE GASES AND TOOLS
Affiliated With: HEALTH PLANS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
HEALTH PLAN INC
HEALTH PLAN INC
PO Box 5199
WESTBOROUGH MA 01581
(508) 752-2480
UTILIZATION REVIEW
CHECK BENEFIT CARD
CARE MANAGEMENT
SERVICES
(866) 325-1550
(508) 752-2480
ADVENT INTERNATIONAL
CORPORATION
Affiliated With: MEDICAL CLAIMS
SERVICE, INC.
Plan Type: Group Health
MEDICAL CLAIMS SERVICES, INC.
MEDICAL CLAIMS SERVICES, INC.
ONE WALL ST STE 2A
RAVENSWOOD WV 26164
MEDICAL CLAIMS SERVICES,
INC.
ADVENTIST HEALTH SYSTEM / WEST- ADVENTIST HEALTH SYSTEM WEST
CORPORATE OFFICE
PO Box 619031
Affiliated With: ADVENTIST HEALTH
ROSEVILLE CA 95661-9002
SYSTEM/WEST
Plan Type: Group Health
ADVENTIST HEALTH SYSTEM WEST CHECK BENEFIT CARD
ADVENTIST RISK MANAGEMENT, INC.
Affiliated With: ADVENTIST RISK
MANAGEMENT, INC.
Plan Type: Group Health
ADVENTIST RISK MANAGEMENT,
INC.
ADVENTIST RISK MANAGEMENT,
INC.
PO Box 4759
Silver Spring MD 20914
(888) 276-4732
CHECK BENEFIT CARD
(888) 276-4732
ADVENTSOURCE
Affiliated With: ADVENTIST RISK
MANAGEMENT, INC.
Plan Type: Group Health
ADVENTIST RISK MANAGEMENT,
INC.
ADVENTIST RISK MANAGEMENT,
INC.
CHECK BENEFIT CARD
11291 Pierce St.
RIVERSIDE CA 92515-8007
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-8
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Advocate Case Management
Affiliated With: CompIQ
Plan Type: Workers' Compensation
AEROTRON AIRPOWER
Affiliated With: PARAGON BENEFITS
INC
Plan Type: Group Health
CLAIMS SUBMISSION
Advocate Case Management
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Advocate Case Management
UTILIZATION REVIEW
CHECK BENEFIT CARD
809 S Agnew Ste H
Oklahoma City OK 73108
(405) 601-2498
PARAGON BENEFITS, INC.
PARAGON BENEFITS, INC.
PO Box 12288
COLUMBUS GA 31917
(703) 279-9218
AMERICAN HEALTH HOLDINGS
(703) 279-9218
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
(703) 279-9218
AFFILIATED HEALTH CARE INC DIRECT PEPM BUSINESS
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC TRAVEL PEPM BUSINESS
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
AFFILIATED HEALTHCARE INC
AFS INSURANCE SERVICES INC
Affiliated With: AFS INSURANCE
SERVICES INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AFS Insurance Services, Inc.
Affiliated With: AFS Insurance Services,
Inc.
Plan Type: Group Health
AFS Insurance Services, Inc
AFS Insurance Services, Inc
PO Box 10895
Scottsdale AZ 85271-0895
(800) 464-7425
Western Grocers Employee
Benefit Trust
(800) 777-3602
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
(801) 978-8336
(800) 464-7425
(801) 978-8336
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-9
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AG SUPPLY
Affiliated With: ASSURECARE
Plan Type: Group Health
CLAIMS SUBMISSION
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ASSURECARE
UTILIZATION REVIEW
(800) 422-2026
Careline UR
(763) 383-4800
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 422-2026
AGIA INC
Affiliated With: HEALTHCOMP
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
AGRI-CEL INC
Affiliated With: EMPLOYEE BENEFITS
ADMINISTRATION & MANAGEMENT
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M)
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M)
PO Box 5079
WESTLAKE VILLAGE CA 91359
(714) 668-8920
8004427247
HINES & ASSOCIATES
(800) 528-2498
(714) 668-8920
AGRI-FAB, INC.
Affiliated With: CONSOCIATE, INC.
Plan Type: Group Health
CONSOCIATE, INC. C/O CCN
AGUA CALIENTE BAND OF CAHUILLA
INDIANS
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
AHI - BUNKIE GENERAL HOSPITAL
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
CONSOCIATE, INC. C/O CCN
CHECK BENEFIT CARD
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
PO Box 3000
SCOTTSDALE AZ 85271-3000
(800) 533-5044
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
2 GREENWAY STE 502
HOUSTON TX 77046
(713) 914-3400
CHECK BENEFIT CARD
(713) 914-3400
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-10
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AHI - CHEM AIR INC
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
AHI - CITY OF OPELOUSAS
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
AHI - DEEP SOUTH
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
CLAIMS SUBMISSION
AFFILIATED HEALTHCARE INC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AFFILIATED HEALTHCARE INC
UTILIZATION REVIEW
(713) 914-3400
AFFILIATED HEALTHCARE INC
(713) 914-3400
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
2 GREENWAY STE 502
HOUSTON TX 77046
(713) 914-3400
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
(713) 914-3400
(713) 914-3400
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
2 GREENWAY STE 502
HOUSTON TX 77046
(713) 914-3400
CHECK BENEFIT CARD
(713) 914-3400
AHI - GRAY AND COMPANY, INC
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI - LOST HIGHWAY
Affiliated With: AFFILIATED HEALTH
CARE, INC.
Plan Type: Group Health
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
AHI - ST MARTIN PARISH SCHOOL
BOARD
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
2 GREENWAY STE 502
HOUSTON TX 77046
(713) 914-3400
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
(713) 914-3400
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-11
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AHI - TEMBEC USA
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
AHI ABBEVILLE GENERAL HOSPITAL
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
CLAIMS SUBMISSION
AFFILIATED HEALTHCARE INC
2 GREENWAY STE 502
HOUSTON TX 77046
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AFFILIATED HEALTHCARE INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(713) 914-3400
(713) 914-3400
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
2 GREENWAY PLAZA STE 502
HOUSTON TX 77042
(713) 914-3400
CHECK BENEFIT CARD
(713) 914-3400
AHI ADAMS DIST CO INC
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AFFILIATED HEALTHCARE INC
AHI AIR EVAC EMS
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI AMERICAN INSURANCE CO OF
TEXAS
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI ARIZONA TRAILS INC
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-12
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI ASBESTOS WORKERS LOCAL
NO 53 WELFARE FUND
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI BEAUREGARD MEMORIAL
HOSPITAL
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
11200 WESTHEIMER
HOUSTON TX 77042
7139143400
AFFILIATED HEALTHCARE INC
7139143400
PAYOR NAME
AHI ARKANSAS DENTAL
ASSOCIATION
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
UTILIZATION REVIEW
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
AHI BOBCAT INC
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
7139143400
AHI CALCASIEU PARISH POLICE
JURY AND THE PORT OF ST
CHARLES
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI CALVERT OIL CO
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-13
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
AHI CAMERON PARISH POLICE JURY AFFILIATED HEALTHCARE INC
Affiliated With: AFFILIATED
2 GREENWAY STE 502
HEALTHCARE, INC
HOUSTON TX 77046
Plan Type: Group Health
(713) 914-3400
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AFFILIATED HEALTHCARE INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(713) 914-3400
AHI CASE ASSOCIATES
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI CHAMBERS LIBERTY COUNTIES
NAVIGATION
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI CHUGACH DEVELOPMENT
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI CITY OF MONROE
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
(713) 914-3400
AHI CITY OF RUSTON
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
(713) 914-3400
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-14
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AHI CITY OF WEST MONROE
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
AHI CLETEX TRUCKING
Affiliated With: AFFILIATED
HEALTHCARE, INC.
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
(713) 914-3400
CLAIMS SUBMISSION
CHECK BENEFIT CARD
UTILIZATION REVIEW
(713) 914-3400
AHI COACH USA
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI COLUMBIA LIGHTHOUSE FOR
THE BLIND
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI COMBINED UNDERWRITERS
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI CRISTI CLEANING SERVICES
LIMITED
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-15
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI DUSTPRO INC
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI ENERGY DYNAMICS INDUSTRIES
INC
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI FCE BENEFIT ADMINISTRATORS
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI FEDERAL HOME PRODUCTS
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI FLINT OIL CO INC
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PAYOR NAME
AHI DATS
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
UTILIZATION REVIEW
Info as of 12/13/2007
Page PIRCA-16
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI FREEDOM LIFE INSURANCE
COMPANY
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI GREENS PRESSURE TESTING
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI GROWERS OIL CO
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI GULF COAST ENTERPRISES
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI GULF COAST ENTERPRISES
MAJOR
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PAYOR NAME
AHI FRANK W MURPHY
MANUFACTURE
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
UTILIZATION REVIEW
Info as of 12/13/2007
Page PIRCA-17
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI HITNEY SOLAR PRODUCTS
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI INDUSTRIAL INSULATION GROUP
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI INDUSTRIAL SPECIALTY
CONTRACTORS
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI INTERMOUNTAIN REFINING
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI JOHN H CARTER CO INC
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PAYOR NAME
AHI HARRIS GALVESTON COASTAL
SUBSIDENCE DIST
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
UTILIZATION REVIEW
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-18
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AHI JUDD AUTO SERVICE
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
AHI K TEK LLC
Affiliated With: AFFILIATED
HEALTHCARE
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
(800) 722-3372
CLAIMS SUBMISSION
CHECK BENEFIT CARD
UTILIZATION REVIEW
(800) 722-3372
AHI LAMB SERVICES
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI LIFE OF AMERICA
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI LIFESHARE BLOOD CENTER
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI LIVINGSTON PARISH SHERIFF'S
OFFICE
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
(713) 914-3400
AFFILIATED HEALTHCARE INC
(713) 914-3400
(713) 914-3400
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-19
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AHI M A PATOUT & SON LTD
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CLAIMS SUBMISSION
AFFILIATED HEALTHCARE INC
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AFFILIATED HEALTHCARE INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(713) 914-3400
(713) 914-3400
AHI MATLOCK GAS AND EQUIPMENT
CO
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI MCDONALD'S B. R.
MANAGEMENT CO.
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
2 GREENWAY PLAZA STE 502
HOUSTON TX 77042
(713) 914-3400
(713) 914-3400
AHI MCNEECE BROS OIL
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI METRO AVIATION
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
AHI MISC KILLMER
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-20
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AHI MMR GROUP
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
AHI NATCHITOCHES REGIONAL
MEDICAL CENTER
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
2 GREENWAY STE 502
HOUSTON TX 77046
(713) 914-3400
CLAIMS SUBMISSION
CHECK BENEFIT CARD
UTILIZATION REVIEW
(713) 914-3400
AHI NATIONAL FOUNDATION LIFE
INSURANCE COMPA
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI NEIL CORPORATION
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI OUTDOOR CAP COMPANY INC
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI PARKER OIL CO
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-21
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AHI PORT TERMINAL RAILROAD
ASSOC EBPT
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
AHI RACELAND RAW SUGAR CORP
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
(713) 914-3400
CLAIMS SUBMISSION
CHECK BENEFIT CARD
UTILIZATION REVIEW
(713) 914-3400
AHI REPUBLIC AMERICAN LIFE
INSURANCE CO
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI SCHMELZIA OIL COMPANY
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI SECURIGUARD
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI SERVICE SOURCE
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-22
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
AHI SHANNON HARDWARE COMPANY AFFILIATED HEALTHCARE INC
Affiliated With: AFFILIATED HEALTH
2 GREENWAY PLAZA STE 502
CARE INC
HOUSTON TX 77042
Plan Type: Group Health
(713) 914-3400
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AFFILIATED HEALTHCARE INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(713) 914-3400
AHI SHAY OIL CO
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI SHEARMAN COMPANY, LLC
Affiliated With: AFFILIATED
HEALTHCARE, INC
Plan Type: Group Health
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
2 GREENWAY STE 502
HOUSTON TX 77046
(713) 914-3400
AHI SIA MANAGEMENT
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
AHI ST JAMES PARISH SCHOOL
BOARD
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
AHI STAR SERVICES
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
(713) 914-3400
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
(713) 914-3400
CHECK BENEFIT CARD
(713) 914-3400
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
(713) 914-3400
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
(713) 914-3400
2 GREENWAY PLAZA STE 502
HOUSTON TX 77046
(713) 914-3400
(713) 914-3400
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-23
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AHI STEIN LLC
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
AHI STERLING SUGARS INC
Affiliated With: AFFILIATE
HEALTHCARE INC
Plan Type: Group Health
CLAIMS SUBMISSION
AFFILIATED HEALTHCARE INC
2 GREENWAY STE 502
HOUSTON TX 77046
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AFFILIATED HEALTHCARE INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(713) 914-3400
(713) 914-3400
LIFEWISE HEALTH PLAN OF
OREGON
2 GREENWAY STE 502
HOUSTON TX 77046
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
(713) 914-3400
(713) 914-3400
AHI STULLER INC
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI SUN WEST CONTAINER CO
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI SUNBELT INDUSTRIES
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI THE NEUROMEDICAL CENTER
INC
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
2 GREENWAY STE 502
HOUSTON TX 77046
(713) 914-3400
(713) 914-3400
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-24
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AHI TRIPLEX INC
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
AHI VERNON PARISH POLICE JURY
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
2 GREENWAY PLAZA STE 502
HOUSTON TX 77042
(713) 914-3400
CLAIMS SUBMISSION
CHECK BENEFIT CARD
UTILIZATION REVIEW
(713) 914-3400
AHI VOCATIONAL GUIDANCE
SERVICES
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI VOCATIONAL TRAINING
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI WEST CALCASIEU CAMERON
HOSPITAL
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AHI WILL STAFF WORLDWIDE INC
Affiliated With: AFFILIATED
HEALTHCARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-25
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AHI-ABELL CORPORATION
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
AHI-AMITE FOUNDRY & MACHINE INC
Affiliated With: AFFILIATED HEALTH
CARE INC
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
AFFILIATED HEALTHCARE INC
AFFILIATED HEALTHCARE INC
CHECK BENEFIT CARD
2 GREENWAY STE 502
HOUSTON TX 77046
(713) 914-3400
CLAIMS SUBMISSION
AFFILIATED HEALTHCARE INC
UTILIZATION REVIEW
2 GREENWAY STE 502
HOUSTON TX 77046
(713) 914-3400
AIG Claim Services Inc
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
AIG Claims Services
Affiliated With: AIG Claims Services
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
AIGCS
AIGCS
AIGCS
(714) 436-5908
AIGCS
(714) 436-5908
Plan Type: Workers' Compensation
One MacArthur Place, Suite 500
South Coast Metro CA 92707
CONTACT EMPLOYER
(714) 436-5908
Air Force The
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
AIR TERMINAL INC
Affiliated With: QUALIFIED BENEFIT
SERVICES
Plan Type: Group Health
QUALIFIED BENEFIT SERVICES LLC
QUALIFIED BENEFIT SERVICES LLC UM NOT APPLICABLE
PO Box 5000
SPRINGVILLE UT 84663
(800) 853-3234
(800) 853-3234
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-26
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Airforce Insurance Fund
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
CONTACT EMPLOYER
DAN R. WAGNON & ASSOCIATES,
INC.
DAN R. WAGNON &
ASSOCIATES, INC.
HINES AND ASSOCIATES
(800) 866-0105
AK-CHIN INDIAN COMMUNITY/FARMS
Affiliated With: DAN R. WAGNON &
ASSOCIATES, INC.
Plan Type: Group Health
DAN R. WAGNON & ASSOCIATES,
INC.
AKIMEKA, LLC
Affiliated With: PREFERRED BENEFIT
ADMINISTRATORS, INC.
Plan Type: Group Health
PREFERRED BENEFIT
ADMINISTRATORS INC
PREFERRED BENEFIT
ADMINISTRATORS INC
PO Box 916188
LONGWOOD FL 32791-6188
(407) 786-2777
UTILIZATION REVIEW
3825 N. 24th St.
PHOENIX AZ 85016
(407) 786-2777
AKROCHEM CORPORATION
Affiliated With: BENEFIT SERVICES,
INC.
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AL TYLER & SONS, INC.
Affiliated With: MEDICAL CLAIMS
SERVICE, INC.
Plan Type: Group Health
MEDICAL CLAIMS SERVICES
MEDICAL CLAIMS SERVICES
ONE WALL ST STE 2A
RAVENSWOOD WV 26164
8882250522
INTRACORP
(972) 302-2700
ALAMEDA HOSPITAL
Affiliated With: HEALTHCOMP TPA
Plan Type: Group Health
(800) 557-1755
HEALTHCOMP
HEALTHCOMP
PO Box 45018
Fresno CA 93718
(800) 442-7247
HEALTHCOMP
(800) 755-7247
(800) 442-7247
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-27
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* Alamo Cement (TRAVEL)
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
GROUP & PENSION
ADMINISTRATORS
12770 MERIT DR STE 200
DALLAS TX 75251
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GROUP & PENSION
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 827-7223
(800) 827-7223
ALAMO NAVAJO SCHOOL BOARD
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
SRT ADMINISTRATORS, INC.
SRT ADMINISTRATORS, INC.
CHECK BENEFIT CARD
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
ALBANY (STRATTON) VA MEDICAL
CENTER 3520
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
ALBANY (STRATTON) VA MEDICAL
CENTER
Attn: FEE BASIS 136E
113 HOLLAND AVE
ALBANY NY 12208
ALBANY (STRATTON) VA MEDICAL
CENTER
CHECK BENEFIT CARD
ALBANY COUNTY SCHOOL DISTRICT
1
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
MBA OF WYOMING C/O CCN
MBA OF WYOMING C/O CCN
MBA OF WYOMING C/O CCN
ALBANY STATE UNIV AIH0057887
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
PO Box 2271
Florence SC 29503
(843) 622-6001
* Albany
Affiliated With: New York State
Insurance Fund
Plan Type: Workers' Compensation
PO Box 25160
SCOTTSDALE AZ 85255-0102
PO Box 3000
SCOTTSDALE AZ 85271
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-28
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ALBANY STATE UNIV AIH0058897
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
ALBANY STATE UNIVERSITY
UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
CLAIMS SUBMISSION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
CHECK BENEFIT CARD
(843) 622-6001
(843) 622-6001
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
ALBUQUERQUE VAMC 3170
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
ALBUQUERQUE VAMC
Attn: FMS-04
1501 SAN PEDRO SE
ALBUQUERQUE NM 87108
ALBUQUERQUE VAMC
CHECK BENEFIT CARD
ALDEN SHOE
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ALEUT CORPORATION
Affiliated With: RISK AND BENEFIT
MANAGEMENT SERVICES, LLC
Plan Type: Group Health
RBMS, LLC
RBMS, LLC
510 L STREET, STE 650
ANCHORAGE AK 99501
(907) 561-3740
MRC
(509) 328-9700
ALEUTIAN SPRAY FISHERIES
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
(907) 561-3740
TRUSTEED PLANS SERVICE GROUP
PO Box 1894
TACOMA WA 98406-1705
TRUSTEED PLANS SERVICE GROUP QUALIS
(800) 783-8606
(800) 345-8563
(800) 426-9786
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-29
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ALEXANDRIA MOULDING INC
Affiliated With: MERCER
ADMINISTRATION
Plan Type: Group Health
Term Effective: 8/31/2007
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
UTILIZATION REVIEW
ALEXANDRIA VAMC 3102
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
ALEXANDRIA VAMC
Attn: FEE BASIS - BLDG 5, Rm 225
SHREVEPORT HWY
ALEXANDRIA LA 71306
ALEXANDRIA VAMC
CHECK BENEFIT CARD
ALICE PECK DAY HEALTH SYSTEMS
JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
EBPA
EBPA
CHECK BENEFIT CARD
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
(802) 846-8060
ALICO INC
Affiliated With: SELF INSURED PLANS
LLC
Plan Type: Auto
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ALL AMERICAN BOTTLING CO
Affiliated With: THE KEMPTON GROUP
INC
Plan Type: Group Health
KEMPTON GROUP
ADMINISTRATORS INC
KEMPTON GROUP
ADMINISTRATORS INC
QUANTUM CARE
(866) 412-8252
PO Box 54889
OKLAHOMA CITY OK 73154
(405) 521-1711
(405) 521-1711
* ALL STAR GAS
Affiliated With: ULTRABENEFITS, INC.
Plan Type: Group Health
Term Effective: 8/31/2007
ULTRABENEFITS INC
ULTRABENEFITS INC
PO Box 763
WESTBOROUGH MA 01581
(866) 858-7223
CHECK BENEFIT CARD
(508) 438-0007
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-30
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ALL TECH INSPECTIONS, INC.
TRAVEL
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
ALLEN SAMUELS AUTO GROUP
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
GROUP & PENSION
ADMINISTRATORS
12770 MERIT DR STE 200
DALLAS TX 75251
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GROUP & PENSION
ADMINISTRATORS
UTILIZATION REVIEW
HEALTH WATCH
(972) 238-7900
(800) 827-7223
(800) 827-7223
GROUP & PENSION
ADMINISTRATORS INC
GROUP & PENSION
ADMINISTRATORS INC
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
HEALTH WATCH
(972) 238-7900
(972) 238-7900
ALLENS, INC
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
3121 QUAIL SPRINGS PKWY
OKLAHOMA CITY OK 73134
(800) 825-3540
MUTUAL ASSURANCE
ADVANTAGE
(800) 825-3540
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 825-3540
ALLIED HOLDING INC
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
ALLIED MACHINE
Affiliated With: THE CHANDLER
GROUP 13352
Plan Type: Group Health
DIRECT CARE AMERICA
DIRECT CARE AMERICA
PO Box 2090 C
STOW OH 44224
(800) 266-5896
ALLIED NATIONAL INC
Affiliated With: ALLIED NATIONAL INC
Plan Type: Group Health
6087838700
CHECK BENEFIT CARD
(800) 266-5896
GLOBALCARE, INC.
ALLIED NATIONAL
6875 SHILOH RD E
ALPHARETTA GA 30005
(800) 825-7531
CHECK BENEFIT CARD
(800) 825-7531
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-31
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ALLSTATE POWER VAC
Affiliated With: BENEFIT CONCEPTS
INC
Plan Type: Group Health
ALLTRADE, INC.
Affiliated With: AFFORDABLE BENEFIT
ADMINISTRATORS, INC. (ABA)
Plan Type: Group Health
CLAIMS SUBMISSION
BENEFIT CONCEPTS, INC.
1021 W 8TH AVE
KING OF PRUSSIA PA 19406
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BENEFIT CONCEPTS, INC.
UTILIZATION REVIEW
(610) 491-4992
BENEFIT CONCEPTS, INC.
(215) 773-2023
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
Alpha Review Corporation
Alpha Review Corporation
(630) 305-8108
(610) 491-4992
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
PO Box 10787
BURBANK CA 91510
Alpha Review Corporation
Alpha Review Corporation
Affiliated With: Alpha Review Corporation 1807 Diehl Rd
Plan Type: Workers' Compensation
Naperville IL 60563
(630) 305-8108
(630) 305-8108
Alpha Review Corporation Auto
Alpha Review Corporation
Affiliated With: Alpha Review Corporation 1807 Diehl Rd
Plan Type: Auto
Naperville IL 60563
(630) 305-8108
Alpha Review Corporation
(630) 305-8108
DIRECT CARE AMERICA
CHECK BENEFIT CARD
Alpha Review Corporation
(630) 305-8108
ALPHA SECURITY PRODUCTS
DIRECT CARE AMERICA
Affiliated With: THE CHANDLER GROUP PO Box 2090 C
Plan Type: Group Health
STOW OH 44224
(800) 266-5896
(800) 266-5896
ALPINE RESOURCES GROUP INC
Affiliated With: REGIONAL CARE INC
19254
Plan Type: Group Health
ALSCO
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
REGIONAL CARE INC
REGIONAL CARE INC
905 W 27th St
Scottsbluff NE 69361
(308) 635-2260
HINES ASSOCIATES
(308) 635-2260
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
CHECK BENEFIT CARD
PO Box 7186
BOISE ID 83707
(800) 953-1801
(308) 635-2260
(800) 953-1801
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-32
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ALTA BATES SUMMIT MEDICAL
CENTER
Affiliated With: BENEFIT AND RISK
MANAGEMENT SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ALTA HEALTHCARE SYSTEM LLC
Affiliated With: ZENITH
ADMINISTRATORS INC PHOENIX
OFFICE
Plan Type: Group Health
ALTA HEALTHCARE SYSTEMS, LLC
ALTOM TRANSPORT INC
Affiliated With: BENEFIT
ADMINISTRATIVE SYSTEMS #10329
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
ALTA HEALTHCARE SYSTEMS, LLC
ALTA HEALTHCARE SYSTEMS,
LLC
BENEFIT ADMINISTRATIVE
SYSTEMS
BENEFIT ADMINISTRATIVE
SYSTEMS
CHECK BENEFIT CARD
17475 Jovanna Dr. STE 1B
HOMEWOOD IL 60430
(708) 647-3433
2001 W. Camelback Rd. #350
PHOENIX AZ 85015
(708) 647-3433
ALTOONA VAMC 3122
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
ALTOONA VAMC
Attn: FEE BASIS (14F)
ALTO-SHAAM INC
Affiliated With: HEALTH DATA
SERVICES
Plan Type: Group Health
EMPLOYEE BENEFIT CONSULTANTS EMPLOYEE BENEFIT CONSULTANTS CHECK BENEFIT CARD
ALUSUISSE COMPOSITES, INC.
Affiliated With: PITTMAN &
ASSOCIATES, INC.
Plan Type: Group Health
ALTOONA VAMC
CHECK BENEFIT CARD
2907 PLEASANT VALLEY BLVD
ALTOONA PA 16602
PO Box 928
FINDLAY OH 45839
(800) 523-5789
(800) 523-5789
PITTMAN & ASSOCIATES, INC.
PITTMAN & ASSOCIATES, INC.
PITTMAN & ASSOCIATES, INC.
PO Box 111047
MEMPHIS TN 38111
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-33
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Alutiiq, LLC
Affiliated With: RBMS LLC
Plan Type: Group Health
CLAIMS SUBMISSION
RBMS, LLC
510 L STREET, STE 650
ANCHORAGE AK 99501
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
RBMS, LLC
(907) 561-3740
UTILIZATION REVIEW
MEDICAL REHABILITATION
CONSULTANTS
(800) 827-5058
(907) 561-3740
ALVERNO CLINICAL LABORATORIES,
INC.
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ALVERNO INFORMATION SERVICES
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
(800) 533-5044
ALVORD UNIFIED SCHOOL DISTRICT
Affiliated With: ALVORD UNIFIED
SCHOOL DISTRICT
Plan Type: Group Health
RIVERSIDE FOUNDATION FOR
MEDICAL CARE
Amalgamated Clothing Fund
Affiliated With: Amalgamated Life
Insurance Co.
Plan Type: Group Health
Amalgamated Clothing Fund
RIVERSIDE FOUNDATION FOR
MEDICAL CARE
RIVERSIDE FOUNDATION FOR
MEDICAL CARE
Amalgamated Life Insurance Co. Clothing Fund
Amalgamated Life Insurance
Co. - Clothing Fund
(800) 332-5426
3993 Jurupa
RIVERSIDE CA 92506
PO Box 11008
Scottsdale AZ 85271-1008
ECS Payor ID 13550
(212) 539-5105
(212) 539-5105
Amalgamated Cotton Fund
Affiliated With: Amalgamated Life
Insurance Co.
Plan Type: Group Health
Amalgamated Cotton Fund
PO Box 11007
Scottsdale AZ 85271-1007
ECS Payor ID 13550
Amalgamated Life Insurance Co. Cotton Fund
(212) 539-5100
Amalgamated Life Insurance
Co. - Cotton Fund
(800) 332-5426
(212) 539-5100
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-34
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Amalgamated Industrial Service
Workers Benefit Fund
Affiliated With: Amalgamated Life
Insurance Co.
Plan Type: Group Health
CLAIMS SUBMISSION
Amalgamated Industrial Service
Workers Benefit Fund
PO Box 8507
Scottsdale AZ 85252-8507
ECS Payor ID 13550
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ALICO
(212) 539-5112
UTILIZATION REVIEW
ALICO
(800) 332-5426
(212) 539-5112
Amalgamated Retail Fund
Affiliated With: Amalgamated Life
Insurance Co.
Plan Type: Group Health
Amalgamated Retail Fund
Amalgamated Life Insurance Co.
99 University Pl
New York NY 10003
ECS Payor ID 13550
(800) 543-4723
Amalgamated Retail Fund
(800) 332-5426
(800) 543-4723
AMALGAMATED RETIREE HEALTH
AND WELFARE TRUST
Affiliated With: ADVANCED BENEFIT
SOLUTIONS LLC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ADVANCED BENEFITS
SOLUTIONS
AMARILLO VAMC 3171
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
AMARILLO VAMC
Attn: FEE 136
AMARILLO VAMC
CHECK BENEFIT CARD
AMBEC
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
Careline UR
(763) 383-4800
6010 AMARILLO BLVD WEST
AMARILLO TX 79106
(800) 422-2026
AMC PPO FOR TCGH-BASED
EMPLOYEES
Affiliated With: ADVENTIST HEALTH
SYSTEMS / WEST
Plan Type: Group Health
ADVENTIST HEALTH
SYSTEMS/WEST
ADVENTIST HEALTH
SYSTEMS/WEST
2100 DOUGLAS
ROSEVILLE CA 95661
(800) 441-2524
UM NOT APPLICABLE
(800) 441-2524
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-35
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
American Administrative Group (AAG)
Affiliated With: American Administrative
Group
Plan Type: Group Health
CLAIMS SUBMISSION
American Administrative Group Inc.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
American Administrative Group Inc.
UTILIZATION REVIEW
(800) 877-7474
First Health
(800) 346-3220
American Alternative Insurance Company CONTACT EMPLOYER
Affiliated With: Genex Services, Inc.
Attn:
Plan Type: Workers' Compensation
CONTACT EMPLOYER
CONTACT EMPLOYER
AMERICAN ASPHALT & GRADING
COMPANY
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
PO Box 34297
San Antonio TX 78265
ECS Payor ID 37283
(800) 877-7474
AMERICAN ASPHALT & GRADING
COMPANY TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
American Baptist
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
International Medical Group, Inc.
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
AMERICAN COMMUNITY - JMS
CHECK BENEFIT CARD
Affiliated With: AMERICAN COMMUNITY
Plan Type: Group Health
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-36
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AMERICAN COMMUNITY MUTUAL
INSURANCE COMPANY
Affiliated With: AMERICAN
COMMUNITY MUTUAL INSURANCE
COMPANY
Plan Type: Group Health
CLAIMS SUBMISSION
AMERICAN COMMUNITY MUTUAL
INSURANCE
39201 Seven Mile Rd
Livonia MI 48152
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AMERICAN COMMUNITY MUTUAL
INSURANCE
UTILIZATION REVIEW
CHECK BENEFIT CARD
(734) 591-4695
(734) 591-4695
AMERICAN DEHYDRATED FOODS,
INC.
Affiliated With: THE EPOCH GROUP,
L.C.
Plan Type: Group Health
THE EPOCH GROUP
EPOCH GROUP LC THE
CHECK BENEFIT CARD
AMERICAN EDUCATION CENTERS
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS
Plan Type: Group Health
PERSONAL INSURANCE
ADMINISTRATORS
PERSONAL INSURANCE
ADMINISTRATORS
CHECK BENEFIT CARD
30401 Agoura Rd #250
Agoura Hills CA 91376
(800) 468-4343
PO Box 12170
OVERLAND PARK KS 66282
(800) 468-4343
AMERICAN EMPLOYERS BENEFIT
TRUST
Affiliated With: EMPLOYEE BENEFIT
MANAGEMENT SERVICES, INC.
Plan Type: Group Health
EMPLOYEE BENEFIT MANAGEMENT
SERVICES, INC.
EMPLOYEE BENEFIT MANAGEMENT CHECK BENEFIT CARD
SERVICES, INC.
PO Box 21367
BILLINGS MT 59104-1367
8007773575
8007773575
AMERICAN EMPLOYMENT GROUP
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AMERICAN FARMERS AND
RANCHERS MUTUAL INSURANCE
COMPANY
Affiliated With: C L FRATES &
COMPANY
Plan Type: Group Health
C.L. FRATES AND COMPANY
C.L. FRATES AND COMPANY
CHECK BENEFIT CARD
PO Box 26967
OKLAHOMA CITY OK 73126-0967
(405) 290-5696
(405) 290-5696
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-37
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AMERICAN GREETINGS
Affiliated With: HEALTHSCOPE
BENEFITS, INC
Plan Type: Group Health
AMERICAN HEALTH CENTERS
AFFILIATED COMPANIES
Affiliated With: WAUSAU BENEFITS INC
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTHSCOPE BENEFITS INC
27 CORPORATE HILL DR
LITTLE ROCK AR 72205
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTHSCOPE BENEFITS INC
UTILIZATION REVIEW
(866) 885-4944
HEALTHSCOPE BENEFITS INC
(501) 218-7691
WAUSAU BENEFITS, INC.
CHECK BENEFIT CARD
(800) 560-4664
WAUSAU BENEFITS, INC.
Attn: LeAnn Fichtner
PO Box 8046
WAUSAU WI 54401-8046
(715) 841-7802
(715) 841-7802
AMERICAN HEALTHCARE ALLIANCE
Affiliated With: AMERICAN
HEALTHCARE ALLIANCE
Plan Type: Group Health
AMERICAN HEALTHCARE ALLIANCE OUT OF AREA
Affiliated With: AMERICAN
HEALTHCARE ALLIANCE 13780
Plan Type: Group Health
AMERICAN MARITIME OFFICERS
Affiliated With: AMERICAN
HEALTHCARE ALLIANCE
Plan Type: Group Health
AMERICAN MISSIONARY
FELLOWSHIP
Affiliated With: BROKERAGE
CONCEPTS BENEFIT CONCEPTS INC
Plan Type: Group Health
AMERICAN HEALTHCARE ALLIANCE
AMERICAN HEALTHCARE ALLIANCE CHECK BENEFIT CARD
PO Box 8530
KANSAS CITY MO 64114-0530
(800) 870-6252
(800) 870-6252
AMERICAN HEALTHCARE ALLIANCE
AMERICAN HEALTHCARE ALLIANCE CHECK BENEFIT CARD
PO Box 8530
KANSAS CITY MO 64114-0530
(800) 870-6252
(800) 870-6252
AMO MEDICAL PLAN
AMO MEDICAL PLAN
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PO Box 35
Dania FL 33004
(800) 348-6515
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-38
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AMERICAN REFRIGERATION
SUPPLIES INC
Affiliated With: ADVANCED BENEFIT
SOLUTIONS
Plan Type: Group Health
AMERICAN REPUBLIC INDIVIDUALS
Affiliated With: AMERICAN REPUBLIC
INSURANCE COMPANY
Plan Type: Group Health
CLAIMS SUBMISSION
ADVANCED BENEFITS SOLUTIONS,
INC.
PO Box 71490
PHOENIX AZ 85050
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
ARIZONA
FOUNDATION FOR
ADVANCED BENEFITS SOLUTIONS,
MEDICAL CARE
INC.
(602) 417-2337
8884191094
8884191094
AMERICAN REPUBLIC INSURANCE
COMPANY
AMERICAN REPUBLIC INSURANCE
COMPANY
PO Box 2975
CLINTON IA 52733
(800) 247-2190
CHECK BENEFIT CARD
(800) 247-2190
American Republic Insurance Company
Affiliated With: American Republic
Insurance Company
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AMERICAN SEAFOODS COMPANY
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS
INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
AMERICAN SECURITY LIFE
INSURANCE COMPANY
Affiliated With: INTERNATIONAL
MANAGED CARE SERVICES
Plan Type: Group Health
INTERNATIONAL MANAGED CARE
SERVICES C/O CCN
INTERNATIONAL MANAGED CARE
SERVICES C/O CCN
CHECK BENEFIT CARD
AMERICAN SENTINEL SPORTS &
ATHLETIC SERIES 600
Affiliated With: PREFERRED CARE,
INC.
Plan Type: Group Health
PREFERRED CARE, INC.
PREFERRED CARE, INC.
CHECK BENEFIT CARD
6 Neshaminy Interplex #205
TREVOSE PA 19053
(800) 222-3085
PO Box 5190
TAMPA FL 33675-5190
(800) 222-3085
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-39
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AMERICAN SENTINEL SPORTS &
ATHLETIC SERIES 800
Affiliated With: PREFERRED CARE,
INC.
Plan Type: Group Health
AMERICAN SERVICES TECHNOLOGY
Affiliated With: CAROLINA BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
PREFERRED CARE, INC.
6 Neshaminy Interplex #205
TREVOSE PA 19053
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PREFERRED CARE, INC.
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 222-3085
(800) 222-3085
FISERV HEALTH TENNESSEE
FISERV HEALTH TENNESSEE
PO Box 530
PUEBLO CO 81002-0530
(800) 255-8109
INTRACORP
(800) 866-8899
AMERICAN SOCIETY FOR
DIRECT CARE AMERICA
ENGINEERING ED
PO Box 2090 C
Affiliated With: THE CHANDLER GROUP STOW OH 44224
Plan Type: Group Health
(800) 266-5896
DIRECT CARE AMERICA
CHECK BENEFIT CARD
AMERICAN TRUETSCHLER
Affiliated With: JSL ADMINISTRATORS
INC
Plan Type: Group Health
JSL ADMINISTRATORS, INC.
JSL ADMINISTRATORS, INC.
201 HAY STREET, STE 302
FAYETTEVILLE NC 28301
(910) 480-3100
AMERICAN TRUETZSCHLER
Affiliated With: JSL ADMINISTRATORS
INC
Plan Type: Group Health
AMERICAN TRUST ADMINISTRATORS
Affiliated With: AMERICAN TRUST
ADMINISTRATORS
Plan Type: Group Health
(800) 255-8109
(800) 266-5896
DOCTORS DIRECT
HEALTHCARE
(910) 485-0510
(910) 480-3100
JSL ADMINISTRATORS, INC.
JSL ADMINISTRATORS, INC.
201 HAY STREET, STE 302
FAYETTEVILLE NC 28301
(910) 480-3100
MEDCOST
(800) 443-9178
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(910) 480-3100
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-40
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
AMERICAN WEST DEVELOPMENT
SIERRA HEALTH & LIFE/HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN OF NEVADA
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
American Youth Hostels
Affiliated With: Benesight
Plan Type: Group Health
Benesight
Benesight
PO Box 360
Pueblo CO 81002-0360
(800) 464-5488
CHECK BENEFIT CARD
(407) 661-4242
AMERIHEALTH ADMINISTRATORS
Affiliated With: AMERIHEALTH
ADMINISTRATORS
Plan Type: Group Health
AMERIHEALTH ADMINISTRATORS
C/O CCN
AMERIHEALTH ADMINISTRATORS
C/O CCN
CHECK BENEFIT CARD
WAUSAU BENEFITS, INC.
CHECK BENEFIT CARD
PO Box 5190
TAMPA FL 33675-5190
AMERIMAX FABRICATED PRODUCTS WAUSAU BENEFITS, INC.
Affiliated With: WAUSAU BENEFITS INC Attn: LeAnn Fichtner
Plan Type: Group Health
PO Box 8046
WAUSAU WI 54401-8046
(715) 841-7802
(715) 841-7802
AMERIRESOURCE GROUP
Affiliated With: EQUITABLE PLAN
SERVICES
Plan Type: Group Health
EQUITABLE PLAN SERVICES
EQUITABLE PLAN SERVICES
PO Box 720460
OKLAHOMA CITY OK 73172
(405) 755-2929
CHECK BENEFIT CARD
(405) 755-2929
AMERISURE
Affiliated With: SOLUTIONS4
Plan Type: Workers' Compensation
Solutions4
AMERITEC CORP.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
CDN
CONTACT EMPLOYER
CONTACT EMPLOYER
CDN
HINES & ASSOCIATES
(800) 528-2498
701 TECHNOLOGY DR STE 201
CANONSBURG PA 15317
PO Box 10999
SCOTTSDALE AZ 85271
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-41
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AMF
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
AMG INC
Affiliated With: BUSINESS
ADMINISTRATORS AND
CONSULTANTS
Plan Type: Group Health
AMGRAPH PACKAGING
Affiliated With: TR PAUL GROUP
SERVICES INC
Plan Type: Group Health
AMHERST COLLEGE
Affiliated With: PIONEER
MANAGEMENT SYSTEMS
Plan Type: Group Health
AMOSKEAG BEVERAGES, INC
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
CONTACT EMPLOYER
BUSINESS ADMINISTRATORS &
CONSULTANTS INC
BUSINESS ADMINISTRATORS &
CONSULTANTS INC
BAC
(801) 954-8010
6331 E LIVINGSTON AVE
REYNOLDSBURG OH 43068
(614) 863-8780
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
UTILIZATION REVIEW
(614) 863-8780
T R PAUL INC.
T R PAUL INC.
PO Box 5508
NEWTOWN CT 06470
7139143400
HINES & ASSOCIATES
(727) 530-3444
PIONEER MANAGEMENT SYSTEMS
PIONEER MANAGEMENT SYSTEMS
CHECK BENEFIT CARD
123 INTERSTATE DR
W SPRINGFIELD MA 01090
(877) 868-9060
(800) 678-8161
(877) 868-9060
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(508) 752-2480
CMS
(866) 325-1550
(508) 752-2480
AmTrust
Affiliated With: FairPay Solutions
Plan Type: Workers' Compensation
FairPay Solutions
Attn: Jon Peebles
14295 Midway Rd Ste 300
Addison TX 75001
FairPay Solutions
(972) 715-8000
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
FairPay Solutions
(972) 715-8000
Info as of 12/13/2007
Page PIRCA-42
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
AMX INTERNATIONAL INC
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
AN DERINGER INC WRAP JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
UTILIZATION REVIEW
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(802) 846-8060
ANA MARIA COLLEGE SPORTS
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ANCHOR CAPITAL
Affiliated With: NORTH AMERICAN
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ANCHOR INDUSTRIES
Affiliated With: MERITIAN HEALTH
Plan Type: Group Health
MERITAIN HEALTH
MERITAIN HEALTH
CHECK BENEFIT CARD
111 SE THIRD ST STE 404
EVANSVILLE IN 47708
(812) 455-1938
(812) 455-1938
ANDOVER NEWTON THEOLOGICAL
SCHOOL
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
Term Effective: 8/31/2007
STUDENT RESOURCES
STUDENT RESOURCES
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 237-0903 Ext 6352
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-43
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ANGELO STATE UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
ANGELS BASEBALL
Affiliated With: ADVANCED BENEFIT
SOLUTIONS LLC
Plan Type: Group Health
CLAIMS SUBMISSION
TRUE CHOICE
PO Box 700307
DALLAS TX 75370
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
TRUE CHOICE
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 251-9665
(800) 251-9665
ADVANCED BENEFIT SOLUTIONS
LLC
ADVANCED BENEFIT SOLUTIONS
LLC
PO Box 71490
PHOENIX AZ 85050
(888) 419-1094
ARIZONA FOUNDATION FOR
MEDICAL CARE
(602) 417-2337
(888) 419-1094
ANN ARBOR VA MEDICAL CENTER
3152
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
ANN ARBOR VA MEDICAL CENTER
Attn: FEE BASIS CHIEF RESOURCE
OFFICER (20)
2215 FULLER
ANN ARBOR MI 48105
ANN ARBOR VA MEDICAL CENTER
CHECK BENEFIT CARD
ANNA MARIA COLLEGE
Affiliated With: PIONEER
MANAGEMENT SYSTEMS
Plan Type: Group Health
PIONEER MANAGEMENT SYSTEMS
INC
PIONEER MANAGEMENT SYSTEMS
INC
330 WHITNEY AVE
HOLYOKE MA 01041
8004234586
PIONEER MANAGEMENT
SYSTEMS INC
8004234586
8004234586
ANNIE E CASEY FOUNDATION, THE
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NY
Plan Type: Group Health
NORTH AMERICAN
ADMINISTRATORS-NY
NORTH AMERICAN
ADMINISTRATORS-NY
PO Box 9501
AMHERST NY 14226
(800) 828-6922
NORTH AMERICAN
ADMINISTRATORS-NY
(800) 828-6922
(800) 828-6922
ANRITSU COMPANY
Affiliated With: BENESIGHT INC
Plan Type: Group Health
BENESIGHT INC
BENESIGHT INC
PO Box 399
PUEBLO CO 81002
(888) 339-7280
VALUECHECK
(214) 920-9076
(888) 339-7280
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-44
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The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ANTELOPE VALLEY UNION HIGH
Affiliated With: K-12 STUDENT
INSURANCE, A DIVISION OF UICI
Plan Type: Group Health
CLAIMS SUBMISSION
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
STUDENT INSURANCE A DIVISION
OF UICI
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 767-0700
(800) 237-0903 Ext 6352
APACHE CORPORATION
Affiliated With: BENEFIT PLANNERS
LTD
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
APA-THE ENGINEERED WOOD
ASSOCIATION
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
TRUSTEED PLANS SERVICE GROUP
TRUSTEED PLANS SERVICE GROUP AMERICAN HEALTH HOLDING
(888) 877-7994
(800) 426-9786
APCO EQUIPMENT
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
PO Box 1894
TACOMA WA 98401-1894
CHECK BENEFIT CARD
(800) 426-9786
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
APEA AFT HEALTH & WELFARE
TRUST
Affiliated With: RBMS, LLC
Plan Type: Group Health
APLICARE, INC.
Affiliated With: T.R. PAUL, INC.
Plan Type: Group Health
RBMS, LLC
RBMS, LLC
510 L STREET, STE 650
ANCHORAGE AK 99501
(907) 561-3740
MEDICAL REHABILITATION
CONSULTANTS
(800) 827-5058
(907) 561-3740
T R PAUL INC.
T R PAUL INC.
PO Box 5508
NEWTOWN CT 06470-5508
(800) 678-8161 Ext 239
CHECK BENEFIT CARD
(800) 678-8161 Ext 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.
Info as of 12/13/2007
Page PIRCA-45
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The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
A-PLUS BENEFITS, INC.
Affiliated With: EVEREST
ADMINISTRATORS, INC.
Plan Type: Group Health
APPALACHIAN BENEFIT
ADMINSTRATORS
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
EVEREST ADMINISTRATORS, INC.
C/O CCN
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EVEREST ADMINISTRATORS, INC.
C/O CCN
UTILIZATION REVIEW
CHECK BENEFIT CARD
PO Box 3000
SCOTTSDALE AZ 85271-3000
GLOBALCARE, INC.
GLOBALCARE, INC.
6875 Shiloh Rd E
ALPHARETTA GA 30005
8008601111
MedWatch
(800) 432-8421
MBA
MBA
6783411722
APPLE STEEL RULE DIE
MBA
Plan Type: Group Health
PO Box 909991
MILWAUKEE WI 53209
APPLETON MCGILL ELECTRIC
SWITCH
Affiliated With: MCGILL ELECTRIC
SWITCH PRODUCT GROUP
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Applied Underwriters
Affiliated With: Applied Underwriters
Plan Type: Workers' Compensation
Applied Underwriters
Applied Underwriters
PO Box 3804
Omaha NE 68103
(402) 827-3424
Applied Underwriters
(402) 827-3424
THE LOOMIS COMPANY
CHECK BENEFIT CARD
(800) 293-3131
ARAMARK
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY 850 N PARK RD
Plan Type: Group Health
WYOMISSING PA 19610
(800) 782-0392
(800) 782-0392
ARAZ
Affiliated With: AMERICAS TPA
Plan Type: Group Health
America's TPA
America's TPA
PO Box 398220
Bloomington MN 55439
(866) 478-6268
CHECK BENEFIT CARD
(952) 896-1255
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-46
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ARC IMPERIAL VALLEY
Affiliated With: EMPLOYEE BENEFITS
ADMINISTRATION & MGMT (EBA&M)
Plan Type: Group Health
CLAIMS SUBMISSION
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M)
PO Box 5079
WESTLAKE VILLAGE CA 91359
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M)
UTILIZATION REVIEW
HINES & ASSOCIATES
(800) 528-2498
(805) 497-4581
(805) 497-4581
ARCA XYTEC SYSTEMS INC
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
CHECK BENEFIT CARD
ARCO INC
Affiliated With: MANAGED BENEFITS
ADMINISTRATOR AND INSURANCE
CONSU
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ARDENT HEALTH SERVICES
Affiliated With: HARRINGTON BENEFIT
SERVICES INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ARETE ASSOCIATES
Affiliated With: AFFORDABLE BENEFIT
ADMINISTRATORS, INC. (ABA)
Plan Type: Group Health
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
ARGOSY UNIVERSITY
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
ADMINISTRATIVE CONCEPTS, INC.
Attn: Customer Service Dept
997 Old Eagle School Rd. #215
WAYNE PA 19087-1706
ADMINISTRATIVE CONCEPTS, INC.
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8004269786
PO Box 10787
BURBANK CA 91510
(610) 293-9229
(610) 293-9229
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-47
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ARGOSY UNIVERSITY
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
PERSONAL INSURANCE
ADMINISTRATORS
30401 Agoura Rd #250
Agoura Hills CA 91376
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PERSONAL INSURANCE
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 468-4343
(800) 468-4343
ARISTOCRATS TRAVEL PLAN
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
ARIZONA STRUCTURE
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
GLOBALCARE
GLOBALCARE
6875 Shiloh Rd E
ALPHARETTA GA 30005
(678) 341-1811
HINES & ASSOCIATES
(800) 670-7718
ECOM PPO ADVISORS, INC
CHECK BENEFIT CARD
(678) 341-1811
ARKANSAS BEST CORPORATION
Affiliated With: ECOM PPO ADVISORS
INC
Plan Type: Group Health
ECOM PPO ADVISORS, INC
Attn: ACCOUNTING
8350 N. CENTRAL EXPWY, STE 600
DALLAS TX 75206
(479) 785-6178
(479) 785-6178
ARKANSAS MILL SUPPLY CO
Affiliated With: ADMINONE
CORPORATION
Plan Type: Group Health
RESOURCEONE ADMINSTRATORS
Attn: Mary Shepherd
PO Box 489
BUCKEYSTOWN MD 21717
(800) 967-2077
MEDCAREONE CORP
(800) 816-1206
ARM, LTD.
ARM, LTD.
CHECK BENEFIT CARD
10200 S.W. Nimbus Ave. Ste G-5
PORTLAND OR 97223
(503) 968-6831
ADMINONE CORPORATION
(800) 967-2077
ARM, LTD.
Affiliated With: ALTERNATIVE RISK
MANAGEMENT LTD NORTHWEST
Plan Type: Group Health
(877) 544-1770
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-48
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ARMFIELD HARRISON & THOMAS
Affiliated With: ASSURECARE
Plan Type: Group Health
CLAIMS SUBMISSION
ASSURECARE
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ASSURECARE
UTILIZATION REVIEW
(800) 422-2026
Careline UR
(763) 383-4800
ARMSTRONG ATLANTIC STATE
PEARCE ADMINISTRATION
UNIVERSITY AIH0057907
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
ARMSTRONG ATLANTIC STATE
PEARCE ADMINISTRATION
UNIVERSITY AIH0057917
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
ARMSTRONG ATLANTIC STATE
UNIVERSITY UNDERGRAD
Attn: WHIT WALTERS
MANDATORY
419 S. COIT ST
Affiliated With: MAKSIN MANAGEMENT
FLORENCE SC 29501
CORP
(800) 222-6491
Plan Type: Group Health
PEARCE ADMINISTRATION
ARNETT HEALTH PLANS
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
GLOBALCARE, INC.
GLOBALCARE, INC.
6875 Shiloh Rd E
ALPHARETTA GA 30005
8008601111
Arnett Health Plans
(765) 448-7725
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M)
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M)
HINES & ASSOCIATES
(800) 528-2498
PO Box 5079
WESTLAKE VILLAGE CA 91359
(805) 497-4581
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
UM NOT APPLICABLE
(800) 222-6491
6783411722
ARNOLD MAGNETICS
Affiliated With: EMPLOYEE BENEFITS
ADMINISTRATION & MGMT (EBA&M)
Plan Type: Group Health
(805) 497-4581
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-49
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Arrowpoint Capital Corp.
Affiliated With: Royal Indemnity Company
Plan Type: Workers' Compensation
ART CENTER COLLEGE OF DESIGN
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
PERSONAL INSURANCE
ADMINISTRATORS, (PIA)
PERSONAL INSURANCE
ADMINISTRATORS, (PIA)
30401 Agoura Rd #250
Agoura Hills CA 91376
(800) 226-5116
UTILIZATION REVIEW
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 226-5116
ART INSTITUTE OF AMERICA
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS
Plan Type: Group Health
PERSONAL INSURANCE
ADMINISTRATORS
PERSONAL INSURANCE
ADMINISTRATORS
30401 Agoura Rd #250
Agoura Hills CA 91376
(800) 468-4343
CHECK BENEFIT CARD
(800) 468-4343
ART INSTITUTE OF AMERICA
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
ADMINISTRATIVE CONCEPTS, INC.
Attn: Customer Service Dept
997 Old Eagle School Rd. #215
WAYNE PA 19087-1706
ADMINISTRATIVE CONCEPTS, INC.
CHECK BENEFIT CARD
(610) 293-9229
(610) 293-9229
ARVEST BANK GROUP INC
Affiliated With: BENEFIT
MANAGEMENT INC
Plan Type: Group Health
ASARCO AZ
Affiliated With: MARITAIN HEALTH
Plan Type: Group Health
BENEFIT MANAGEMENT INC.
BENEFIT MANAGEMENT INC.
PO BOX 3767
BARTLESVILLE OK 74006
(800) 824-5034
CHECK BENEFIT CARD
(800) 824-5034
NORTH AMERICAN
ADMINISTRATORS
Attn: Claims Dept
PO Box 853921
Richardson TX 75085-3921
(800) 397-2122
NORTH AMERICAN
ADMINISTRATORS
(800) 397-2122
DIRECT CARE AMERICA
CHECK BENEFIT CARD
NORTH AMERICAN
ADMINISTRATORS
(800) 397-2122
ASC INDUSTRIES
DIRECT CARE AMERICA
Affiliated With: THE CHANDLER GROUP PO Box 2090 C
Plan Type: Group Health
STOW OH 44224
(800) 266-5896
(800) 266-5896
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-50
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ASH BROKERAGE
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NEW YORK
Plan Type: Group Health
CLAIMS SUBMISSION
NORTH AMERICAN
ADMINISTRATORS-NY
PO Box 730
AMHERST NY 14226
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NORTH AMERICAN
ADMINISTRATORS-NY
UTILIZATION REVIEW
(800) 397-2122
NORTH AMERICAN
ADMINISTRATORS
(800) 828-6922
(800) 397-2122
ASH BROKERAGE CORPORATION
Affiliated With: AMERICAN
HEALTHCARE ALLIANCE
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ASHEVILLE VAMC 3134
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
ASHVILLE VAMC
Attn: FEE BASIS 136
1100 TUNNEL RD
ASHVILLE NC 28805
ASHVILLE VAMC
CHECK BENEFIT CARD
ASHLEY
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
4040 HUNSAKER STE 110
LANSING MI 38823
(800) 968-6616
CARELINE
(763) 383-4800
(800) 968-6616
ASIA FOUNDATION
Affiliated With: GALLAGHER BENEFIT
ADMINISTRATORS INC
Plan Type: Group Health
GALLAGHER BENEFIT
ADMINISTRATORS INC
GALLAGHER BENEFIT
ADMINISTRATORS INC
PO Box 34297
San Antonio TX 78265
(630) 493-3849
GALLAGHER BENEFIT
ADMINISTRATORS INC
(630) 493-3842
Mountain States Administrative
Services
Mountain States Administrative
Services
Hines and Associates
(847) 214-2780
7202 E ROSEWOOD STE 200
TUCSON AZ 85710
(520) 722-7133
(800) 877-7474
ASML
Affiliated With: MOUNTAIN STATES
ADMINISTRATIVE SERVICES
Plan Type: Group Health
(520) 722-7133
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-51
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ASMO MANUFACTURING
Affiliated With: HEALTHSCOPE
BENEFITS, INC
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTHSCOPE BENEFITS INC
27 CORPORATE HILL DR
LITTLE ROCK AR 72205
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTHSCOPE BENEFITS INC
UTILIZATION REVIEW
(866) 885-4944
HEALTHSCOPE BENEFITS INC
(501) 218-7691
(800) 560-4664
ASPEN EDUCATION
Affiliated With: BENEFIT PLANNERS
LTD
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ASR TRIALON
Affiliated With: GLOBALCARE
Plan Type: Group Health
GLOBALCARE
GLOBALCARE
6875 SHILOH RD E
ALPHARETTA GA 30005
(888) 285-4864
AEGIS CARE MANAGEMENT
(800) 868-1660
International Medical Group, Inc.
International Medical Group, Inc.
CHECK BENEFIT CARD
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
(888) 285-4864
Assemblies of God (AG10000036598)
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
ASSETS, INC
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
(317) 655-4500 Outside US
(800) 628-4664 Inside US
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
Associated Food Stores, Inc.
Affiliated With: Associated Food Stores,
Inc.
Plan Type: Group Health
AFS Insurance
AFS Insurance
1850 W 2100 S
Salt Lake City UT 84119
(800) 464-7425
AFS Insurance
(801) 973-4400
(801) 978-8336
(800) 464-7425
(801) 978-8336
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-52
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The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ASSOCIATED GENERAL
CONTRACTORS (AGC)
Affiliated With: CONSOCIATE, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
CONSOCIATE, INC.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONSOCIATE, INC.
CONSOCIATE, INC.
CHECK BENEFIT CARD
CHECK BENEFIT CARD
UTILIZATION REVIEW
PO Box 1068
DECATUR IL 62521
ASSOCIATED PLAN
ADMINISTRATORS
Affiliated With: GLOBALCARE
Plan Type: Group Health
CHECK BENEFIT CARD
ASSUMPTION COLLEGE SPORTS
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ASSUMPTION GRAIN COOPERATIVE
GRAIN COMPANY
Affiliated With: NORTH AMERICA
ADMINISTRATORS LP TENNESSEE
Plan Type: Group Health
NORTH AMERICA
ADMINISTRATORS, L.P.
NORTH AMERICA
ADMINISTRATORS, L.P.
MED-CERT
(800) 356-7126
PO Box 1984
NASHVILLE TN 37202
(800) 411-3650
ASSURANT HEALTH PREFERRED
PLAN
Affiliated With: FORTIS BENEFITS
INSURANCE COMPANY
Plan Type: Group Health
ASSURECARE
Affiliated With: ASSURECARE
Plan Type: Group Health
6783411722
(800) 411-3650
KEY BENEFIT ADMINISTRATORS
KEY BENEFIT ADMINISTRATORS
8330 ALLISON POINT TRAIL
INDIANAPOLIS IL 46250
(866) 387-0489
FORTIS BENEFITS
INSURANCE COMPANY
(866) 387-3407
(317) 284-7649
ASSURECARE
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
Careline UR
(763) 383-4800
(800) 422-2026
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-53
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ASSURED SOURCE
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
CLAIMS SUBMISSION
ACCOUNT EXECUTIVE
20 WINTER ST
PEMBROKE MA 02359
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ACCOUNT EXECUTIVE
(800) 242-4472
UTILIZATION REVIEW
GISC OPTIMUM CARE /
AMERICAN HEALTH
(800) 290-4698
(800) 242-4472
ASTELLAS PHARMA
Affiliated With: ASTELLAS PHARMA
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ASTEN JOHNSON
Affiliated With: PRIMARY PHYSICIAN
CARE INC
Plan Type: Group Health
PPC
PPC
PO Box 11088
CHARLOTTE NC 28220
(800) 446-5439
PRIMARY PHYSICIANCARE,
INC.
7045232758
ATASCADERO UNIFIED SCHOOL
DISTRICT
Affiliated With: K-12 STUDENT
INSURANCE, A DIVISION OF UICI
Plan Type: Group Health
* Atascosa County (TRAVEL)
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
(800) 446-5439
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
CHECK BENEFIT CARD
(800) 827-7223
ATCO RUBBER PRODUCTS INC
Affiliated With: GROUP & PENSION
ADMINISTRATORS INC
Plan Type: Group Health
GROUP & PENSION
ADMINISTRATORS INC
GROUP & PENSION
ADMINISTRATORS INC
PO Box 749075
DALLAS TX 75374-9075
(800) 827-7223
GPA/HEALTH WATCH
(972) 587-1402
(972) 587-2311
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-54
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Athens Administrators
Affiliated With: CompIQ
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
CompIQ Corporation
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CompIQ Corporation
UTILIZATION REVIEW
(800) 293-3131
CompIQ Corporation
(800) 293-3131
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
PO Box 2271
Florence SC 29503
(843) 622-6001
35 Tesla Way #100
Irvine CA 92618
(800) 293-3131
ATLANTA METRO AIH0057927
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
ATLANTA METRO COLLEGE
UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
(843) 622-6001
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
ATLANTA VAMC 3545
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
ATLANTA VAMC
Attn: FEE BASIS 508/16
1670 CLAIRMONT RD
DECATUR GA 30033
ATLANTA VAMC
CHECK BENEFIT CARD
ATLANTIC BROADBAND
Affiliated With: INSURANCE
ADMINISTRATOR OF AMERICA, INC.
(IAA)
Plan Type: Group Health
INSURANCE ADMINISTRATORS OF
AMERICA INC
INSURANCE ADMINISTRATORS OF
AMERICA INC
1934 OLNEY AVE STE 200
CHERRY HILL NJ 08003
8885991515
HEALTHCARE STRATEGIES
INC
8885991515
CONTACT EMPLOYER
CONTACT EMPLOYER
Atlantic Charter Insurance Co
Affiliated With: GENEX Services, Inc
Plan Type: Workers' Compensation
8885991515
CONTACT EMPLOYER
Attn:
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-55
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
Atlantic Medical Insurance Company LTD Atlantic Medical Insurance Company
LTD
Affiliated With: Colonial Group
International LTD
Atlantic House 2nd Ter and Collins Ave
PO Box SS-5915
Plan Type: Group Health
Nassau, Bahamas, NP
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Atlantic Medical Insurance Company
LTD
UTILIZATION REVIEW
First Health
(800) 423-9130
(242) 326-8191
(242) 326-8191
ATLANTIC MUTUAL
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
PIONEER MANAGEMENT SYSTEMS
PIONEER MANAGEMENT SYSTEMS
CHECK BENEFIT CARD
PO Box 9040
WEST SPRINGFIELD MA 01090
(413) 539-9900
Plan Type: Workers' Compensation
ATLANTIC UNION COLLEGE
Affiliated With: PIONEER
MANAGEMENT SERVICES
Plan Type: Group Health
ATLAS AMERICA
Affiliated With: CORESOURCE
Plan Type: Group Health
(413) 539-9900
CORESOURCE
CORESOURCE
PO Box 2920
CLINTON OH 52733-2920
(800) 354-5233
UM NOT APPLICABLE
(800) 354-5233
Attenta
Affiliated With: Attenta
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attenta
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
ATWOOD DISTRIBUTING
Affiliated With: INSURANCE
MANAGEMENT SERVICES
Plan Type: Group Health
(800) 580-1642
Attenta
(800) 580-2273
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
INSURANCE MANAGEMENT
SERVICES
INSURANCE MANAGEMENT
SERVICES
CHECK BENEFIT CARD
PO Box 15688
AMARILLO TX 79105
(800) 687-5944
Attenta
(800) 687-5944
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-56
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ATWOOD MOBILE PRODUCTS INC
Affiliated With: NGS AMERICAN INC
Plan Type: Group Health
CLAIMS SUBMISSION
NGS AMERICAN, INC.
PO Box 7676
DETROIT MI 48080
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NGS AMERICAN, INC.
UTILIZATION REVIEW
UM NOT APPLICABLE
8005211555
8005211555
AUBURN UNIVERSITY
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
Term Effective: 8/31/2007
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 767-0700
AUGUSTA - EXTERNAL AFFAIRS 3715
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
AUGUSTA - EXTERNAL AFFAIRS
Attn: EXTERNAL AFFAIRS (112E)
950 15TH ST Rm 1D-103
AUGUSTA GA 30901
AUGUSTA - EXTERNAL AFFAIRS
CHECK BENEFIT CARD
AUGUSTA - FEE BASIS 3542
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
AUGUSTA - FEE BASIS
Attn: FEE BASIS 116
950 15TH ST
AUGUSTA GA 30901
AUGUSTA - FEE BASIS
CHECK BENEFIT CARD
AUGUSTA STATE UNIV AIH0057947
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
PO Box 2271
Florence SC 29503
(843) 622-6001
AUGUSTA STATE UNIV AIH0057957
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
(843) 622-6001
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-57
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
AUGUSTA STATE UNIVERSITY
PEARCE ADMINISTRATION
UNDERGRAD MANDATORY
Attn: WHIT WALTERS
Affiliated With: MAKSIN MANAGEMENT 419 S. COIT ST
CORP
FLORENCE SC 29501
Plan Type: Group Health
(800) 222-6491
AUSTIN COLLEGE
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
AUTOMOBILES OF ITALY INC
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 222-6491
TRUE CHOICE
TRUE CHOICE
PO Box 700307
DALLAS TX 75370
(800) 251-9665
UM NOT APPLICABLE
(800) 251-9665
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
AVALON BENEFIT SERVICES
Affiliated With: NATIONAL HEALTH
BENEFIT CORPORATION NHBC
#12717
Plan Type: Group Health
AVALON CORRECTIONAL SERVICES
INC
Affiliated With: WATERSTONE
BENEFITS ADMINISTRATORS, INC.
Plan Type: Group Health
AVALON HEALTHCARE
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
NHBC
NHBC
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
CHECK BENEFIT CARD
(888) 621-7900
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
(405) 440-8888
CHECK BENEFIT CARD
(405) 843-9551
(405) 440-8888
SMITH ADMINISTRATORS
SMITH ADMINISTRATORS
3761 S. 700 E.
SALT LAKE CITY UT 84106
(801) 261-5511
SERVICE ASSOCIATES
(801) 261-5511
(801) 261-5511
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-58
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
AVALON HEALTHCARE - INSURANCE HEALTH NETWORK AMERICA
COMPANY
246 INDUSTRIAL WAY WEST
Affiliated With: HEALTH NETWORK
EATONTOWN NJ 07724
AMERICA
(732) 676-2637
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTH NETWORK AMERICA
(732) 676-2637
UTILIZATION REVIEW
HEALTH NETWORK AMERICA
(732) 676-2637
AVANT-INT'L EMPLOYEE BENEFIT
SERVICES/ALPHA AMERIC
AVANT-INT'L EMPLOYEE
BENEFIT SERVICES/ALPHA
AMERIC
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
AVANT - INTERNATIONAL EMPLOYEE
BENEFIT SERVICES
Affiliated With: AVANT INTERNATIONAL EMPLOYEE
BENEFIT SERVICES
Plan Type: Group Health
AVANT-INT'L EMPLOYEE BENEFIT
SERVICES/ALPHA AMERIC
AVI RESORT & CASINO
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
700 B Smithridge Dr. #104
RENO NV 89502
(702) 242-7700
AWANA CLUBS INTERNATIONAL, INC
Affiliated With: ALLIED BENEFIT
SYSTEMS INC
Plan Type: Group Health
AZCONA HARVESTING LLC
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS INC
Plan Type: Group Health
ALLIED BENEFIT SYSTEMS, INC
ALLIED BENEFIT SYSTEMS, INC
208 S. LASALLE STREET
CHICAGO IL 60604
3129068080
CHECK BENEFIT CARD
3129068080
TRANSWESTERN INSURANCE
ADMINISTRATORS, INC.
TRANSWESTERN INSURANCE
ADMINISTRATORS, INC.
PO Box 45019
Fresno CA 93718
8002218942
CHECK BENEFIT CARD
8002218942
AZUSA PACIFIC UNIVERSITY
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 786-7930
AMERIBEN SOLUTIONS
(800) 786-7930
(800) 786-7930
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-59
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BABB, INC
Plan Type: Group Health
CLAIMS SUBMISSION
BABB, INC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BABB, INC
INTRACORP
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
CHECK BENEFIT CARD
850 RIDGE AVE
PITTSBURGH PA 15212
Refer to Intercorp
(412) 237-2139
BACHEM, INC.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
BADEN SPORT
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS,
INC
Plan Type: Group Health
HEALTHCARE MANAGEMENT
ADMINISTRATORS INC
HEALTHCARE MANAGEMENT
ADMINISTRATORS INC
PO Box 85016
Bellevue WA 98015-8516
(800) 869-7093
BAINBRIDGE COLLEGE AIH0057967
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
BAINBRIDGE COLLEGE UNDERGRAD
MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
UTILIZATION REVIEW
PO Box 3000
SCOTTSDALE AZ 85271-3000
(800) 869-7093
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
BAKER COMPANY
Affiliated With: PATIENT ADVOCATE
LLC
Plan Type: Group Health
PATIENT ADVOCATES LLC
PATIENT ADVOCATES LLC
CHECK BENEFIT CARD
PO Box 1959
Gray ME 04039
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-60
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Baldwin and Lyons
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
BALL ENTERPRISES, INC.
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
* Ball Horticultureal
Affiliated With: PROFESSIONAL
BENEFIT ADMINISTRATORS INC
Plan Type: Group Health
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
SMITH ADMINISTRATORS
SMITH ADMINISTRATORS
428 E WINCHESTER ST, STE 200
SALT LAKE CITY UT 84107
(801) 261-5511
UTILIZATION REVIEW
CONTACT EMPLOYER
SERVICE ADVOCATES
(877) 261-5511
(801) 261-5511
PROFESSIONAL BENEFIT
ADMINISTRATORS
PROFESSIONAL BENEFIT
ADMINISTRATORS
900 Jorie Blvd Ste 250
Oakbrook IL 60523
(630) 655-3755
UM NOT APPLICABLE
(630) 655-3755
BALLY TECHNOLOGY - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
BANK OF COMMERCE
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
BARBER FOODS
Affiliated With: PATIENT ADVOCATE
LLC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8007867930
8007867930
PATIENT ADVOCATES LLC
PATIENT ADVOCATES LLC
CHECK BENEFIT CARD
PO Box 1959
Gray ME 04039
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-61
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
BARGREEN ELLINGSON INC
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
BARONA BAND OF MISSION INDIANS
Affiliated With: CENBEN USA INC
Plan Type: Group Health
CENBEN USA
Attn: Melissa Joseph
4079 Executive Pkwy
Westerville OH 43081
CENBEN USA
CHECK BENEFIT CARD
PAYOR NAME
BAREFOOT GOLF RESORT
Affiliated With: CNIC HEALTH
SOLUTIONS
Plan Type: Group Health
UTILIZATION REVIEW
(614) 797-5204
(614) 797-5204
BARTLETT-COLLINS
Affiliated With: MEDBEN
Plan Type: Group Health
WINTERBROOK/CCN
WINTERBROOK/CCN
PO Box 568800
OKLAHOMA CITY OK 73156-8800
(405) 843-9551 Ext 106
CHECK BENEFIT CARD
(405) 843-9551 Ext 106
BASIC AMERICAN FOODS
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 953-1801
AUM
(800) 388-3193
CompIQ Corporation
CompIQ Corporation
CONTACT EMPLOYER
2 South Pointe
Lake Forest CA 92630
(800) 293-3131
(800) 953-1801
Bass and Babb
Affiliated With: CompIQ
Plan Type: Workers' Compensation
(800) 293-3131
Bass and Babb Auto
Affiliated With: CompIQ
Plan Type: Auto
CompIQ Corporation
CompIQ Corporation
2 South Pointe
Lake Forest CA 92630
(800) 293-3131
CHECK BENEFIT CARD
(800) 293-3131
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-62
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
BATAVIA VAMC 4001
ALBANY (STRATTON) VA MEDICAL
Affiliated With: HEALTH NET FEDERAL CENTER
SERVICES
Attn: FEE BASIS 136E
Plan Type: Group Health
113 HOLLAND AVE
ALBANY NY 12208
Bates College
Affiliated With: CONSOLIDATED
HEALTH PLANS
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTH NET FEDERAL SERVICES
UTILIZATION REVIEW
UM NOT APPLICABLE
(972) 550-2836
CONSOLIDATED HEALTH PLANS
CONSOLIDATED HEALTH PLANS
195 STAFFORD ST
SPRINGFIELD MA 01104
(800) 633-7867
UM NOT APPLICABLE
(800) 633-7867
BATH VAMC 4002
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
ALBANY (STRATTON) VA MEDICAL
CENTER
Attn: FEE BASIS 136E
113 HOLLAND AVE
ALBANY NY 12208
HEALTH NET FEDERAL SERVICES
BATTLE CREET VAMC 3153
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
BATTLE CREEK VAMC
Attn: FEE BASIS (136)
5500 ARMSTRONG RD
BATTLE CREEK MI 49015
BATTLE CREEK VAMC
CHECK BENEFIT CARD
BAY INDUSTRIES INC
Affiliated With: SISCO/Cottingham &
Butler
Plan Type: Group Health
SISCO
SISCO
CHECK BENEFIT CARD
PO Box 389
DUBUQUE IA 52004-0389
(800) 547-4726
BAY MEDICAL CENTER
Affiliated With: CADENT
ADMINISTRATORS INC
Plan Type: Group Health
UM NOT APPLICABLE
(972) 550-2836
(800) 547-4726
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-63
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* Bay Path College
Affiliated With: PIONEER
MANAGEMENT SYSTEMS
Plan Type: Group Health
CLAIMS SUBMISSION
PIONEER MANAGEMENT SYSTEMS
123 INTERSTATE DR
W SPRINGFIELD MA 01089
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PIONEER MANAGEMENT SYSTEMS
UTILIZATION REVIEW
UM NOT APPLICABLE
(413) 534-8658
(413) 534-8658
BAY PINES VA MEDICAL CENTER
3144
Affiliated With: HEALTH NET
FEDERALSERVICES
Plan Type: Group Health
BAY PINES RD
Attn: FEE BASIS 136A
10000 BAY PINES RD
BAY PINES FL 33744
BAY PINES RD
CHECK BENEFIT CARD
BAYLOR UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
TRUE CHOICE USA
TRUE CHOICE USA
CHECK BENEFIT CARD
PO Box 700307
DALLAS TX 75370
(800) 785-2446
(800) 785-2446
BBP CONCRETES CONSTRUCTION
Affiliated With: ELDORADO CLAIMS
SERVICES, INC.
Plan Type: Group Health
Zenith Administrators
BCLG CORPORATION
Affiliated With: ADMINISTRATIVE
SOLUTIONS, INC.
Plan Type: Group Health
BDS MARKETING, INC.
Affiliated With: WAUSAU BENEFITS
Plan Type: Group Health
Zenith Administrators
CHECK BENEFIT CARD
ADMINISTRATIVE SOLUTIONS INC
ADMINISTRATIVE SOLUTIONS INC
CHECK BENEFIT CARD
PO Box 2490
ALPHARETTA GA 30023
(678) 339-0211
2001 CAMELBACK
PHOENIX AZ 85014
(678) 339-0211
WAUSAU BENEFITS, INC.
Attn: LeAnn Fichtner
PO Box 8046
WAUSAU WI 54401-8046
WAUSAU BENEFITS, INC.
(715) 841-7802
WAUSAU BENEFITS, INC.
(800) 808-4424
(715) 841-7802
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-64
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BEACH MOLD & TOOL
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
BEACON GROUP
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
CLAIMS SUBMISSION
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PREFERRED HEALTH PLANS INC.
(800) 832-8212
UTILIZATION REVIEW
PHCS Utilization Management
(888) 551-7427
(800) 832-8212
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
Bear Cat Inc.
Affiliated With: QVI Risk Solutions Inc
Plan Type: Group Health
ASSURECARE
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
BEAULIEU OF AMERICA HOLLYTEX
Affiliated With: S AND S HEALTHCARE
STRATEGIES LTD
Plan Type: Group Health
S AND S HEALTHCARE
STRATEGIES
S AND S HEALTHCARE
STRATEGIES
PO Box 141097
CINCINNATI OH 45250
(800) 717-2872
CHECK BENEFIT CARD
(800) 717-2872
BEAVER RUN RESORT
Affiliated With: CNIC HEALTH
SOLUTIONS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
BECHTEL NEVADA
Affiliated With: BENEFIT PLANNERS
LTD
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-65
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BECKER COLLEGE
Affiliated With: PIONEER
MANAGEMENT SERVICES
Plan Type: Group Health
BECKER COLLEGE - SPORTS
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
BECKETT MEDIA
Affiliated With: MERCER
ADMINISTRATION
Plan Type: Group Health
BECKLEY SINGLETON TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
PIONEER MANAGEMENT SYSTEMS
PO Box 9040
WEST SPRINGFIELD MA 01090
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PIONEER MANAGEMENT SYSTEMS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(413) 539-9900
(413) 539-9900
ADMINISTRATIVE CONCEPTS, INC.
ADMINISTRATIVE CONCEPTS, INC.
997 OLD EAGLE SCHOOL
WAYNE PA 19087-1706
(888) 293-9229
CHECK BENEFIT CARD
(888) 293-9229
MERCER ADMINISTRATION
MERCER ADMINISTRATION
701 Market St Ste 1350
St Louis MO 63101
(314) 982-5622
UM NOT APPLICABLE
(314) 982-5622
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
BECKLEY VAMC 3547
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
BECKLEY VAMC
BEDFORD VA MEDICAL CENTER 3111
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
BEDFORD VA MEDICAL CENTER
Attn: FEE BASIS - (518-136B)
BECKLEY VAMC
CHECK BENEFIT CARD
BEDFORD VA MEDICAL CENTER
CHECK BENEFIT CARD
200 VETERANS AVE
BECKLEY WV 23667
200 SPRINGS RD
BEDFORD MA 01730
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-66
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BEEHIVE CREDIT UNION
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
TALL TREE ADMINISTRATORS
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
TALL TREE ADMINISTRATORS
(801) 274-8100
UTILIZATION REVIEW
CORVEL
(801) 269-8723
(801) 274-8100
Behavior Management
Affiliated With: Rapid City Regional
Hospital DBA Western Health
Plan Type: Group Health
Western Health
Western Health
529 Kansas City St Ste 200
Rapid City SD 57701
(605) 719-4600 or (888) 3411766
Western Health
(605) 719-4640 or (800) 2290892
BELDEN WIRE AND CABLE
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
BELL CARTER FOODS INC
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
(800) 533-5044
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
PO Box 1147
STOCKTON CA 95201
(209) 474-5647
CHECK BENEFIT CARD
(209) 474-5647
BELLA VISTA VILLAGE
Affiliated With: BENEFIT PLANNERS
LTD
Plan Type: Group Health
CHECK BENEFIT CARD
BELLARMINE UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
MAKSIN MANAGEMENT CORP
MAKSIN MANAGEMENT CORP
2500 McClellan Ave
Pennsauken NJ 08109
(800) 220-1123
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 292-5386
UM NOT APPLICABLE
(800) 220-1123
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-67
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BELMAR INTERNATIONAL
Affiliated With: FISERV HEALTH KANSAS
Plan Type: Group Health
BELMARK, INC
Affiliated With: EMPLOYEE BENEFIT
CONSULTANTS
Plan Type: Group Health
CLAIMS SUBMISSION
FISERV HEALTH KANSAS
PO Box 520
Pueblo CO 81002-0520
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
FISERV HEALTH KANSAS
(800) 235-7160
UTILIZATION REVIEW
TRUSTMARK LIFE INSURANCE
CO.
(800) 725-6566
(800) 235-7160
EMPLOYEE BENEFIT CONSULTANTS EMPLOYEE BENEFIT CONSULTANTS CHECK BENEFIT CARD
PO Box 928
(800) 558-7798
FINDLAY OH 45839
(800) 558-7798
BENEFIRST LLC
Affiliated With: BENEFIRST LLC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
BENEFIT AND RISK MANAGEMENT
SERVICES WRAP
Affiliated With: BENEFIT AND RISK
MANAGEMENT SERVICES
Plan Type: Group Health
BRMS
BRMS
PO Box 2650
RANCHO CORDOVA CA 98401
(888) 326-2555
BRMS
(800) 368-0767
NHBC
NHBC
CHECK BENEFIT CARD
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
BENEFIT MANAGEMENT SYSTEMS
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
BENEFIT PLAN SERVICES INC
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
(888) 326-2555
(888) 621-7900
NHBC
NHBC
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
CHECK BENEFIT CARD
(888) 621-7900
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-68
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BENEFITSOURCE, INC
Affiliated With: NATIONAL HEALTH
BENEFIT CORPORATION NHBC
#12717
Plan Type: Group Health
BENESYS
Affiliated With: GLOBALCARE
Plan Type: Group Health
CLAIMS SUBMISSION
NHBC
8990 E. Raintree Dr.
Scottsdale AZ 85260
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NHBC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(888) 621-7900
(888) 621-7900
GLOBALCARE
GLOBALCARE
6875 SHILOH RD E
ALPHARETTA GA 30005
(888) 285-4864
AEGIS CARE MANAGEMENT
(800) 868-1660
BENICORP INSURANCE COMPANY
Benicorp Insurance Company
Affiliated With: BENICORP INSURANCE PO Box 68917
COMPANY
Indianapolis IN 46268-0917
Plan Type: Group Health
(317) 290-1205
Benicorp Insurance Company
CHECK BENEFIT CARD
Benicorp Insurance Company
Benicorp Insurance Company
PO Box 68917
Indianapolis IN 46268-0917
(800) 837-1205
(888) 285-4864
Benicorp Insurance Company
Affiliated With: Benicorp Insurance
Company
Plan Type: Group Health
(317) 290-1205
Individualized Care Management
(888) 448-1864
(800) 837-1205
-Network participation is contingent upon
proper member identification. The First
Health® Network Logo must be on the
benefit card.
Benicorp Travel Access
Affiliated With: Benicorp Insurance
Company
Plan Type: Group Health
BENTLY PRESSURIZED BEARING
COMPANY
Affiliated With: HEALTHCOMP
ADMINISTRATORS INC
Plan Type: Group Health
Benicorp Insurance Company
Benicorp Insurance Company
PO Box 68917
Indianapolis IN 46268-0917
(800) 837-1205
Benicorp Insurance Company
(888) 448-1864
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 837-1205
CHECK BENEFIT CARD
8009607247
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-69
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BERING SEA ECCOTECH, INC
Affiliated With: ALTERNATIVE RISK
MANAGEMENT LTD NORTHWEST
Plan Type: Group Health
BERKLEY RISK ADMINISTRATORS
Affiliated With: PREFERREDONE
ADMINISTRATIVE SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
ARM, LTD.
10200 S.W. Nimbus Ave. Ste G-5
PORTLAND OR 97223
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ARM, LTD.
(877) 544-1770
UTILIZATION REVIEW
HINES & ASSOCIATES
(888) 437-9927
(877) 544-1770
PREFERREDONE ADMINISTRATIVE
SERVICES
PO Box 59212
MINNEAPOLIS MN 55459
PREFERREDONE ADMINISTRATIVE PREFERREDONE
ADMINISTRATIVE SERVICES
SERVICES
(800)
997-1750
(800) 997-1750
(800) 997-1750
BERKSHIRE CORPORATION
Affiliated With: GROUP INSURANCE
SERVICE CENTER INC
Plan Type: Group Health
GROUP INSURANCE SERVICE
CENTER INC
GROUP INSURANCE SERVICE
CENTER INC
20 INDUSTRIAL PARK DR
PEMBROKE MA 02359
(800) 242-4472
GISC TOTALCARE
(800) 242-4472
(800) 242-4472
BERLIN-GORHAM OPERATIONS
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NEW YORK
Plan Type: Group Health
NORTH AMERICAN
ADMINISTRATORS-NY
NORTH AMERICAN
ADMINISTRATORS-NY
PO Box 9501
AMHERST NY 14226
(800) 397-2122
NORTH AMERICAN
ADMINISTRATORS-NY
(800) 397-2122
(800) 397-2122
BERRY HINCKLEY INDUSTRIES
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
DELTA HEALTH SYSTEMS
Attn: Tish Asuncion
PO Box 692590
STOCKTON CA 95269
DELTA HEALTH SYSTEMS
(866) 547-1714
DELTA TEAM CARE
3129068080
(866) 547-1714
BEST CHAIRS, INC.
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
(800) 832-8212
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-70
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BEST HEALTH PLANS, LLC
Affiliated With: BEST HEALTH PLANS,
LLC
Plan Type: Group Health
CLAIMS SUBMISSION
BEST HEALTH PLANS, LLC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BEST HEALTH PLANS, LLC
CHECK BENEFIT CARD
BEST LIFE AND HEALTH
CHECK BENEFIT CARD
UTILIZATION REVIEW
2505 McCabe Way
IRVINE CA 92614-6243
BEST LIFE AND HEALTH
BEST LIFE AND HEALTH
Affiliated With: BEST LIFE AND HEALTH PO Box 19721
Plan Type: Group Health
Irvine CA 92623-9721
(800) 433-0088
(800) 433-0088
Best Life and Health Insurance (IAC)
Affiliated With: INSURERS
ADMINISTRATIVE CORP
Plan Type: Group Health
Insurers Administrative Corp
Insurers Administrative Corp
PO Box 828
Park Ridge IL 60068-0828
(800) 964-4948
(602) 906-6263
Best Life and Health Insurance
Company
HEALTH INTERNATIONAL
PPC
PPC
PO Box 11088
CHARLOTTE NC 28220
(800) 446-5439
PPC
(704) 523-2758
CHECK BENEFIT CARD
CHECK BENEFIT CARD
BEST LIFE AND HEALTH INSURANCE
COMPANY
Affiliated With: BEST LIFE AND
HEALTH INSURANCE COMPANY
Plan Type: Group Health
Best Life and Health Insurance
Company
BETCO, INC
Affiliated With: PRIMARY PHYSICIAN
CARE
Plan Type: Group Health
BETHEL FARMS LTD
Affiliated With: HERITAGE
CONSULTANTS INC
Plan Type: Group Health
Med-Valu
(800) 522-2161
PO Box 19721
IRVINE CA 92713-9721
(800) 446-5439
CHECK BENEFIT CARD
9419674139
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-71
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BETTERAVIA FARMS
Affiliated With: HEALTHCOMP
ADMINISTRATORS INC
Plan Type: Group Health
BH INC. & A & D HACKING INC.
Affiliated With: MANAGED BENEFIT
ADMINISTRATORS & INSURANCE
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
8002666311
MANAGED BENEFITS
ADMINISTRATOR & INSURANCE
CONSULTANTS
MANAGED BENEFITS
ADMINISTRATOR & INSURANCE
CONSULTANTS
PO Box 651109
SALT LAKE CITY UT 84165-1109
(800) 877-3727
CRITIQUE
(800) 666-5551
(800) 877-3727
BIANCHI INTERNATIONAL
Affiliated With: TRIDENT PLAN
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
BICARA, LTD.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
BIG HORN COUNTY
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
MOUNTAIN STATES REVIEW
MBA OF WYOMING
MBA OF WYOMING
BIG HORN FEDERAL
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
MBA OF WYOMING
MBA OF WYOMING
MBA OF WYOMING
PO Box 3000
SCOTTSDALE AZ 85271-3000
PO Box 94
WORLAND WY 82401
PO Box 98
WORLAND WY 82401
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-72
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BIG SPRING VAMC
CHECK BENEFIT CARD
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
HEALTH WATCH
(972) 238-7900
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
PAYOR NAME
CLAIMS SUBMISSION
BIG SPRINGS VAMC 3172
BIG SPRING VAMC
Affiliated With: HEALTH NET FEDERAL Attn: FEE BASIS
SERVICES
300 VETERANS BLVD
Plan Type: Group Health
BIG SPRING TX 79720
BIG TEX TRAILERS PRIMARY
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
UTILIZATION REVIEW
(800) 827-7223
BIG TEX TRAILERS TRAVEL
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
HEALTH WATCH
(972) 238-7900
(800) 827-7223
BINGHAM EQUIPMENT COMPANY
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS INC
Plan Type: Group Health
* Binghampton
Affiliated With: New York State
Insurance Fund
Plan Type: Workers' Compensation
BINIONS
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8002218942
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-73
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BIOLA UNIVERSITY
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
CLAIMS SUBMISSION
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AMERIBEN SOLUTIONS
UTILIZATION REVIEW
(800) 786-7930
AMERIBEN SOLUTIONS
(800) 786-7930
(800) 786-7930
BIRMINGHAM VAMC 3538
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
BIRMINGHAM VAMC
Attn: FEE BASIS - 136E
700 S 19TH ST
BIRMINGHAM AL 35233
BIRMINGHAM VAMC
CHECK BENEFIT CARD
BLACK AND COMPANY
Affiliated With: CONSOCIATE INC
Plan Type: Group Health
CONSOCIATE, INC.
CONSOCIATE, INC.
PO Box 1068
DECATUR IL 62525
(800) 798-2422
NATIONAL HEALTH SERVICES
(800) 558-4353
CHECK BENEFIT CARD
(800) 798-2422
BLACK HILLS HCS 3710
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
VA BLACK HILLS HCS (3710)
HEALTH NET FEDERAL SERVICES
500 NORTH 5TH STREET, FEE BUS13
HOT SPRINGS SD 57747
(916) 985-1259
Black Hills Workshop and Training
Center Inc
Affiliated With: Rapid City Regional
Hospital DBA Western Health
Plan Type: Group Health
Western Health
Western Health
529 Kansas City St Ste 200
Rapid City SD 57701
(605) 719-4600 or (888) 3411766
Western Health
(605) 719-4640 or (800) 2290892
CHECK BENEFIT CARD
CHECK BENEFIT CARD
BLACK MESA PIPELINE
Affiliated With: MARSH ADVANTAGE
AMERICA
Plan Type: Group Health
(605) 719-4600 or (888) 3411766
CHECK BENEFIT CARD
9185867926
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-74
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BLACKFOOT MEDICAL
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
BLACKHAWK CREDIT UNION
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC.
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CRITIQUE
CHECK BENEFIT CARD
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
Q-REVIEW
(608) 783-8706
2700 MIDWEST DR
ONALASKA WI 54650
(800) 542-6642
CLAIMS SUBMISSION
MANAGED BENEFITS
ADMINISTRATOR AND INSURANCE
CONSULTANTS
UTILIZATION REVIEW
PO Box 651109
SALT LAKE CITY UT 84165-1109
(800) 542-6642
BLUE BELLCREAMERIES USA
Affiliated With: BLUE BELL BENEFIT
TRUST
Plan Type: Group Health
BLUEGRASS FAMILY HEALTH
BLUE BELL BENEFIT TRUST
BLUE BELL BENEFIT TRUST
PO Box 605
BRENHAM TX 77834
(979) 830-7388
CHECK BENEFIT CARD
(979) 830-7388
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Bluegrass Health Network
CONTACT EMPLOYER
Affiliated With: Bluegrass Health Network Attn:
Plan Type: Workers' Compensation
CONTACT EMPLOYER
CONTACT EMPLOYER
BOHLIN CYWINSKI JACKSON
Affiliated With: AMERIHEALTH
ADMINISTRATORS
Plan Type: Group Health
AMERIHEALTH ADMINISTRATORS
AMERIHEALTH ADMINISTRATORS
720 BLAIR MILL RD.
HORSHAM PA 19044
(215) 793-3223
AMERIHEALTH
ADMINISTRATORS
(215) 793-3223
Plan Type: Group Health
(215) 793-3223
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-75
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BOISE STATE UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
CLAIMS SUBMISSION
MAKSIN MANAGEMENT CORP
2500 McClellan Ave
Pennsauken NJ 08109
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MAKSIN MANAGEMENT CORP
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 220-1123
(800) 220-1123
BOISE VAMC 3177
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
BOISE VAMC
Attn: MAS 136
500 W FORT ST
BOISE ID 83702
BOISE VAMC
CHECK BENEFIT CARD
BOLLINGER, INC.
Affiliated With: BOLLINGER, INC.
Plan Type: Group Health
BOLLINGER, INC.
BOLLINGER, INC.
BOLLINGER, INC.
830 Morris Turnpike
SHORT HILLS NJ 07078
(973) 467-8005 Ext 1007
(973) 467-8005 Ext 1007
BONHAM VA 3168
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
VA BONHAM
Attn: BRENDA MAGNASS
1201 E 9TH ST
BONHAM TX 75048
VA BONHAM
CHECK BENEFIT CARD
BOOTHCREEK SKI HOLDING JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
EBPA
EBPA
CHECK BENEFIT CARD
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
BOOTZ MANUFACTORING CO
Affiliated With: PREFERRED HEALTH
PLAN INC 962550088
Plan Type: Group Health
(802) 846-8060
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
(502) 992-4535
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-76
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BORDER FOODS COMPANIES
Affiliated With: PREFERREDONE
ADMINISTRATIVE SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
PREFERREDONE ADMINISTRATIVE
SERVICES
PO Box 59212
MINNEAPOLIS MN 55459
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
PREFERREDONE
PREFERREDONE ADMINISTRATIVE
ADMINISTRATIVE SERVICES
SERVICES
(800) 997-1750
(800) 997-1750
(800) 997-1750
BORREGO PASS SCHOOL
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
SRT ADMINISTRATORS
BOSKOVICH FARMS
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS, INC.
Plan Type: Group Health
BOSSARD METRICS INC
Affiliated With: BENESIGHT INC
Plan Type: Group Health
SRT ADMINISTRATORS
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Benesight
Benesight
PO Box 310
PUEBLO CO 81002
8009928354
Benesight
8009928354
ADMINISTRATIVE CONCEPTS, INC.
ADMINISTRATIVE CONCEPTS, INC.
CHECK BENEFIT CARD
997 OLD EAGLE SCHOOL
WAYNE PA 19087-1706
(888) 293-9229
PO Box 25160
SCOTTSDALE AZ 85255-0102
8009928354
BOSTON BAPTIST COLLEGE
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
(888) 293-9229
BOSTON COLLEGE
Affiliated With: KLAIS AND COMPANY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
BOSTON COLLEGE
Affiliated With: KLAIS & COMPANY
Plan Type: Group Health
KLAIS & COMPANY INC
KLAIS & COMPANY INC
CHECK BENEFIT CARD
1867 W MARKET ST
AKRON OH 44313
(330) 867-8443
(330) 867-8443
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-77
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BOSTON HIGASHI SCHOOL
Affiliated With: MEDICAL CLAIMS
SERVICES, INC.
Plan Type: Group Health
BOSTON VA MEDICAL CENTER 3118
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
MEDICAL CLAIMS SERVICES, INC.
ONE WALL ST STE 2A
RAVENSWOOD WV 26164
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MEDICAL CLAIMS SERVICES, INC.
(888) 225-0522
UTILIZATION REVIEW
AMERICAN HEALTH
HOLDINGS INC
(886) 614-4244
(888) 225-0522
HEALTH NET FEDERAL SERVICES
Attn: FEE BASIS 136F
150 S HUNTINGTON AVE
BOSTON MA 02130
HEALTH NET FEDERAL SERVICES
CHECK BENEFIT CARD
(214) 387-3232
(214) 387-3232
BOTHWELL SAXTON RESTAURANTS,
LLC
Affiliated With: GILSBAR INC
Plan Type: Group Health
BOULDER ADMINISTRATIVE
SERVICES
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
12717
Plan Type: Group Health
BOWDOIN COLLEGE
Affiliated With: PIONEER
MANAGEMENT SERVICES
Plan Type: Group Health
BOYD COUNTERTOPS INC
Affiliated With: FISERV HEALTH KANSAS
Plan Type: Group Health
GILSBAR
GILSBAR
2100 COVINGTON CENTRE
COVINGTON LA 70433
(888) 215-9841
MED COM CARE MGT
(985) 898-1505
NHBC
NHBC
CHECK BENEFIT CARD
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
(888) 215-9841
(888) 621-7900
PIONEER MANAGEMENT SYSTEMS
PIONEER MANAGEMENT SYSTEMS
PO Box 9040
WEST SPRINGFIELD MA 01090
(413) 539-9900
CHECK BENEFIT CARD
(413) 539-9900
FISERV HEALTH KANSAS
FISERV HEALTH KANSAS
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
TRUSTMARK LIFE INSURANCE
CO.
(800) 725-6566
(800) 235-7160
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-78
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BRADLEY DIXIE COMPANIES
Affiliated With: PARAGON BENEFITS,
INC.
Plan Type: Group Health
BRADY INDUSTRIES
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
Bradley/Dixie Company
PO Box 12288
COLUMBUS GA 31904
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Bradley/Dixie Company
(866) 360-7926
UTILIZATION REVIEW
QUANTUM HEALTH
(800) 257-2038
(866) 360-7926
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
BRANDEIS UNIVERSITY
Affiliated With: KLAIS & COMPANY
Plan Type: Group Health
KLAIS & COMPANY INC
KLAIS & COMPANY INC
1867 W MARKET ST
AKRON OH 44313
(800) 331-1096
CHECK BENEFIT CARD
(800) 331-1096
BRASSELER USA
Affiliated With: HOLDEN & COMPANY
Plan Type: Group Health
HOLDEN & COMPANY C/O CCN
CHECK BENEFIT CARD
BRATTLEBORO MEMORIAL HOSPITAL CHECK BENEFIT CARD
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Brokerage Concepts, Inc.
Brokerage Concepts, Inc.
PO Box 61553
KING OF PRUSSIA PA 19406
6104914911
Brokerage Concepts, Inc.
(215) 773-3722
BRENNAN TRANSPORTATION
SERVICE
Affiliated With: BROKERAGE
CONCEPTS BENEFITS CONCEPTS
INC
Plan Type: Group Health
HOLDEN & COMPANY C/O CCN
PO Box 5190
TAMPA FL 33675-5190
6104914911
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-79
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BRENTWOOD INDUSTRIES INC
Affiliated With: THE LOOMIS COMPANY
Plan Type: Group Health
BRENTWOOD VOLVO
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
UTILIZATION REVIEW
CHECK BENEFIT CARD
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
BREVARD ACHIEVEMENT CENTER
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
BREWER YACHT YARD GROUP
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
BRIDGES WTC, INC.
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
BRIDGESTONE
Affiliated With: ASSURECAREE
Plan Type: Group Health
ASSURECARE
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
Careline UR
(763) 383-4800
(800) 422-2026
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-80
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
British Caymanian Insurance
Affiliated With: Colonial Group
International LTD
Plan Type: Group Health
CLAIMS SUBMISSION
British Caymanian Insurance
PO Box 11518
Scottsdale AZ 85271-1518
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Colonial Medical Insurance Company
UTILIZATION REVIEW
(345) 949-8699
First Health
(800) 423-9130
(441) 296-3200
BRITZ COMPANIES ET AL
Affiliated With: HEALTHCOMP
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Broadspire, A Crawford Company
Affiliated With: Broadspire, A Crawford
Company
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
Crawford & Company
Crawford & Company
(404) 256-0830
BRONCO DRILLING
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
3121 QUAIL SPRINGS PKWY
OKLAHOMA CITY OK 73134
(405) 607-2694
(404) 256-0830
CHECK BENEFIT CARD
(405) 607-2694
BRONCO DRILLING COMPANY INC
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
BRONX VA MEDICAL CENTER 3121
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
BRONX VA MEDICAL CENTER
Attn: FEE BASIS 00AM
BRONX VA MEDICAL CENTER
CHECK BENEFIT CARD
130 W KINGSBRIDGE RD
BRONX NY 10468
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-81
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
BROOKLYN VA MEDICAL CENTER
BROOKLYN VA MEDICAL CENTER
3521
Attn: FEE BASIS 136
Affiliated With: HEALTH NET FEDERAL 800 POLY PLACE
SERVICES
BROOKLYN NY 11209
Plan Type: Group Health
BROTHERS TRADING CO INC AND
INVENTORY HANDLERS INC
Affiliated With: UNDERWRITERS
SAFETY & CLAIMS
Plan Type: Group Health
UNDERWRITERS SAFETY & CLAIMS
PO Box 23507
Louisville KY 40223-0507
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BROOKLYN VA MEDICAL CENTER
UTILIZATION REVIEW
CHECK BENEFIT CARD
UNDERWRITERS SAFETY & CLAIMS HEALTH SERVICE REVIEW
(800) 334-6468
(800) 678-1536
(800) 678-1536
BROULIMS SUPERMARKETS
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
BROWARD CORRECTIONAL
INSTITUTION/SITE #360
Affiliated With: PRISON HEALTH
SERVICES, INC.
Plan Type: Group Health
PRISON HEALTH SERVICES, INC.
PRISON HEALTH SERVICES, INC.
PRISON HEALTH SERVICES,
INC.
BROWN MACKIE COLLEGE
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
ADMINISTRATIVE CONCEPTS, INC.
Attn: Customer Service Dept
997 Old Eagle School Rd. #215
WAYNE PA 19087-1706
ADMINISTRATIVE CONCEPTS, INC.
CHECK BENEFIT CARD
105 W Park Dr STE 300
BRENTWOOD TN 37027
(610) 293-9229
(610) 293-9229
BROWN MACKIE COLLEGE
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
ADMINISTRATIVE CONCEPTS INC
Attn: Customer Service Dept
997 Old Eagle School Rd. #215
WAYNE PA 19087-1706
ADMINISTRATIVE CONCEPTS INC
UM NOT APPLICABLE
(610) 293-9229
(610) 293-9229
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-82
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Brown University
Affiliated With: CONSOLIDATED
HEALTH PLANS
Plan Type: Group Health
BRUTGER EQUITIES, INC
Affiliated With: PREFERREDONE
ADMINISTRATIVE SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
CONSOLIDATED HEALTH PLANS
195 STAFFORD ST
SPRINGFIELD MA 01104
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONSOLIDATED HEALTH PLANS
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 633-7867
(800) 633-7867
PREFERREDONE ADMINISTRATIVE
SERVICES
PO Box 59212
MINNEAPOLIS MN 55459
PREFERREDONE ADMINISTRATIVE PREFERREDONE
ADMINISTRATIVE SERVICES
SERVICES
(800)
997-1750
(800) 997-1750
(800) 997-1750
BSI INC
Affiliated With: INTEGRITY HEALTH
SERVICES
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
BUCKINGHAM COMPANIES
Affiliated With: COMMERCE BENEFITS
GROUP
Plan Type: Group Health
COMMERCE BENEFITS GROUP
COMMERCE BENEFITS GROUP
33479 LAKE RD
AVON LAKE OH 44012
(800) 223-9941
CARDINAL UTILIZATION
MANAGEMENT
(877) 272-7040
BUEHLER HOME
Affiliated With: OSF HEALTHPLANS
Plan Type: Group Health
(800) 223-9941
OSF HealthPlans, Inc.
OSF HealthPlans, Inc.
PO Box 5128
PEORIA IL 61601-5128
(877) 677-8222
CHECK BENEFIT CARD
(877) 677-8222
* Buffalo
Affiliated With: New York State
Insurance Fund
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CONTACT EMPLOYER
Info as of 12/13/2007
Page PIRCA-83
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BUFFALO CHINA
Affiliated With: ASSURECARE
Plan Type: Group Health
CLAIMS SUBMISSION
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ASSURECARE
UTILIZATION REVIEW
(800) 422-2026
Careline UR
(763) 383-4800
UM NOT APPLICABLE
(800) 422-2026
BUFFALO VAMC 4003
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
ALBANY (STRATTON) VA MEDICAL
CENTER
Attn: FEE BASIS 136E
113 HOLLAND AVE
ALBANY NY 12208
HEALTH NET FEDERAL SERVICES
Builders Insurance Group
Builders Insurance Group
Builders Insurance Group
Plan Type: Workers' Compensation
PO Box 723099
Atlanta GA 31139-0099
(678) 309-4000
Excludes specific hospitals
BUILDER'S SUPPLY INC
Affiliated With: HEALTHCARE
SOLUTIONS GROUP INC
Plan Type: Group Health
(972) 550-2836
Builders Insurance Group
(678) 309-4172
(678) 309-4172
HEALTHCARE SOLUTIONS GROUP,
INC.
HEALTHCARE SOLUTIONS GROUP,
INC.
PO Box 1309
MUSKOGEE OK 74402
(800) 749-1422
CHECK BENEFIT CARD
(800) 749-1422
Bunch & Associates Inc.
Affiliated With: Bunch & Associates Inc.
Plan Type: Workers' Compensation
Bunch & Associates Inc
Bunch & Associates Inc
PO Box 32045
Lakeland FL 33802
(888) 853-4735
Bunch & Associates Inc
(888) 853-4735
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(888) 853-4735
BURLINGTON RESOURCES
Affiliated With: BENEFIT PLANNERS
LTD
Plan Type: Group Health
CHECK BENEFIT CARD
BURRELL PROFESSIONAL LABS
Affiliated With: J.F. MOLLOY &
ASSOCIATES, INC.
Plan Type: Group Health
J.F. MOLLOY & ASSOCIATES, INC.
C/O CCN
(800) 292-5386
J F MOLLOY AND ASSOCIATES INC
J F MOLLOY AND ASSOCIATES
INC
PO Box 5190
TAMPA FL 33675-5190
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-84
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
BUTLER BENEFIT SERVICES INC
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
CLAIMS SUBMISSION
NHBC
8990 E. Raintree Dr.
Scottsdale AZ 85260
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NHBC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(888) 621-7900
(888) 621-7900
BUTLER VAMC 3123
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
BUTLER VAMC
Attn: FEE BASIS (70)
325 NEW CASTLE RD
BUTLER PA 16001
BUTLER VAMC
CHECK BENEFIT CARD
BUTTE CO. JAIL/BUTTE JUVENILE
HALL
Affiliated With: PRISON HEALTH
SERVICES, INC.
Plan Type: Group Health
PRISON HEALTH SERVICES, INC.
PRISON HEALTH SERVICES, INC.
PRISON HEALTH SERVICES,
INC.
BYRD HARVEST INC
Affiliated With: HEALTHCOMP
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
C L FRATES AND COMPANY
Affiliated With: C L FRATES &
COMPANY
Plan Type: Group Health
C.L. FRATES AND COMPANY
C.L. FRATES AND COMPANY
PO Box 268967
OKLAHOMA CITY OK 73126
(405) 290-5696
C.L. FRATES AND COMPANY
(800) 669-1815
Mountain States Administrative
Services
Mountain States Administrative
Services
Hines and Associates
(847) 214-2780
7202 E ROSEWOOD STE 200
TUCSON AZ 85710
(520) 722-7133
C T I INC
Affiliated With: MOUNTAIN STATES
ADMINISTRATIVE SERVICES
Plan Type: Group Health
105 W Park Dr STE 300
BRENTWOOD TN 37027
(405) 290-5696
(520) 722-7133
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-85
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CABLE AMERICA
Affiliated With: ZENITH
ADMINISTRATORS
Plan Type: Group Health
CABLE COMMUNICATIONS
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
CABRILLO COLLEGE
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
Term Effective: 8/31/2007
CADDOCK ELECTRONICS, INC.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
Plan Type: Group Health
CAINS FOODS LP
Affiliated With: ULTRABENEFITS INC
Plan Type: Group Health
CLAIMS SUBMISSION
Zenith Administrators
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Zenith Administrators
UTILIZATION REVIEW
CHECK BENEFIT CARD
2001 CAMELBACK
PHOENIX AZ 85014
SMITH ADMINISTRATORS
SMITH ADMINISTRATORS
3800 SANDSHELL DR STE 260
FT. WORTH TX 76134
(817) 335-2582
SERVICE ADVOCATES
(801) 261-5511
(817) 335-2582
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 786-7930
AMERIBEN SOLUTIONS
(800) 786-7930
EBA&M
EBA&M
CHECK BENEFIT CARD
PO Box 8572
WEST LAKE VILLAGE CA 91359
(714) 668-8920
(800) 786-7930
(714) 668-8920
ULTRABENEFITS INC
ULTRABENEFITS INC
29 EAST MOUNTAIN ST
WORCESTER MA 01606
(866) 858-7223
AMERICAN HEALTH HOLDINGS
(614) 818-3222
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
PO Box 1147
STOCKTON CA 95201
(209) 948-8483 Ext 3327
(866) 858-7223
CAJON VALLEY UNION SCHL
DIST/ACTIVE EES
Affiliated With: CAJON VALLEY UNION
SCHOOL DISTRICT
Plan Type: Group Health
(209) 948-8483 Ext 3327
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-86
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CALAIS REGIONAL HOSPITAL WRAP
JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
CALDWELL FREIGHT LINES
Affiliated With: JSL ADMINISTRATORS
INC
Plan Type: Group Health
CALIFORNIA BAPTIST UNIVERSITY
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
CLAIMS SUBMISSION
EBPA
PO Box 2365
SOUTH BURLINGTON VT 05403
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EBPA
UTILIZATION REVIEW
CHECK BENEFIT CARD
(802) 846-8060
(802) 846-8060
J SMITH LANIER & CO
J SMITH LANIER & CO
201 HAY STREET, STE 302
FAYETTEVILLE NC 28301
(910) 480-3100
CHECK BENEFIT CARD
(910) 480-3100
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 786-7930
AMERIBEN SOLUTIONS
(800) 786-7930
(800) 786-7930
CALIFORNIA INSTITUTE OF
INTEGRAL STUDIES
PERSONAL INSURANCE
ADMINISTRATORS
PERSONAL INSURANCE
ADMINISTRATORS
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
30401 Agoura Rd #250
Agoura Hills CA 91376
(800) 468-4343
CHECK BENEFIT CARD
(800) 468-4343
CALIFORNIA INSTITUTE OF
TECHNOLOGY
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CALIFORNIA LUTHERAN UNIVERSITY
Affiliated With: SUMMIT AMERICA
INSURANCE SERVICES
Plan Type: Group Health
SUMMIT AMERICA INSURANCE
SERVICES
SUMMIT AMERICA INSURANCE
SERVICES
SUMMIT AMERICA INSURANCE
SERVICES
5001 College Blvd., #216
LEAWOOD KS 66211
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-87
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CALIFORNIA STATE UNIVERSITY LOS ANGELES
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
Term Effective: 9/30/2007
CLAIMS SUBMISSION
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
THE LEWER AGENCY, INC.
CALIFORNIA STEEL INDUSTRIES
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
CALLIDUS TECHNOLOGIES INC
Affiliated With: GILSBAR INC
Plan Type: Group Health
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 767-0700
(800) 237-0903 Ext 6352
CALIFORNIA STATE UNIVERSITY AT
DOMINGUEZ HILLS
Affiliated With: THE LEWER AGENCY,
INC.
Plan Type: Group Health
CALISE AND SONS
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
STUDENT INSURANCE A DIVISION
OF UICI
THE LEWER AGENCY
THE LEWER AGENCY
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
PO Box 80
Stockton CA 95201
(800) 807-0820
DELTA TEAM CARE
(209) 939-3438
4534 WORNAL
KANSAS CITY MO 64111
(800) 807-0820
GISC, INC
GISC, INC
20 WINTER ST
PEMBROKE MA 02359
(800) 242-4472
GISC TOTALCARE
(800) 999-1077
GILSBAR
GILSBAR
CHECK BENEFIT CARD
PO Box 2947
COVINGTON LA 70434
(800) 445-7227
(800) 242-4472
(800) 445-7227
CALLISONS INC - PEPM
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
TRUSTEED PLANS SERVICE GROUP
PO Box 1894
TACOMA WA 98401-1894
TRUSTEED PLANS SERVICE GROUP AMERICAN HEALTH HOLDING
(888) 877-7994
(800) 426-9786
(800) 426-9786
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-88
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CAMBERLEY HOTEL CO
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
Term Effective: 8/31/2007
CLAIMS SUBMISSION
SMITH ADMINISTRATORS
3800 SANDSHELL DR STE 260
FT. WORTH TX 76134
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SMITH ADMINISTRATORS
UTILIZATION REVIEW
(817) 335-2582
SERVICE ADVOCATES
(877) 261-5511
(817) 335-2582
Cambridge Integrated Services/Allied
Automotive Group
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
Cambridge Life Insurance Company
Affiliated With: First Health Life and
Health Insurance Company
Plan Type: Group Health
First Health
Health Plan Services
PO Box 44199
Las Vegas NV 89116
(800) 681-0056
First Health
(800) 639-9157
CAMCO, INC.
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
(800) 681-0056
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
CAMERON UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
* CANADIAN MEDICAL NETWORK
Affiliated With: CANADIAN MEDICAL
NETWORK
Plan Type: Group Health
TRUE CHOICE
TRUE CHOICE
PO Box 700307
DALLAS TX 75370
(800) 251-9665
UM NOT APPLICABLE
(800) 251-9665
Canadian Medical Network
Canadian Medical Network
Canadian Medical Network
140 Renfrew Dr. Ste 103
Ontario, Canada L3R 6B3
DBA: Care Management Network
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-89
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CANADIAN PIPE & SUPPLY CO INC
Affiliated With: FISERV HEALTH
KANSAS
Plan Type: Group Health
CANADIAN VALLEY ELECTRIC CO-OP
Affiliated With: NATIONAL RURAL
ELECTRIC COOPERATIVE
ASSOCIATION
Plan Type: Group Health
CLAIMS SUBMISSION
FISERV HEALTH INC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
FISERV HEALTH INC
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
COOPERATIVE BENEFIT
ADMINISTRATOR
COOPERATIVE BENEFIT
ADMINISTRATOR
PO Box 6249
LINCOLN NE 68506-0249
(402) 483-9200
ALBANY (STRATTON) VA MEDICAL
CENTER
Attn: FEE BASIS 136E
113 HOLLAND AVE
ALBANY NY 12208
HEALTH NET FEDERAL SERVICES
CANCER TREATMENT CENTERS OF
AMERICA INC
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
Cannon Cochran Management Services,
Inc.
Affiliated With: Stratacare
Plan Type: Workers' Compensation
CHECK BENEFIT CARD
(402) 483-9200
CANANDAIGUA VAMC 4004
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
UTILIZATION REVIEW
AVIDYN HEALTH
(866) 802-1328
UM NOT APPLICABLE
(972) 550-2836
CHECK BENEFIT CARD
(800) 533-5044
Cannon Cochran Management
Services Inc
Cannon Cochran Management
Services Inc
Town Centre Bldg 2 East Main St Ste
208
Danville IL 61832
(800) 252-5059
CONTACT EMPLOYER
(800) 277-6512
CAPITAL FULFILLMENT GROUP
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
APS HEALTHCARE
(406) 327-7250
Info as of 12/13/2007
Page PIRCA-90
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
CAPITAL INTERNATIONAL
ECOM PPO ADVISORS, INC
MANAGEMENT
Attn: ACCOUNTING
Affiliated With: ECOM PPO ADVISORS 8350 N. CENTRAL EXPWY, STE 600
INC
DALLAS TX 75206
Plan Type: Group Health
CAPITAL LUMBER COMPANY
FISERV HEALTH INC
Affiliated With: WAUSAU BENEFITS INC PO Box 450
Plan Type: Group Health
Pueblo CO 81002-0450
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ECOM PPO ADVISORS, INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 826-9781
AVIDYN HEALTH
(800) 808-4424
FISERV HEALTH INC
(800) 826-9781
CAPITOL ROOFING SERVICES
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CARBON COUNTY HOLDING CO
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
MOUNTAIN STATES REVIEW
MBA OF WYOMING
MBA OF WYOMING
CARDIOVASCULAR CONSULTANTS
PC
Affiliated With: THE EPOCH GROUP
10469
Plan Type: Group Health
THE EPOCH GROUP, LC
THE EPOCH GROUP, LC
PO Box 12170
OVERLAND PARK KS 66282
(913) 362-0040
THE EPOCH GROUP, LC
(913) 362-0040
GROUP & PENSION
ADMINISTRATORS INC
GROUP & PENSION
ADMINISTRATORS INC
HEALTH WATCH
(972) 238-7900
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
CARDON HEALTHCARE
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
PO Box 94
WORLAND WY 82401
(913) 362-0040
(972) 238-7900
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-91
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
CAREER EDUCATION CORPORATION KLAIS & COMPANY INC
Affiliated With: KLAIS & COMPANY
1867 W MARKET ST
Plan Type: Group Health
AKRON OH 44313
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
KLAIS & COMPANY INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 331-1096
(800) 331-1096
CARESYS AUTO
Affiliated With: MCMC LLC
Plan Type: Auto
MCMC LLC
MCMC LLC
701 Technology Dr Ste 100
Canonsburg PA 15317
(888) 350-1150 Ext 228
CareWorks
CHECK BENEFIT CARD
CareWorks
(800) 627-0065
CareWorks
(800) 627-0065
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
RESOURCEONE ADMINSTRATORS
Attn: Mary Shepherd
PO Box 489
BUCKEYSTOWN MD 21717
RESOURCEONE ADMINSTRATORS
MEDCAREONE CORP
(800) 816-1206
Plan Type: Group Health
CareWorks
MCMC LLC
(888) 350-1150 Ext 228
Plan Type: Workers' Compensation
CAREY JOHNSON OIL COMPANY
Affiliated With: RESOURCEONE
ADMINISTRATORS
Plan Type: Group Health
(800) 967-2077
(800) 967-2077
CARLING TECHNOLOGIES INC.
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
Carlson Restaurants Worldwide Platinum and Gold
Affiliated With: Carlson Holdings Inc.
Plan Type: Group Health
First Health
First Health
PO Box 8400
London KY 40742
(800) 654-5321
First Health
(800) 654-5321
(800) 654-5321
Exclude all freestanding psych/cd
facilities.
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-92
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Carlson Restaurants Worldwide - Silver
Affiliated With: Carlson Holdings Inc.
Plan Type: Group Health
CLAIMS SUBMISSION
First Health
PO Box 8400
London KY 40742
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
First Health
(800) 654-5321
UTILIZATION REVIEW
First Health
(800) 654-5321
(800) 654-5321
CARR PRINTING COMPANY, INC.
Affiliated With: TALL TREE
ADMININSTRATORS
Plan Type: Group Health
TALL TREE ADMINISTRATORS
TALL TREE ADMINISTRATORS
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
(801) 274-8100
CORVEL
(801) 269-8723
(801) 274-8100
CARRIAGE INC
Affiliated With: ALLIED BENEFIT
SYSTEMS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CARROLL DISTRIBUTING COMPANY
Affiliated With: CORESOURSE
Plan Type: Group Health
CORESOURCE
CORESOURCE
5200 77 CENTER DR STE 400
CHARLOTTE NC 28217
(800) 327-5462
CORESOURCE
(866) 794-0770
SELECT BENEFIT
ADMINISTRATORS, INC.
SELECT BENEFIT
ADMINISTRATORS, INC.
CHECK BENEFIT CARD
(800) 327-5462
CARSTAR
Affiliated With: SELECT BENEFIT
ADMINISTRATORS, INC.
Plan Type: Group Health
SELECT BENEFIT
ADMINISTRATORS, INC. C/O CCN
CARVILL AMERICA INC
Affiliated With: T R PAUL INC.
Plan Type: Group Health
T R PAUL INC.
T R PAUL INC.
PO Box 5508
NEWTON CT 06470-5508
8006788161 Ext 244
PO Box 3000
SCOTTSDALE AZ 85271-3000
8006788161 Ext 244
CAS - Claims Administrative Services
Affiliated With: STRATACARE
Plan Type: Workers' Compensation
Claims Administrative Services, Inc.
Claims Administrative Services, Inc.
501 Shelley Dr
Tyler TX 75711
(800) 765-2412
Forte
(800) 580-4567
(800) 765-2412
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-93
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CASCADE AUTOMOTIVE, INC.
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
CASHMAN EQUIPMENT
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
ASSURECARE
1011 SW EMKAY DR STE 209
BEND OR 97702
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
QVI RISK SOLUTIONS INC
(541) 312-8512
UTILIZATION REVIEW
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
CASHMAN PHOTO ENTERPRISES OF
NEVADA - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CATA
Affiliated With: ASSURECARE
Plan Type: Group Health
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
ASSURECARE
ASSURECARE
4040 HUNSAKER STE 110
LANSING MI 38823
(800) 968-6616
CARELINE
(763) 383-4800
MBA OF WYOMING
MBA OF WYOMING
CHECK BENEFIT CARD
(800) 968-6616
CATHEDRAL HOMES FOR CHILDREN
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
MOUNTAIN STATES REVIEW
CATHOLIC DIOCESE OF PEORIA
Affiliated With: OSF HEALTHPLANS
INC #20714
Plan Type: Group Health
OSF HealthPlans, Inc.
OSF HealthPlans, Inc.
PO Box 5128
PEORIA IL 61601-5128
(800) 673-5222
PO Box 94
WORLAND WY 82401
(309) 677-8356
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-94
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The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
CATHOLIC HEALTHCARE WEST CHW SCHALLER ANDERSON
ARIZONA
HEALTHCARE INC. LLC
Affiliated With: SCHALLER ANDERSON PO Box 62735
HEALTHCARE LLC
PHOENIX AZ 85082-2735
Plan Type: Group Health
CAVLIER TELEPHONE
Affiliated With: AMERICAS CHOICE
HEALTHPLAN
Plan Type: Group Health
Cayman Islands
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
CAYUCOS ELEMENTARY SCHOOL
Affiliated With: K-12 STUDENT
INSURANCE, A DIVISION OF UICI
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SCHALLER ANDERSON
HEALTHCARE INC. LLC
AMERICAS CHOICE HEALTHPLANS
AMERICAS CHOICE HEALTHPLANS
13111 Northwest Fwy, Ste 510
Houston TX 77040
(800) 633-4226
UTILIZATION REVIEW
CHECK BENEFIT CARD
HEALTHCARE SOLUTIONS
GROUP, INC.
(800) 582-1535
(800) 633-4226
International Medical Group, Inc.
International Medical Group, Inc.
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
CHECK BENEFIT CARD
(317) 655-4500 Outside US
(800) 628-4664 Inside US
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
CBCA Administrators, Inc.
CBCA Administrators Inc
Affiliated With: CBCA Administrators, Inc. 1979 Marcus Ave Ste C101
Plan Type: Group Health
Lake Success NY 11042
CBCA Administrators Inc
(800) 831-7783
Capp Care
(800) 937-2277 or (714) 2512200
(800) 831-7783
CCASAPE
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-95
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
CCASAPE/Clark County School District - SIERRA HEALTH & LIFE/HEALTH
TRAVEL
PLAN OF NEVADA
Affiliated With: SIERRA HEALTH & LIFE PO Box 15645
/ HEALTH PLAN OF NEVADA
LAS VEGAS NV 89114
Plan Type: Group Health
(702) 242-7700
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
CCN ELECTRONIC DIRECTORY GH
Affiliated With: CCN ELECTRONIC
DIRECTORY FORMERLY POW
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CCN ELECTRONIC DIRECTORY
INTERNATIONAL
Affiliated With: CCN ELECTRONIC
DIRECTORY FORMERLY POW
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CCSD SUPPORT STAFF
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
CEDAR HAMMOCK FIRE CONTROL
DISTRICT
Affiliated With: SELF INSURED PLANS
LLC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SELF INSURED PLANS LLC
Cedar Hill Insurance
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-96
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CEGA GROUP
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
CENTER IMT
Affiliated With: CREATIVE PLAN
ADMINISTRATORS, INC.
Plan Type: Group Health
CENTRAL CALIFORNIA ELECTRICAL
WORKERS (CCEW)
Affiliated With: HEALTHCOMP THIRD
PARTY ADMINISTRATORS
Plan Type: Group Health
* CENTRAL DETROIT DIESEL ALLISON INC
CLAIMS SUBMISSION
CHECK BENEFIT CARD
CREATIVE PLAN ADMINISTRATORS
PO Box 734
BUCKEYSTOWN MD 21717
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
CREATIVE PLAN ADMINISTRATORS AMERICAN HEALTH HOLDINGS
(866) 648-5554
(301) 695-0480
(301) 695-0480
HEALTHCOMP TPA
HEALTHCOMP TPA
PO Box 45018
Fresno CA 93718
(800) 442-7247
CHECK BENEFIT CARD
(800) 442-7247
FISERV HEALTH KANSAS
FISERV HEALTH KANSAS
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
AVIDYN / VALUE CHECK
(866) 802-1328
CENTRAL ILLINOIS CARPENTERS
CENTRAL ILLINOIS CARPENTERS
HEALTH AND WELFARE TRUST FUND HEALTH AND WELFARE TRUST
FUND
Plan Type: Group Health
200 MADIGAN
LINCOLN IL 62656
CENTRAL ILLINOIS CARPENTERS
HEALTH AND WELFARE TRUST
FUND
CENTRAL ILLINOIS
CARPENTERS HEALTH AND
WELFARE TRUST FUND
CENTRAL IOWA HCS 3708
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
CENTRAL IOWA HCS (3708)
CHECK BENEFIT CARD
Affiliated With: FISERV HEALTH KANSAS
Plan Type: Group Health
CENTRAL IOWA HCS (3708)
Attn: FEE OAS-D
3600 30TH STREET
DES MOINES IA 50310
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-97
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CENTRAL METHODIST UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
CENTRAL PROCESSING
CORPORATION
Affiliated With: WAUSAU BENEFITS,
INC.
Plan Type: Group Health
CLAIMS SUBMISSION
MAKSIN MANAGEMENT CORP
2500 McClellan Ave
Pennsauken NJ 08109
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MAKSIN MANAGEMENT CORP
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 220-1123
(800) 220-1123
WAUSAU BENEFITS, INC.
Attn: LeAnn Fichtner
PO Box 8046
WAUSAU WI 54401-8046
WAUSAU BENEFITS, INC.
CHECK BENEFIT CARD
(715) 841-7802
(715) 841-7802
CENTRAL RESERVE LIFE
INSURANCE COMPANY
Affiliated With: AMERICAN REPUBLIC
INSURANCE CO.
Plan Type: Group Health
CERES c/o World Insurance
CERES c/o World Insurance
PO Box 2804
Clinton IA 52733
(800) 253-4641
CHECK BENEFIT CARD
(800) 253-4641
CENTRAL STATES INDUSTRIAL
HCH ADMINISTRATION INC
EQUIPMENT & SERVICE, INC
PO Box 1986
Affiliated With: HEALTH DATA SERVICE PEORIA IL 61656
Plan Type: Group Health
(877) 876-5969
CENTRAL VALLEY GENERAL
HOSPITAL
Affiliated With: ADVENTIST HEALTH
SYSTEM/WEST
Plan Type: Group Health
ADVENTIST HEALTH SYSTEM/WEST
C/O CCN
CENTRAL VALLEY TRUST
Affiliated With: HEALTHCOMP
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
HCH ADMINISTRATION INC
CHECK BENEFIT CARD
(877) 876-5969
ADVENTIST HEALTH SYSTEM WEST CHECK BENEFIT CARD
PO Box 3000
SCOTTSDALE AZ 85271-3000
CHECK BENEFIT CARD
CHECK BENEFIT CARD
5594992450
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-98
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CENTRALIA SCHOOL DISTRICT
Affiliated With: CBIZ/SCEET
Plan Type: Group Health
CENTURY FOODS
Affiliated With: SISCO/Cottingham &
Butler
Plan Type: Group Health
CENTURY WESTPORT
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NEW YORK
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
THE PLAN HANDLERS, INC.
THE PLAN HANDLERS, INC.
SISCO
SISCO
CHECK BENEFIT CARD
PO Box 389
DUBUQUE IA 52004-0389
(800) 547-4726
CLAIMS SUBMISSION
THE PLAN HANDLERS, INC.
UTILIZATION REVIEW
930 Canterbury Pl.
ESCONDIDO CA 92025
(800) 547-4726
NORTH AMERICAN
ADMINISTRATORS-NY
NORTH AMERICAN
ADMINISTRATORS-NY
PO Box 9501
AMHERST NY 14226
(800) 397-2122
CHECK BENEFIT CARD
(800) 397-2122
CENTURY WORKERS COMP
CENTURY WORKERS COMP
CENTURY WORKERS COMP
(866) 266-9236
CENTURY WORKERS COMP
(866) 266-9236
Plan Type: Workers' Compensation
2400 Corporate Exchange Dr. Suite 290
Columbus OH 43231
CERES c/o World Insurance
CERES c/o World Insurance
CHECK BENEFIT CARD
PO Box 2804
Clinton IA 52733
(800) 786-7557
(866) 266-9236
CERES GROUP - CRS100 FH
Affiliated With: AMERICAN REPUBLIC
INSURANCE CO.
Plan Type: Group Health
CERSOSIMO INDUSTRIES, INC
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
(800) 786-7557
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-99
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
CERSOSIMO LUMBER COMPANY, INC DIVERSIFIED ADMINISTRATION
CORPORATION
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
PO Box 299
Plan Type: Group Health
MARLBOROUGH CT 06447
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
DIVERSIFIED ADMINISTRATION
CORPORATION
(888) 322-2524
UTILIZATION REVIEW
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
CFI
CFI
CFI
(417) 623-5229
CFI
(417) 623-5229
Plan Type: Workers' Compensation
4701 East 32nd Street
Joplin MO 64803
CERES c/o World Insurance
CERES c/o World Insurance
CHECK BENEFIT CARD
PO Box 2804
Clinton IA 52733
(800) 253-4641
(417) 623-5229
CGI MAJOR MEDICAL CRS100 CCN
Affiliated With: AMERICAN REPUBLIC
INSURANCE CO.
Plan Type: Group Health
CHADWICK MEDICAL ASSOCIATES,
P.C.
Affiliated With: ULTRABENEFITS, INC.
Plan Type: Group Health
CHALLENGE ENTERPRISES OF
NORTH FLORIDA
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
CHAPMAN UNIVERSITY
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
(800) 253-4641
ULTRABENEFITS INC
ULTRABENEFITS INC
PO Box 763
WESTBORO MA 01581
(866) 858-7223
CHECK BENEFIT CARD
(866) 858-7223
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
STUDENT INSURANCE DIVISION
CHECK BENEFIT CARD
(800) 283-4927
STUDENT INSURANCE DIVISION
PO Box 809025
DALLAS TX 75390-9025
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-100
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
CHARLESTON AUTO PARTS
SIERRA HEALTH & LIFE/HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN OF NEVADA
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
CHARLESTON COUNTY DETENTION
CENTER
Affiliated With: PRISON HEALTH
SERVICES, INC.
Plan Type: Group Health
PRISON HEALTH SERVICES, INC.
CHARLESTON SOUTHERN
UNIVERSITY
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
PRISON HEALTH SERVICES, INC.
PRISON HEALTH SERVICES,
INC.
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHARLESTON VAMC (RALPH H
JOHNSON VA) 3539
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
CHARLESTON VAMC (RALPH H
JOHNSON)
Attn: FEE BASIS 136F
109 BEE ST
CHARLESTON VAMC (RALPH H
JOHNSON)
CHECK BENEFIT CARD
CHARTER SCHOOLS
Affiliated With: UNITED BENEFITS
DIVISION
Plan Type: Group Health
BROWN & BROWN, INC.
BROWN & BROWN, INC.
CHECK BENEFIT CARD
CHATHAM COUNTY DETENTION
CENTER
Affiliated With: PRISON HEALTH
SERVICES, INC.
Plan Type: Group Health
PRISON HEALTH SERVICES, INC.
PRISON HEALTH SERVICES, INC.
PRISON HEALTH SERVICES,
INC.
105 W Park Dr STE 300
BRENTWOOD TN 37027
CHARLESTON SC 29401
PO Box 2480
DAYTONA BEACH FL 32115-2480
105 Westpark Dr STE 300
BRENTWOOD TN 37027
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-101
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* CHATHAM STEEL CORP
Affiliated With: WELLS FARGO THIRD
PARTY ADMINISTRATOR
Plan Type: Group Health
CHECK CITY
Affiliated With: MANAGED BENEFIT
ADMINISTRATORS & INSURANCE
Plan Type: Group Health
CLAIMS SUBMISSION
ACORDIA NATIONAL C/O CCN
PO Box 3262
CHARLESTON WV 25332
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ACORDIA NATIONAL C/O CCN
UTILIZATION REVIEW
CHECK BENEFIT CARD
(888) 685-7774
(888) 685-7774
MBA
MBA
PO Box 651109
SALT LAKE CITY UT 84165-1109
(800) 877-3727
CRITIQUE
(800) 666-5551
(800) 877-3727
CHELMSFORD AUTO
Affiliated With: MCMC LLC
Plan Type: Auto
MCMC LLC
MCMC LLC
701 Technology Dr Ste 100
Canonsburg PA 15317
(888) 350-1150 Ext 228
MCMC LLC
(888) 350-1150 Ext 228
CHEMEKETA COMMUNITY COLLEGE
Affiliated With: STUDENT ASSURANCE
SERVICES INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Cherokee Insurance
Affiliated With: Cherokee Insurance
Plan Type: Workers' Compensation
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
HEALTHSCOPE BENEFITS INC
HEALTHSCOPE BENEFITS INC
CHECK BENEFIT CARD
27 CORPORATE HILL DR
LITTLE ROCK AR 72205
(800) 560-4664
* CHESAPEAKE ENERGY
CORPORATION
Affiliated With: HEALTHSCOPE
BENEFITS
Plan Type: Group Health
Term Effective: 12/31/2007
6514397098
(800) 560-4664
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-102
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Chevron Corporation
Affiliated With: Chevron Corporation
Plan Type: Workers' Compensation
CHEVRON CORPORATION
Affiliated With: CHEVRON
CORPORATION
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
Chevron
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
6001 Bollinger Canyon Rd Ste E
San Ramon CA 94583-2324
CHEVRON CORPORATION
CHEVRON CORPORATION
6001 Bollinger Canyon Rd. E1208B
San Ramon CA 94583
(925) 842-8157
CHEVRON CORPORATION
(925) 842-8157
(925) 842-8157
Participates in California Select Network
CHEYENNE VAMC 3531
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
CHEYENNE VAMC
Attn: FEE BASIS
WILLIAM ST off HWY 12 WEST
FORT HARRISON MT 59636
CHEYENNE VAMC
CHECK BENEFIT CARD
CHICAGO (JESSE BROWN VAMC)
3160
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
JESSE BROWN VAMC
Attn: FEE 136E
820 S DAMEN AVE 5210
CHICAGO IL 60612
JESSE BROWN VAMC
CHECK BENEFIT CARD
CHICAGO MCGILL ELECTRIC SWITCH
Affiliated With: MCGILL ELECTRIC
SWITCH PRODUCT GROUP
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHICAGO-VEGAS HOLDING
COMPANY, INC
Affiliated With: PREMIER CLAIMS
ADMINISTRATORS, INC.
Plan Type: Group Health
PREMIER CLAIMS ADMINISTRATORS PREMIER CLAIMS ADMINISTRATORS UNIVERSAL HEALTH
NETWORK
PO Box 19338
7753245644
(702)
356-1159
RENO NV 89511
7753245644
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-103
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CHICK PACKAGING
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
CHICKSAW HOLDING COMPANY
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
UTILIZATION REVIEW
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 825-3540
CHILDRENS HEART CENTER LV TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
CHILES RESTAURANT GROUP
Affiliated With: SELF INSURED PLANS
LLC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHILLICOTHE VA MEDICAL CENTER
3524
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
CHILLICOTHE VA MEDICAL CENTER
Attn: 136 BLD 27 RM 17
CHILLICOTHE VA MEDICAL CENTER CHECK BENEFIT CARD
CHITTENDEN CORPORATION JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
EBPA
EBPA
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
17273 STATE RT 104
CHILLICOTHE OH 45601
CHECK BENEFIT CARD
(802) 846-8060
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-104
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
SUPERIOR INSURANCE SERVICES
CHJ, INC.
Affiliated With: SUPERIOR INSURANCE 3741 Merced Dr. #K
SERVICES
RIVERSIDE CA 92503
Plan Type: Group Health
CHOCTAW ELECTRIC COOPERATIVE
INC
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SUPERIOR INSURANCE SERVICES
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
UTILIZATION REVIEW
SUPERIOR INSURANCE
SERVICES
CHECK BENEFIT CARD
(800) 825-3540
UPSTATE ADMINISTRATIVE
SERVICES C O CHOICE PLUS OF
VERMONT
CHECK BENEFIT CARD
BENEFIT MANAGEMENT INC.
BENEFIT MANAGEMENT INC.
PO Box 1090
GREAT BEND KS 67530
(800) 290-1368
MedWatch
(800) 432-8421
CHOICE PLUS OF VERMONT
Affiliated With: UPSTATE
ADMINISTRATIVE SERVICES C O
Plan Type: Group Health
UPSTATE ADMINISTRATIVE
SERVICES C O CHOICE PLUS OF
VERMONT
CHOICE SOLUTIONS, INC
Affiliated With: BENEFIT
MANAGEMENT INC
Plan Type: Group Health
PO Box 6589
SYR NY 13217-6589
(800) 290-1368
CH'OOSHGAI COMMUNITY SCHOOL
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
SRT ADMINISTRATORS, INC.
SRT ADMINISTRATORS, INC C/O
CCN
CHECK BENEFIT CARD
CHRISTENSEN & GRIFFITH
CONSTRUCTION
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
TALL TREE ADMINISTRATORS
TALL TREE ADMINISTRATORS
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
(801) 274-8100
CORVEL
(801) 269-8723
PO Box 25160
SCOTTSDALE AZ 85255-0102
(801) 274-8100
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-105
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CHRISTIAN BROTHERS EMPLOYEE
BENEFIT TRUST
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
CLAIMS SUBMISSION
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
(800) 522-2161
ADVENTIST RISK MANAGEMENT,
INC.
CHECK BENEFIT CARD
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
CHECK BENEFIT CARD
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
ADVENTIST RISK MANAGEMENT,
INC.
CHROMA TECH WRAP JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
CHROMALLOY
Affiliated With: CDS GROUP HEALTH
Plan Type: Group Health
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 533-5044
CHRISTIAN RECORD SERVICES
Affiliated With: ADVENTIST RISK
MANAGEMENT, INC.
Plan Type: Group Health
CHROMA TECH WRAP VST
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PRINCIPAL FINANCIAL GROUP
11291 Pierce St.
RIVERSIDE CA 92515-8007
(802) 846-8060
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
CHECK BENEFIT CARD
(802) 846-8060
CDS Group Health
CDS Group Health
1625 E PRATER WAY BLDG C STE
101
SPARKS NV 89461
(775) 352-6951
UNIVERSAL HEALTH REVIEW
(775) 355-0921
(775) 352-6951
Chrysler
Affiliated With: Medical Mutual of Ohio
Plan Type: Group Health
CHECK BENEFIT CARD
Medical Mutual of Ohio
(800) 892-6200
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Medical Mutual of Ohio
(800) 258-2873
Info as of 12/13/2007
Page PIRCA-106
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CIGNA SPORTS AND ATHLETIC
PROGRAMS
Affiliated With: PREFERRED CARE
Plan Type: Group Health
CLAIMS SUBMISSION
PREFERRED CARE, INC.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PREFERRED CARE, INC.
UTILIZATION REVIEW
PREFERRED CARE, INC.
6 Neshaminy Interplex #205
TREVOSE PA 19053
CIMARRON ELECTRIC COOPERATIVE Cimarron Electric c/o First Health
Affiliated With: AMERICAN
PO Box 5215
ADMINISTRATIVE GROUP
Tampa FL 33675
Plan Type: Group Health
American Administrative Group
Cincinnati Reds
Affiliated With: Underwriters Safety &
Claims Inc.
Plan Type: Group Health
Underwriters Safety & Claims, Inc.
Underwriters Safety & Claims, Inc.
PO Box 23507
Louisville KY 40223-0507
(800) 678-1536
Bluegrass Health Network
(800) 264-5702
(800) 658-9777
American Administrative Group
(877) 202-6379 Ext 2530
(800) 678-1536
CINCINNATI VA MEDICAL CENTER
3197
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
CINCINNATI VA MEDICAL CENTER
Attn: FEE BASIS 136E
3200 VINE ST
CINCINNATI OH 45220
CINCINNATI VA MEDICAL CENTER
CHECK BENEFIT CARD
CITIZEN PUBLISHING - PEPM
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
HEALTH PLAN INC
HEALTH PLAN INC
PO Box 5199
WESTBOROUGH MA 01581
(508) 752-2480
CARE MANAGEMENT
SERVICES
(886) 325-1550
(508) 752-2480
CITIZENS BANK AND TRUST OF
ARDMORE
Affiliated With: FISERV HEALTH
Plan Type: Group Health
FISERV HEALTH INC
FISERV HEALTH INC
PO Box 530
PUEBLO CO 81002-0530
(800) 235-7160
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
AVIDYN HEALTH
(214) 647-6194
Info as of 12/13/2007
Page PIRCA-107
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CITIZENS FIRST BANK
Affiliated With: UNITED BENEFITS
DIVISION
Plan Type: Group Health
CLAIMS SUBMISSION
BROWN & BROWN BENEFITS, INC.
UTILIZATION REVIEW
CHECK BENEFIT CARD
PO Box 2480
DAYTONA BEACH FL 32115-2480
NORTH AMERICAN BENEFITS
NETWORK, INC. C/O CCN
CHECK BENEFIT CARD
GROUP BENEFIT SERVICES, INC.
GROUP BENEFIT SERVICES,
INC.
MBA OF WYOMING
MBA OF WYOMING
EQUITABLE PLAN SERVICES
EQUITABLE PLAN SERVICES
CHECK BENEFIT CARD
PO Box 720460
OKLAHOMA CITY OK 73172
(405) 755-2929
CITIZENS UTILITIES
Affiliated With: NORTH AMERICAN
BENEFITS NETWORK, INC.
Plan Type: Group Health
NORTH AMERICAN BENEFITS
NETWORK, INC. C/O CCN
CITY OF CARUTHERSVILLE
Affiliated With: GROUP BENEFIT
SERVICES, INC.
Plan Type: Group Health
GROUP BENEFIT SERVICES, INC.
CITY OF CASPER
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
MOUNTAIN STATES REVIEW
CITY OF CHICKASHA
Affiliated With: EQUITABLE PLAN
SERVICES
Plan Type: Group Health
CITY OF CHUBBUCK
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BROWN & BROWN BENEFITS, INC.
PO Box 5190
TAMPA FL 33675-5190
1736 E. Sunshine #200
SPRINGFIELD MO 65804
PO Box 94
WORLAND WY 82401
(405) 755-2929
MANAGED BENEFITS
ADMINISTRATOR AND INSURANCE
CONSULTANTS
MANAGED BENEFITS
ADMINISTRATOR AND INSURANCE
CONSULTANTS
CHECK BENEFIT CARD
PO Box 651109
SALT LAKE CITY UT 84165-1109
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-108
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CITY OF CLERMONT
Affiliated With: PREFERRED BENEFIT
ADMINISTRATORS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
PREFERRED BENEFIT
ADMINISTRATORS INC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PREFERRED BENEFIT
ADMINISTRATORS INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
PO Box 916188
LONGWOOD FL 32791-6188
CITY OF COMPTON
CITY OF COMPTON
CITY OF COMPTON
(310) 605-5582
CITY OF COMPTON
(310) 605-5582
Plan Type: Workers' Compensation
205 S Willowbrook Avenue
Compton CA 90220
CONSOCIATE, INC. C/O CCN
CHECK BENEFIT CARD
FISERV HEALTH INC
FISERV HEALTH INC
CHECK BENEFIT CARD
(310) 605-5582
CITY OF DECATUR
Affiliated With: CONSOCIATE, INC.
Plan Type: Group Health
CONSOCIATE, INC. C/O CCN
CITY OF DOWNEY
Affiliated With: BENESIGHT, INC.
Plan Type: Group Health
FISERV HEALTH INC
CITY OF GARY
Affiliated With: PROFESSIONAL
CLAIMS MANAGEMENT
Plan Type: Group Health
PROFESSIONAL CLAIMS MGMT
PROFESSIONAL CLAIMS MGMT
16 W 455 S FRONTGATE RD STE 216
BURR RIDGE IL 60527
(630) 655-1001
CITY OF GRANBURY TRAVEL
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
PO Box 3000
SCOTTSDALE AZ 85271-3000
PO Box 29050
PHOENIX AZ 85038
(630) 655-1001
GROUP & PENSION
ADMINISTRATORS INC
GROUP & PENSION
ADMINISTRATORS INC
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
HEALTH WATCH
(972) 238-7900
(972) 238-7900
CITY OF HAZLEHURST
Affiliated With: PARAGON BENEFITS
INC
Plan Type: Group Health
PARAGON BENEFITS, INC.
PARAGON BENEFITS, INC.
PO Box 12288
COLUMBUS GA 31917
(706) 327-9218
AMERICAN HEALTH HOLDINGS
(706) 327-9218
(706) 327-9218
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-109
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CITY OF HOBART
Affiliated With: EMPLOYEE BENEFIT
CONSULTANTS INC
Plan Type: Group Health
CITY OF JACKSONVILLE
Affiliated With: JSL ADMINISTRATORS
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
CLAIMS SUBMISSION
COMPENSABILITY
EMPLOYEE BENEFIT CONSULTANTS EMPLOYEE BENEFIT CONSULTANTS UM NOT APPLICABLE
(800) 367-9939
PO Box 928
(866) 296-4002
FINDLAY OH 45839
(866) 296-4002
JSL ADMINISTRATORS, INC.
JSL ADMINISTRATORS, INC.
201 HAY STREET, STE 302
FAYETTEVILLE NC 28301
(910) 480-3100
DOCTORS DIRECT
HEALTHCARE
(910) 485-0510
(910) 480-3100
City of Long Beach
Affiliated With: Tristar
Plan Type: Workers' Compensation
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
City of Los Angeles
Affiliated With: Fair Isaac Corp /
Diversified HealthCare Services
Plan Type: Workers' Compensation
CITY OF LOS ANGELES
CITY OF LOS ANGELES
700 E. Temple St Rm 210
Los Angeles CA 90012
(213) 847-9712
CITY OF LOS ANGELES
(213) 847-9712
CITY OF MICHIGAN CITY
Affiliated With: ASSURECARE
Plan Type: Group Health
(213) 847-9712
ASSURECARE
ASSURECARE
4040 HUNSAKER STE 110
LANSING MI 38823
(800) 968-6616
CARELINE
(763) 383-4800
GROUP ADMINISTRATORS, LTD.
GROUP ADMINISTRATORS, LTD.
CHECK BENEFIT CARD
PO Box 95600
HOFFMAN ESTATES IL 60195
(800) 749-1422
(800) 968-6616
CITY OF MIDWEST CITY
Affiliated With: GROUP
ADMINISTRATORS LTD
Plan Type: Group Health
(800) 749-1422
CITY OF MODESTO
CITY OF MODESTO
CITY OF MODESTO
Plan Type: Workers' Compensation
1010 Tenth St., Suite 5600
Modesto CA 95353
(209) 577-5246
Participates in California Select Network
CITY OF MODESTO
(209) 577-5246
(209) 577-5246
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-110
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CITY OF MOORE
Affiliated With: C L FRATES &
COMPANY
Plan Type: Group Health
CITY OF NORMAN
Affiliated With: BENEFIT PLANNERS
Plan Type: Group Health
CLAIMS SUBMISSION
C.L. FRATES AND COMPANY
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
C.L. FRATES AND COMPANY
UTILIZATION REVIEW
(405) 290-5696
C.L. FRATES AND COMPANY
(800) 669-1815
Benefit Planners
Benefit Planners
CHECK BENEFIT CARD
PO Box 690450
SAN ANTONIO TX 78269
(800) 292-5386
PO Box 26967
OKLAHOMA CITY OK 73126-0967
(405) 290-5696
(800) 292-5386
CITY OF OKLAHOMA FALLS
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR
BEND OR 97702
(541) 312-8512
(541) 312-8512
CITY OF PADUCAH
Affiliated With: EBC MID-AMERICA
Plan Type: Group Health
EBC MID-AMERICA
CITY OF PERRY
Affiliated With: ADMINISTRATIVE
SOLUTIONS, INC.
Plan Type: Group Health
CITY OF PLANO
Affiliated With: EMPLOYEE BENEFIT
SERVICES, INC.
Plan Type: Group Health
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
EBC MID-AMERICA
CHECK BENEFIT CARD
ADMINISTRATIVE SOLUTIONS INC
ADMINISTRATIVE SOLUTIONS INC
CHECK BENEFIT CARD
PO Box 2490
ALPHARETTA GA 30023
(678) 339-0211
9200 Shelbyville Rd Ste 500
LOUISVILLE KY 40222-5134
(678) 339-0211
EMPLOYEE BENEFIT SERVICES SHREVEPORT
EMPLOYEE BENEFIT SERVICES SHREVEPORT
CHECK BENEFIT CARD
PO Box 70100
SHREVEPORT LA 71137-0100
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-111
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CITY OF PONCA CITY
Affiliated With: AMERICAS CHOICE
HEALTHPLANS
Plan Type: Group Health
CITY OF POPLER BLUFF
Affiliated With: THE EPOCH GROUP,
INC
Plan Type: Group Health
CITY OF PUYALLUP
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS,
INC
Plan Type: Group Health
CLAIMS SUBMISSION
AHC CHOICE HEALTH PLANS
PO Box 922009
HOUSTON TX 77292-2009
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AHC CHOICE HEALTH PLANS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 559-1322
(800) 559-1322
THE EPOCH GROUP, LC
THE EPOCH GROUP, LC
10795 Watson Rd
St. Louis MO 63129
(800) 365-9036
CHECK BENEFIT CARD
(800) 365-9036
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
220 120TH Ave NE Bldg D
Bellevue WA 98005
(800) 700-7153
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
2094992000
MBA OF WYOMING
MBA OF WYOMING
CHECK BENEFIT CARD
(800) 700-7153
CITY OF RAWLINS
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
MBA OF WYOMING
City of Sacramento
Affiliated With: Fair Isaac Corp
Plan Type: Workers' Compensation
Fair Isaac Corp
Fair Isaac Corp
110 Theory Dr
Irvine CA 92617
(949) 655-3820
PO Box 98
WORLAND WY 82401
(949) 655-3820
City of San Jose
Affiliated With: Fair Isaac
Plan Type: Workers' Compensation
Fair Isaac Corp
Fair Isaac Corp
110 Theory Dr
Irvine CA 92617
(949) 655-3820
CHECK BENEFIT CARD
(949) 655-3820
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-112
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
City of San Jose
Affiliated With: Diversified Healthcare
Systems
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
CONTACT EMPLOYER
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
CONTACT EMPLOYER
UTILIZATION REVIEW
CITY OF SAN RAMON
Affiliated With: COASTAL TPA INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CITY OF SCOTTSDALE
Affiliated With: MAYO MANAGEMENT
SERVICES INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CITY OF SIERRA VISTA
Affiliated With: THIRD PARTY
ADMINISTRATIVE SERVICES
Plan Type: Group Health
THIRD PARTY ADMINISTRATIVE
SERVICES
THIRD PARTY ADMINISTRATIVE
SERVICES
THIRD PARTY
ADMINISTRATIVE SERVICES
7493 N Oracle Rd Ste 200
Tucson AZ 85704
(520) 670-0227
(520) 670-0227
CITY OF VALPARAISO
Affiliated With: EMPLOYEE BENEFIT
CONSULTANTS INC
Plan Type: Group Health
CIVIL TOWN OF CLARKSVILLE
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
EMPLOYEE BENEFIT CONSULTANTS EMPLOYEE BENEFIT CONSULTANTS UM NOT APPLICABLE
(800) 367-9939
PO Box 928
(866) 296-4002
FINDLAY OH 45839
(866) 296-4002
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
(800) 832-8212
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-113
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Claims Indemnity Services Inc
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
CONTACT EMPLOYER
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CLAIMS TECHNOLOGY INC
Affiliated With: GLOBALCARE
Plan Type: Group Health
CHECK BENEFIT CARD
CLARCOR, INC
Affiliated With: ALLIED BENEFIT
SYSTEMS INC
Plan Type: Group Health
ALLIED BENEFIT SYSTEMS, INC
ALLIED BENEFIT SYSTEMS, INC
208 S LASALLE ST STE 1300
CHICAGO IL 60604
(312) 906-8080 Ext 259
CLAREMONT FLOCK CORPORATION
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
UTILIZATION REVIEW
6783411722
UM NOT APPLICABLE
(312) 906-8080 Ext 259
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(508) 752-2480
CMS
(866) 325-1550
KHS, A KMG AMERICA COMPANY
KHS, A KMG AMERICA COMPANY
CHECK BENEFIT CARD
210 S WHITE ST
LANCASTER SC 29720
(800) 822-1274
(508) 752-2480
CLAREMONT RESTAURANT GROUP,
LLC
Affiliated With: KHS A KMG AMERICA
COMPANY
Plan Type: Group Health
(800) 822-1274
CLARK COUNTY
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY PO Box 7011
Plan Type: Group Health
WYOMISSING PA 19610-6011
THE LOOMIS COMPANY
CHECK BENEFIT CARD
(800) 346-1223
(800) 346-1223
CLARK COUNTY MISSOURI
Affiliated With: GROUP BENEFIT
SERVICES
Plan Type: Group Health
GROUP BENEFIT SERVICES, INC.
GROUP BENEFIT SERVICES, INC.
1736 E. Sunshine Ste 200
Springfield MO 65804
(517) 631-3469
HEALTHLINK
(314) 989-6115
(800) 995-3569
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-114
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Clark District Co. of Versailles
Affiliated With: Underwriters Safety &
Claims Inc.
Plan Type: Group Health
CLARKSBURG VA MEDICAL CENTER
3663
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
Underwriters Safety & Claims, Inc.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Underwriters Safety & Claims, Inc.
UTILIZATION REVIEW
(800) 678-1536
Bluegrass Health Network
(800) 264-7502
HEALTH NET FEDERAL SERVICES
HEALTH NET FEDERAL SERVICES
CHECK BENEFIT CARD
5504 HILL HEAVEN CT
FRISCO TX 75035
(214) 387-3232
PO Box 23507
Louisville KY 40223-0507
(800) 678-1536
(214) 387-3232
CLAYTON COLLEGE & STATE UNIV
PEARCE ADMINISTRATION
AIH0057987
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
CLAYTON COLLEGE & STATE UNIV
AIH0057997
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
CLAYTON COLLEGE & STATE
UNIVERSITY UNDERGRAD
Attn: WHIT WALTERS
MANDATORY
419 S. COIT ST
Affiliated With: MAKSIN MANAGEMENT
FLORENCE SC 29501
CORP
(800) 222-6491
Plan Type: Group Health
PEARCE ADMINISTRATION
CLAYTON COUNTY GORGIA
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
UM NOT APPLICABLE
(800) 222-6491
CHECK BENEFIT CARD
Plan Type: Group Health
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-115
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The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
PEARCE ADMINISTRATION
CLAYTON STATE UNIVERSITY ICS
AII61217
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
Clements and Company - USAID
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
CLEMENTS FOOD COMPANY
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
CHECK BENEFIT CARD
(843) 622-6001
International Medical Group, Inc.
International Medical Group, Inc.
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
CHECK BENEFIT CARD
(317) 655-4500 Outside US
(800) 628-4664 Inside US
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
CLEMSON UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2437
Florence SC 29503-2437
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
CLEVELAND VA MEDICAL CENTER
3196
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
CLEVELAND VA MEDICAL CENTER
Attn: FEE BASIS 136BF
CLEVELAND VA MEDICAL CENTER
CHECK BENEFIT CARD
CLICK BOND, INC
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
PO Box 80
Stockton CA 95201
(209) 474-5421
UNIVERSAL HEALTH
NETWORK
(800) 776-6959
10000 BRECKSVILLE RD
BRECKSVILLE OH 44141
(209) 474-5421
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-116
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The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLINICA DE SALUD DEL PUEBLO
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
CLINICAL RADIOLOGISTS
Affiliated With: NORTH AMERICA
ADMINISTRATORS L P
Plan Type: Group Health
CLAIMS SUBMISSION
TALL TREE ADMINISTRATORS
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
TALL TREE ADMINISTRATORS
(801) 274-8100
UTILIZATION REVIEW
CORVEL
(810) 269-8723
(801) 274-8100
NORTH AMERICA
ADMINISTRATORS, L.P.
NORTH AMERICA
ADMINISTRATORS, L.P.
PO Box 1984
NASHVILLE TN 37202
6152563561 Ext 147
CHECK BENEFIT CARD
(800) 411-3650
CLINICAS DEL CAMINO REAL
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATORS
Plan Type: Group Health
EMPLOYEE BENEFIT
ADMINISTRATORS
EMPLOYEE BENEFIT
ADMINISTRATORS
424 N. First Ave.
ARCADIA CA 91006-2804
(626) 294-2800
CHECK BENEFIT CARD
(818) 842-0147
(626) 294-2800
CLOTHESTIME STORES, INC.
Affiliated With: CORESOURCE, MN
Plan Type: Group Health
CORESOURCE MN
CLOUGHERTY PACKING COMPANY
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CLOUGHERTY PACKING COMPANY
CLOUGHERTY PACKING COMPANY
Plan Type: Workers' Compensation
2727 East 27th St.
Los Angeles CA 90058
CORESOURCE MN
CORESOURCE MN
CHECK BENEFIT CARD
CHECK BENEFIT CARD
7830 BROADWAY
TUCSON AZ 85710
8002218942
CLOUGHERTY PACKING COMPANY CLOUGHERTY PACKING
COMPANY
(323) 583-8791
(323) 583-8791
(323) 583-8791
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-117
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLOVIS UNIFIED SCHOOL DISTRICT
Affiliated With: PINNACLE CLAIMS
MANAGEMENT
Plan Type: Group Health
CM ALMY AND SONS - %
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
CLAIMS SUBMISSION
PINNACLE CLAIMS MANAGEMENT
PO Box 2220
NEWPORT BEACH CA 92658
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PINNACLE CLAIMS MANAGEMENT
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 649-9121
(800) 649-9121
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(508) 752-2480
CHECK BENEFIT CARD
(508) 752-2480
CM ALMY AND SONS INC
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
HEALTH PLAN INC
HEALTH PLAN INC
PO Box 5199
WESTBOROUGH MA 01581
(800) 343-7674
CARE MANAGEMENT
SERVICES
8663251550
(800) 343-7674
CM PRODUCTS
Affiliated With: ALLIED BENEFIT
SYSTEMS, INC.
Plan Type: Group Health
ALLIED BENEFIT SYSTEMS, INC
ALLIED BENEFIT SYSTEMS, INC
208 S LASALLE ST STE 1300
CHICAGO IL 60604
(312) 906-8080 Ext 259
AMERICAN HEALTH HOLDING
(312) 906-8080 Ext 259
(312) 906-8080 Ext 259
CMH FLOORING PRODUCTS INC
Affiliated With: KHS A KMG AMERICA
COMPANY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CNA Commerical Insurance
Affiliated With: Crawford and Company
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
Accessed through Crawford and
Company, name does not appear on the
Payor List as a separate payor
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-118
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
COAST COMMUNITY COLLEGE
DISTRICT
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
COAST JANITORIAL
Affiliated With: FCE BENEFIT
ADMINISTRATORS
Plan Type: Group Health
COAST UNIFIED SCHOOL DISTRICT
Affiliated With: K-12 STUDENT
INSURANCE, A DIVISION OF UICI
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
FCE BENEFIT ADMINISTRATORS
FCE BENEFIT ADMINISTRATORS
CHECK BENEFIT CARD
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
CLAIMS SUBMISSION
CHECK BENEFIT CARD
UTILIZATION REVIEW
(800) 899-9355
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
COASTAL CAROLINA UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
COASTAL GEORGIA COMMUNITY
ACTION AUTHORITY
Affiliated With: PARAGON BENEFITS
INC
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2437
Florence SC 29503-2437
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
PARAGON BENEFITS
PARAGON BENEFITS
PO Box 12288
COLUMBUS GA 31917
(706) 327-9218
AMERICAN HEALTH HOLDING
(877) 417-3363
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
(706) 327-9218
PEARCE ADMINISTRATION
COASTAL GEORGIA COMMUNITY
COLLEGE AIH0058007
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-119
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
PEARCE ADMINISTRATION
COASTAL GEORGIA COMMUNITY
COLLEGE AIH0058017
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
COASTAL GEORGIA COMMUNITY
COLLEGE UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
CHECK BENEFIT CARD
(843) 622-6001
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
Coastal International Security
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC
Plan Type: Group Health
FCE BENEFIT ADMINISTRATORS
FCE BENEFIT ADMINISTRATORS
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
UM NOT APPLICABLE
(800) 899-9355
COASTAL PET PRODUCTS
DIRECT CARE AMERICA
Affiliated With: THE CHANDLER GROUP PO Box 2090 C
Plan Type: Group Health
STOW OH 44224
DIRECT CARE AMERICA
CHECK BENEFIT CARD
(800) 266-5896
(800) 266-5896
COATES FIELD SERVICE
Affiliated With: EQUITABLE PLAN
SERVICES
Plan Type: Group Health
COATESVILLE VAMC 3124
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
EQUITABLE PLAN SERVICES
EQUITABLE PLAN SERVICES
PO Box 720460
OKLAHOMA CITY OK 73172
(405) 755-2929
CHECK BENEFIT CARD
(405) 755-2929
COATESVILLE VAMC
Attn: FEE BASIS - 115E
1400 BLACKHORSE HILL RD
COATSVILLE PA 19320
COATESVILLE VAMC
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-120
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
Western Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Western Health
UTILIZATION REVIEW
(605) 719-4600 or (888) 3411766
Western Health
(605) 719-4640 or (800) 2290892
COCA COLA BOTTLERS
IntraCorp
ASSOCIATION THE
1111 MARKET
Affiliated With: COCA COLA BOTTLERS CHATTANOOGA TN 37402-3306
ASSOCIATION THE
Plan Type: Group Health
IntraCorp
CIGNA HEALTHCARE
COCOPAH NURSERIES INC
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CODALE ELECTRIC SUPPLY INC
Affiliated With: P5 HEALTH PLAN
SOLUTIONS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
COGBURN HEALTH SERVICES
Affiliated With: CAROLINA BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
COHEN BROTHERS, INC.
Affiliated With: BENEFIT SREVICES
INC.
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Coca Cola
Affiliated With: Rapid City Regional
Hospital DBA Western Health
Plan Type: Group Health
529 Kansas City St Ste 200
Rapid City SD 57701
(605) 719-4600 or (888) 3411766
8002218942
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-121
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
COLD SPRINGS GRANITE COMPANY
Affiliated With: CORESOURCE, MN
Plan Type: Group Health
COLDWELL BANKER UNITED,
REALTORS
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
COLLEGE OF CHARLESTON
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CORESOURCE MN
CORESOURCE MN
GROUP & PENSION
ADMINISTRATORS INC
GROUP & PENSION
ADMINISTRATORS INC
HEALTH WATCH
(972) 238-7900
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
CLAIMS SUBMISSION
CORESOURCE MN
UTILIZATION REVIEW
7830 BROADWAY
TUCSON AZ 85710
(972) 238-7900
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2437
Florence SC 29503-2437
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
COLLEGE VIEW ACADEMY
Affiliated With: ADVENTIST RISK
MANAGEMENT, INC.
Plan Type: Group Health
ADVENTIST RISK MANAGEMENT,
INC.
COLLEY MCCOY MANAGEMENT
GROUP WRAP JMS
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATORS
Plan Type: Group Health
EBPA
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
ADVENTIST RISK MANAGEMENT,
INC.
CHECK BENEFIT CARD
EBPA
CHECK BENEFIT CARD
11291 Pierce St.
RIVERSIDE CA 92515-8007
(800) 578-3272
(800) 578-3272
COLLINS PRODUCTS LLC
Affiliated With: QVI RISK SOLUTIONS
INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-122
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
COLONIAL GROUP
Affiliated With: PRIMARY
PHYSICIANCARE INC
Plan Type: Group Health
Colonial Medical Insurance Company
Affiliated With: Colonial Group
International LTD
Plan Type: Group Health
COLONY RESORT TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
PRIMARY PHYSICIAN CARE
PO Box 11088
CHARLOTTE NC 28220
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PRIMARY PHYSICIAN CARE
(704) 527-8102
UTILIZATION REVIEW
PRIMARY PHYSICIAN CARE
(704) 523-2758
(704) 527-8102
Colonial Medical Insurance Company
Colonial Medical Insurance Company
PO Box 11519
Scottsdale AZ 85271-1519
(441) 296-3200
First Health
(800) 356-0810
(441) 296-3200
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
COLORADO STATE UNIVERSITY
Affiliated With: SUMMIT AMERICA
INSURANCE SERVICES LC
Plan Type: Group Health
SUMMIT AMERICA INSURANCE
SERVICES
Attn: VIVIAN PAUL
7400 COLLEGE BLVD STE 100
OVERLAND PARK KS 66220
SUMMIT AMERICA INSURANCE
SERVICES
CHECK BENEFIT CARD
(877) 246-6997
(877) 246-6997
COLUMBIA (DORN VAMC) 3540
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
COLUMBIA - DORN VAMC
Attn: FEE BASIS - 136F
6439 GARNERS FERRY RD
COLUMBIA SC 29209
COLUMBIA - DORN VAMC
CHECK BENEFIT CARD
COLUMBIA (HARRY S TRUMAN
VAMC) 3525
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
HARRY S TRUMAN VAMC
Attn: BUSSINESS OFFICE ADMN FEE
HARRY S TRUMAN VAMC
CHECK BENEFIT CARD
800 HOSPITAL DR
COLUMBIA MO 65201
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-123
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
COLUMBIA COLLEGE AMH9038017
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
COLUMBIA COLLEGE JOHO482842
Affiliated With: MAKSIN MANAGEMENT
CORPORATION
Plan Type: Group Health
CLAIMS SUBMISSION
PEARCE ADMINISTRATION
PO Box 2437
Florence SC 29503-2437
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
CHECK BENEFIT CARD
(843) 622-6001
(843) 622-6001
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
(843) 622-6001
(843) 622-6001
* COLUMBIA LIGHTHOUSE FOR THE
BLIND
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC UM NOT APPLICABLE
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
COLUMBUS HOUSING AUTHORITY
Affiliated With: PARAGON BENEFITS,
INC.
Plan Type: Group Health
PARAGON BENEFITS, INC.
COLUMBUS STATE UNIV AIH0058027
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
COLUMBUS STATE UNIV AIH0058037
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
PARAGON BENEFITS, INC.
PARAGON BENEFITS, INC.
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
PO Box 2271
Florence SC 29503
(843) 622-6001
2221 Manchester Expressway
COLUMBUS GA 31904
(843) 622-6001
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-124
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
COLUMBUS STATE UNIVERSITY
PEARCE ADMINISTRATION
UNDERGRAD MANDATORY
Attn: WHIT WALTERS
Affiliated With: MAKSIN MANAGEMENT 419 S. COIT ST
CORP
FLORENCE SC 29501
Plan Type: Group Health
(800) 222-6491
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 222-6491
COLUMBUS VA OPC 3195
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
COLUMBUS VA OPC
Attn: FEE BASIS 136B2
543 TAYLOR AVE
COLUMBUS OH 43203
COLUMBUS VA OPC
CHECK BENEFIT CARD
COMANCHE COUNTY MEMORIAL
HOSPITAL
Affiliated With: WATERSTONE
BENEFITS ADMINISTRATORS, INC.
Plan Type: Group Health
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
CHECK BENEFIT CARD
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
(888) 440-0971
(888) 440-0971
CHECK BENEFIT CARD
CHECK BENEFIT CARD
COMMERCE BENEFITS GROUP
COMMERCE BENEFITS GROUP
PO Box 900
ELYRIA OH 44036
(440) 930-7500
COMMERCE BENEFITS GROUP
(440) 930-7500
COMMERCE BENEFITS GROUP
COMMERCE BENEFITS GROUP
COMMENCEMENT BAY CORRUGATED CHECK BENEFIT CARD
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
COMMERCE BENEFITS GROUP PEPM
Affiliated With: COMMERCE BENEFITS
GROUP
Plan Type: Group Health
COMMERCE BENEFITS
GROUP/BUCKEYE PREFERRED
Affiliated With: COMMERCE BENEFITS
GROUP
Plan Type: Group Health
(440) 930-7500
COMMERCE BENEFITS GROUP
PO Box 900
ELYRIA OH 44036
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-125
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
COMMERCIAL ENVIRONMENT
SYSTEMS
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
COMMERCIAL SEWING INC
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
CLAIMS SUBMISSION
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MUTUAL ASSURANCE
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 825-3540
(800) 825-3540
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
CORPORATE MANAGEMENT
HEALTH SERVICES
(800) 423-5597
(888) 322-2524
PREFERRED BENEFIT
ADMINISTRATORS INC
CHECK BENEFIT CARD
COMMUNITY ADMINISTRATORS
COMMUNITY
ADMINISTRATORS
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
COMMUNICATIONS INTERNATIONAL,
INC.
Affiliated With: PREFERRED BENEFIT
ADMINISTRATORS, INC.
Plan Type: Group Health
PREFERRED BENEFIT
ADMINISTRATORS INC
COMMUNITY ADMINISTRATORS
Affiliated With: THE COMMUNITY
HEALTH GROUP
Plan Type: Group Health
COMMUNITY ADMINISTRATORS
COMMUNITY BANK OF NEVADA
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
PO Box 916188
LONGWOOD FL 32791-6188
PO Box 1177
CHULA VISTA CA 91912
(702) 242-7700
COMMUNITY COLLEGE OF DENVER
Affiliated With: AMERIBEN SOLUTIONS
#15255
Plan Type: Group Health
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 953-1801
CHECK BENEFIT CARD
(800) 953-1801
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-126
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
COMMUNITY DENTAL
Affiliated With: COMMUNITY HEALTH
GROUP
Plan Type: Group Health
COMMUNITY HEALTH GROUP HMO
Affiliated With: THE COMMUNITY
HEALTH GROUP
Plan Type: Group Health
COMMUNITY HEALTH SERVICES
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
COMMUNITY ADMINISTRATORS
CHECK BENEFIT CARD
COMMUNITY ADMINISTRATORS
COMMUNITY ADMINISTRATORS
CHECK BENEFIT CARD
PO Box 1177
CHULA VISTA CA 91912
(800) 838-2869
CLAIMS SUBMISSION
COMMUNITY ADMINISTRATORS
UTILIZATION REVIEW
PO Box 1177
CHULA VISTA CA 91912
(800) 838-2869
NHBC
NHBC
8990 East Raintree Dr
Scottsdale AZ 85751
(888) 621-7900
CHECK BENEFIT CARD
(888) 621-7900
COMMUNITY HOSPITAL OF THE
MONTEREY PENINSULA
Affiliated With: COASTAL TPA INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
COMMUNITY HOSPITAL OF THE
MONTEREY PENINSULA
Affiliated With: COASTAL TPA INC
Plan Type: Group Health
COASTAL TPA, INC.
COASTAL TPA, INC.
CHECK BENEFIT CARD
PO Box 80308
SALINAS CA 93912
(800) 564-7475
Community One Federal Credit Union Travel
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
(800) 564-7475
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-127
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
COMNET COMMUNICATIONS
Affiliated With: T.R. PAUL, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
T R PAUL INC.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MANAGED CARE STRATEGIES
MANAGED CARE STRATEGIES
UM NOT APPLICABLE
UTILIZATION REVIEW
PO Box 5508
NEWTOWN CT 06470-5508
Comp IQ - ASP
Affiliated With: CompIQ
Plan Type: Workers' Compensation
CompIQ Corporation
CompIQ Corporation
35 Tesla Way #100
Irvine CA 92618
(800) 293-3131
Comp IQ - ASP AUTO
Affiliated With: CompIQ
Plan Type: Auto
CompIQ Corporation
CompIQ Corporation
35 Tesla Way #100
Irvine CA 92618
(800) 293-3131
UM NOT APPLICABLE
(800) 293-3131
COMPANION LIFE INSURANCE
COMPANY
Affiliated With: INSURERS
ADMINISTRATIVE CORPORATION
#11337
Plan Type: Group Health
Companion Life Insurance Company
Affiliated With: Insurers Administrative
Corporation
Plan Type: Group Health
Compass Rose Benefit Group
Affiliated With: Compass Rose Benefit
Group
Plan Type: Group Health
Insurers Administrative Corporation
(IAC)
Insurers Administrative Corporation
(IAC)
PO Box 828
Park Ridge IL 60068-0828
(800) 843-3106
Med-Valu
(800) 522-2161
(800) 843-3106
Insurers Administrative Corp
Insurers Administrative Corp
PO Box 828
Park Ridge IL 60068-0828
(800) 964-4948
Med-Valu
(800) 522-2161
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(602) 906-6263
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-128
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
COMPIQ
Affiliated With: GLOBAL EMERGENCY
MEDICAL SERVICES, INC. (GEMS)
Plan Type: Group Health
CompIQ
Affiliated With: CompIQ #13910
Plan Type: Workers' Compensation
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GLOBALCARE
(GLOBALCARE/WEYCO)
GLOBALCARE
(GLOBALCARE/WEYCO)
CompIQ Corporation
CompIQ Corporation
UM NOT APPLICABLE
35 Tesla Way #100
Irvine CA 92618
(800) 293-3131
CLAIMS SUBMISSION
GLOBALCARE
(GLOBALCARE/WEYCO)
UTILIZATION REVIEW
2001 Westside Pkwy. #120
ALPHARETTA GA 30004
(800) 293-3131
COMPLETE BENEFITS SOLUTIONS
LLC
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
CompMed Advantage / City of Peekskill
Affiliated With: CompMed Advantage
Plan Type: Workers' Compensation
NHBC
NHBC
8990 East Raintree Dr
Scottsdale AZ 85751
(888) 621-7900
CHECK BENEFIT CARD
(888) 621-7900
Network Adjusters
Network Adjusters
PO Box 6008
Garden City NY 11530
(516) 750-1319
CONTACT EMPLOYER
(516) 750-1319
COMPONE SERVICES LTD
Affiliated With: THE KEMPTON GROUP
Plan Type: Group Health
KEMPTON GROUP
ADMINISTRATORS INC
KEMPTON GROUP
ADMINISTRATORS INC
PO Box 54889
OKLAHOMA CITY OK 73154
(405) 521-1711
CHECK BENEFIT CARD
(405) 521-1711
COMPREHENSIVE BENEFIT
ADMINISTRATOR INC JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
EBPA
EBPA
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
CHECK BENEFIT CARD
(802) 846-8060
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-129
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CONCENTRA / FOCUS (Part of NHR)
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
CONCENTRA / FOCUS (Part of NHR)
720 Cool Springs Blvd., #300
Franklin TN 37067
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONCENTRA / FOCUS (Part of NHR)
(800) 243-2336
UTILIZATION REVIEW
CONCENTRA / FOCUS (Part of
NHR)
(800) 243-2336
(800) 243-2336
CONCORD HOSPITALITY
ENTERPRISES COMPANY
Affiliated With: WELLS FARGO THIRD
PARTY ADMINISTRATOR
Plan Type: Group Health
CONCORDIA HOMES OF NEVADA
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
ACORDIA NATIONAL
ACORDIA NATIONAL
PO Box 3262
CHARLESTON WV 25332
(888) 685-7774
CHECK BENEFIT CARD
(888) 685-7774
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
CONGREGATION OF THE SISTERS
OF ST JOSEPH OF BOSTON
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CONNECTICUT COLLEGE
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
ADMINISTRATIVE CONCEPTS, INC.
ADMINISTRATIVE CONCEPTS, INC.
CHECK BENEFIT CARD
997 OLD EAGLE SCHOOL
WAYNE PA 19087-1706
(888) 293-9229
CONNECTICUT STEEL WRAP JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
(888) 293-9229
EBPA
EBPA
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
CHECK BENEFIT CARD
(802) 846-8060
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-130
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
CONNECTICUT VA HEALTHCARE
CONNECTICUT VA HEALTHCARE
SYSTEM 3113
SYSTEM
Affiliated With: HEALTH NET FEDERAL Attn: FEE BASIS (04F)
SERVICES
555 WILLIARD AVE
Plan Type: Group Health
NEWINGTON CT 06111
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONNECTICUT VA HEALTHCARE
SYSTEM
UTILIZATION REVIEW
CHECK BENEFIT CARD
CONNOLLY BOVE LODGE & HUTZ LLP Brokerage Concepts, Inc.
Affiliated With: BROKERAGE
PO Box 61553
CONCEPTS BENEFIT CONCEPTS, INC. KING OF PRUSSIA PA 19406
Plan Type: Group Health
6104914911
Brokerage Concepts, Inc.
6104914911
Brokerage Concepts, Inc.
(215) 773-3722
CONSOLIDATED CASTING TRAVEL
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
HEALTH WATCH
(972) 238-7900
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
(800) 827-7223 Ext 2325
Consolidated Electrical Supply Co.
Affiliated With: First Health
Plan Type: Group Health
First Health
First Health
PO Box 671248
Houston TX 77267-1248
(800) 231-3337
First Health
(800) 525-2394
(800) 231-3337
CONSOLIDATED GRAPHICS
Affiliated With: BENEFIT PLANNERS
LTD
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CONSOLIDATED HEALTH PLAN
Affiliated With: ADMINONE
CORPORATION
Plan Type: Group Health
RESOURCEONE ADMINSTRATORS
Attn: Mary Shepherd
ADMINONE CORPORATION
MEDCAREONE CORP
(800) 816-1206
(800) 967-2077
PO Box 489
BUCKEYSTOWN MD 21717
(800) 967-2077
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-131
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CONSOLIDATED MINERALS INC
Affiliated With: PREFERRED BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
PREFERRED BENEFIT
ADMINISTRATORS INC
PO Box 916188
LONGWOOD FL 32791-6188
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PREFERRED BENEFIT
ADMINISTRATORS INC
UTILIZATION REVIEW
HEALTHCHOICE
(407) 481-7125
(407) 786-2777
(407) 786-2777
CONSOLIDATED RESOURCES INC
Affiliated With: MERCER
ADMINISTRATION #10442
Plan Type: Group Health
CONSTRUCTION DATA COMPANY
Affiliated With: UNITED BENEFITS
DIVISION
Plan Type: Group Health
CONSTRUCTION PROTECTIVE
SERVICES INC
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS INC
Plan Type: Group Health
* Consumer Credit Services Inc Travel
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
MERCER ADMINISTRATION
MERCER ADMINISTRATION
PO Box 1520
IOWA CITY IA 52244
8005624023
CARE ALLIES
(972) 307-2700
8005624023
ULTRABENEFITS INC
ULTRABENEFITS INC
PO Box 2480
DAYTONA BEACH FL 32115-2480
(800) 323-4890
INTRACORP
(800) 875-5315
(800) 323-4890
TRANSWESTERN INSURANCE
ADMINISTRATORS, INC.
TRANSWESTERN INSURANCE
ADMINISTRATORS, INC.
PO Box 45019
Fresno CA 93718
5594992000
CHECK BENEFIT CARD
8002218942
8002218942
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
CONSUMER'S CHOICE/USA
Affiliated With: AMERICAS HEALTH
CARE BENEFIT PLAN
Plan Type: Group Health
Insurers Administrative Corporation
(IAC)
Insurers Administrative Corporation
(IAC)
PO Box 39119
Phoenix AZ 85069-9119
(602) 906-6263
Insurers Administrative
Corporation (IAC)
(602) 395-7096
(602) 906-6263
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-132
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CONSUMERS INTERSTATE
CORPORATION
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
CONTACT-RURAL METRO
Affiliated With: SCHALLER ANDERSON
HEALTHCARE
Plan Type: Group Health
CLAIMS SUBMISSION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
DIVERSIFIED ADMINISTRATION
CORPORATION
(888) 322-2524
UTILIZATION REVIEW
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
SCHALER ANDERSON HEALTHCARE
SCHALER ANDERSON HEALTHCARE CHECK BENEFIT CARD
4645 E. COTTON CENTER BLVD
BLDG 1 #200
PHOENIX AZ 85040
(602) 659-1403
(602) 659-1403
CONTINENTAL GENERAL
INSURANCE COMPANY
Affiliated With: AMERICAN REPUBLIC
INSURANCE CO.
Plan Type: Group Health
CONTINENTAL RESOURCES
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
CERES c/o World Insurance
CERES c/o World Insurance
PO Box 2804
Clinton IA 52733
(800) 786-7557
CHECK BENEFIT CARD
(800) 786-7557
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
Continental Western Group
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTRACT LUMBER
Affiliated With: BUSINESS
ADMNISTRATORS & CONSULTANTS
INC
Plan Type: Group Health
BAC
BAC
6331 E LIVINGSTON AVE
REYNOLDSBURG OH 43068
(614) 863-8780
BAC
(614) 863-8780
(614) 863-8780
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-133
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CONTRACTORS BONDING AND
INSURANCE COMPANY
Affiliated With: EBMS EMPLOYEE
BENEFIT MANAGEMENT SERVICES
Plan Type: Group Health
CONTROL DEVICES INC DBA FIRST
TECHNOLOGY
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
CONTROL TECHNOLOGIES JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
CONTROL TECHNOLOGIES WRAP
JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
CONTROLLED POWER
Affiliated With: THE CHANDLER
GROUP #13352
Plan Type: Group Health
* COOPER CAMERON CORPORATION
Affiliated With: BENEFIT PLANNERS
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
8007773575
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(508) 752-2480
CARE MANAGEMENT
SERVICES
(866) 325-1550
(508) 752-2480
EBPA
EBPA
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
CHECK BENEFIT CARD
(802) 846-8060
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
CHECK BENEFIT CARD
(802) 846-8060
DIRECT CARE AMERICA
DIRECT CARE AMERICA
PO Box 2090 C
STOW OH 44224
(800) 266-5896
CHECK BENEFIT CARD
(800) 266-5896
Benefit Planners
Benefit Planners
PO Box 690450
SAN ANTONIO TX 78269
(800) 292-5386
CHECK BENEFIT CARD
(800) 292-5386
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-134
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
COOPER STANDARD AUTOMOTIVE
INC
Affiliated With: HEALTH DESIGN PLUS
Plan Type: Group Health
COOPER TIRE & RUBBER COMPANY
Affiliated With: HEALTH DESIGN PLUS
Plan Type: Group Health
CLAIMS SUBMISSION
Health Design Plus
1755 GEORGETOWN ROAD
HUDSON OH 44236
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Health Design Plus
(877) 286-3559
UTILIZATION REVIEW
Health Design Plus
(800) 385-7085
(877) 286-3559
Health Design Plus
Health Design Plus
1755 GEORGETOWN ROAD
HUDSON OH 44236
(877) 286-3559
Health Design Plus
(800) 385-7085
Employee Benefit Management Corp
(EBMC)
Employee Benefit Management Corp
(EBMC)
ACMS
(800) 831-6677
4789 Rings Rd
Dublin OH 43017-1599
(614) 766-5800
(877) 286-3559
COOPERATIVE GROUP BENEFITS
PLAN
Affiliated With: EMPLOYEE BENEFIT
MANAGEMENT CORP
Plan Type: Group Health
COPE PLASTICS
Affiliated With: BENEFIT
ADMINISTRATIVE SYSTEMS INC
Plan Type: Group Health
(614) 766-5800
BENEFIT ADMINISTRATIVE
SYSTEMS
BENEFIT ADMINISTRATIVE
SYSTEMS
6 EXECUTIVE DR, SUITE ONE
FAIRVIEW HEIGHTS IL 62208
(800) 737-0878
CHECK BENEFIT CARD
(800) 737-0878
COPLEY PRESS, INC.
Affiliated With: COPLEY PRESS, INC.
Plan Type: Group Health
AETNA HEALTH PLANS
CORBIS CORPORATION
Affiliated With: EBMS EMPLOYEE
BENEFIT MANAGEMENT SERVICES
Plan Type: Group Health
CHECK BENEFIT CARD
AETNA HEALTH PLANS
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PO Box 129002
SAN DIEGO CA 92112-9002
8007773575
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-135
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CORE CARRIER CORPORATION
Affiliated With: NORTH AMERICA
ADMINISTRATORS LP
Plan Type: Group Health
CLAIMS SUBMISSION
NORTH AMERICA
ADMINISTRATORS, L.P.
PO Box 1984
NASHVILLE TN 37202
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NORTH AMERICA
ADMINISTRATORS, L.P.
UTILIZATION REVIEW
MED-CERT
(800) 356-7126
(800) 411-3650
(800) 411-3650
CORE INNOVATIVE SOLUTIONS, LLC
Affiliated With: QUALIFIED BENEFIT
SERVICES, INC
Plan Type: Group Health
QUALIFIED BENEFIT SERVICES LLC
QUALIFIED BENEFIT SERVICES LLC CHECK BENEFIT CARD
691 W 1200 N, Suite 200
SPRINGVILLE UT 84663
(801) 853-1300
(801) 853-1300
CORESLAB STRUCTURES
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY PO Box 7045
Plan Type: Group Health
Wyomissing PA 19610
(877) 634-9814
HINES & ASSOCIATES
(888) 826-5769
THE LOOMIS COMPANY
(877) 634-9814
CORNISH COLLEGE OF THE ARTS
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CORONET MANUFACTURING CO INC
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CORPORATE BENEFIT SERVICES OF
AMERICA (CBSA)
Affiliated With: CORPORATE BENEFIT
SERVICES OF AMERICA (CBSA)
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-136
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The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CORPORATE RESOURCE
MANAGEMENT INC
Affiliated With: AMERICAN STERLIN
Plan Type: Group Health
CORPORATE WINGS
Affiliated With: WELLS FARGO THIRD
PARTY ADMINISTRATOR
Plan Type: Group Health
CORRPRO COMPANIES
Affiliated With: ENTRUST INC
Plan Type: Group Health
CLAIMS SUBMISSION
AMERICAN STERLIN
PO Box 26103
OVERLAND PARK KS 66225
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AMERICAN STERLIN
UTILIZATION REVIEW
CHECK BENEFIT CARD
(877) 292-6037
(877) 292-6037
ACORDIA NATIONAL
ACORDIA NATIONAL
PO Box 3262
CHARLESTON WV 25332
(888) 685-7774
ACORDIA NATIONAL
(304) 353-8743
(888) 685-7774
ENTRUST INC
ENTRUST INC
14701 ST MARY'S LN STE 150
HOUSTON TX 77079
(281) 368-7878
MEDICAL HELPLINE
(877) 463-3435
CHECK BENEFIT CARD
(281) 368-7878
Cost Containment Solutions
Affiliated With: CompIQ
Plan Type: Workers' Compensation
Cost Containment Solutions
Cost Containment Solutions
PO Box 58
Montclair CA 91763
(909) 949-3939
COTKIN, COLLINS & GINSBURG
Affiliated With: AMERICAN INSURANCE
ADMINISTRATORS
Plan Type: Group Health
AMERICAN INSURANCE
ADMINISTRATORS
AMERICAN INSURANCE
ADMINISTRATORS
13191 CROSSROADS PARK NORTH
STE 205
CITY OF INDUSTRY CA 91746-3434
(800) 654-7900
CHECK BENEFIT CARD
(800) 654-7900
Cottingham and Butler SISCO
Affiliated With: Fair Isaac Corporation
Plan Type: Workers' Compensation
SISCO
SISCO
PO Box 28
Dubuque IA 52004
(563) 587-5175
SISCO
(563) 587-5175
(563) 587-5175
Participates in California Select Network
COTTON ELECTRIC COOPERATIVE
Affiliated With: THE KEMPTON GROUP
INC
Plan Type: Group Health
KEMPTON GROUP
ADMINISTRATORS INC
KEMPTON GROUP
ADMINISTRATORS INC
PO Box 54889
OKLAHOMA CITY OK 73154
(405) 521-1711
CHECK BENEFIT CARD
(405) 521-1711
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-137
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Council on International Educational
Exchange (CIEE)
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
COUNTY OF KERN POS PLAN
Affiliated With: GALLAGHER BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
International Medical Group, Inc.
407 N Fulton St
Indianapolis IN 46202-3684
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
International Medical Group, Inc.
(317) 636-4721
UTILIZATION REVIEW
Check Benefit Card
CUNA Mutual Insurance Society
PO Box 1648
Madison WI 52701 or
(317) 636-4721
GALLAGHER BENEFIT
ADMINISTRATORS INC
GALLAGHER BENEFIT
ADMINISTRATORS INC
PO Box 5227
LISLE IL 60532
(888) 478-2650
GALLAGHER BENEFIT
ADMINISTRATORS INC
(630) 493-3925
(888) 478-2650
COUNTY OF KERN PPO PLAN
Affiliated With: GALLAGHER BENEFIT
ADMINISTRATORS
Plan Type: Group Health
GALLAGHER BENEFIT
ADMINISTRATORS INC
GALLAGHER BENEFIT
ADMINISTRATORS INC
PO Box 5227
LISLE IL 60532
(888) 478-2650
GALLAGHER BENEFIT
ADMINISTRATORS INC
(630) 493-3925
(888) 478-2650
COUNTY OF KINGS
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
County Of Los Angeles
Affiliated With: Diversified HealthCare
Services
Plan Type: Workers' Compensation
COUNTY OF MENDOCINO
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
PO Box 1147
STOCKTON CA 95201
(800) 556-5918
DELTA TEAMCARE
(877) 464-1441
(800) 556-5918
COUNTY OF LOS ANGELES
COUNTY OF LOS ANGELES
3333 Wilshire Blvd Ste 1000
Los Angeles CA 90010
(213) 637-0822
COUNTY OF LOS ANGELES
(213) 637-0822
(213) 637-0822
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
PO Box 1147
STOCKTON CA 95201
(209) 474-5647
HEALTH CARE EVALUATION
(209) 951-6711
(209) 474-5647
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-138
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
County of San Diego
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
CONTACT EMPLOYER
UTILIZATION REVIEW
County of Santa Barbara
Affiliated With: Stratacare
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
COUNTY OF SANTA CLARA - DEPT
OF CORRECTIONS
Affiliated With: COUNTY OF SANTA
CLARA
Plan Type: Group Health
VALLEY HEALTH PLAN
VALLEY HEALTH PLAN
2325 Enborg Lane #290
San Jose CA 95128
(408) 885-4582
VALLEY HEALTH PLAN
(888) 421-8444
COUNTY OF SANTA CLARA UNSPONSORED PROGRAMS
Affiliated With: COUNTY OF SANTA
CLARA
Plan Type: Group Health
COUNTY OF SANTA CLARA DBA:
SANTA CLARA VALLEY HEALTH &
HOSPITAL SYSTEM
Affiliated With: COUNTY OF SANTA
CLARA
Plan Type: Group Health
COURTESY AUTOMOTIVE GROUP
TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
(408) 885-4582
VALLEY HEALTH PLAN
VALLEY HEALTH PLAN
2325 Enborg Lane #290
San Jose CA 95128
(408) 885-4582
VALLEY HEALTH PLAN
(888) 421-8444
(408) 885-4582
VALLEY HEALTH PLAN
VALLEY HEALTH PLAN
2325 Enborg Lane #290
San Jose CA 95128
(888) 421-8444
VALLEY HEALTH PLAN
(888) 421-8444
(888) 421-8444
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-139
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
COURTNEY & PHARR
Affiliated With: CAROLINA BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
CAROLINA BENEFIT
ADMINISTRATORS
333 SOUTH PINE ST
SPARTANBURG SC 29302
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CAROLINA BENEFIT
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 476-2295
(800) 476-2295
Coventry Health Care
Affiliated With: Coventry Health Care
Plan Type: Group Health
Coventry HealthCare of Louisiana, Inc.
PO Box 7707
London KY 40742
Coventry HealthCare of Louisiana, Inc. Coventry HealthCare of
Louisiana, Inc.
(800) 708-9355
(800) 708-9355
(800) 341-6613
COVENTRY OF KANSAS CITY
Affiliated With: COVENTRY HEALTH
CARE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
COWLES COMPANY
Affiliated With: WAUSAU BENEFITS
INC 12851
Plan Type: Group Health
WAUSAU BENEFITS, INC.
WAUSAU BENEFITS, INC.
PO Box 8013
WAUSAU WI 54402-8013
(800) 826-9781
WAUSAU BENEFITS, INC.
(800) 808-4424
GROUP & PENSION
ADMINISTRATORS INC
GROUP & PENSION
ADMINISTRATORS INC
HEALTH WATCH
(972) 238-7900
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
CPR HEARTPLACE
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
(800) 826-9781
(972) 238-7900
Cracker Barrel
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CONTACT EMPLOYER
Info as of 12/13/2007
Page PIRCA-140
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
CRAFTSMEN INDUSTRIES INC
SIERRA HEALTH & LIFE/HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN OF NEVADA
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH & LIFE /
HEALTH PLAN
(702) 242-7345
(702) 242-7700
Crawford & Company
CONTACT EMPLOYER
Attn:
Crawford & Company
CRAWFORD / ISP
CRAWFORD/ISP
CRAWFORD/ISP
(973) 628-3148
CRAWFORD/ISP
(973) 628-3148
Plan Type: Workers' Compensation
1361 Alts Road
Wayne NJ 07470
Plan Type: Auto
(888) 382-0039
Crawford & Company
(800) 241-2541
(973) 628-3148
Crawford and Company
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
CREATIVE MANAGEMENT
TECHNOLOGY INC
Affiliated With: CAROLINA BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CREATIVE OFFICE PAVILLION
Affiliated With: BENEFIT PLAN
MANAGEMENT
Plan Type: Group Health
BENEFIT PLAN MANAGEMENT
BENEFIT PLAN MANAGEMENT
CONTACT EMPLOYER
PO Box 536
ROCKLAND MA 02370
(781) 753-7559
CREDIT ONE TRAVEL PLAN
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
(781) 753-7559
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-141
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
CREEL PRINTING
SIERRA HEALTH & LIFE/HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN OF NEVADA
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
CRESCENT ELECTRIC SUPPLY CO
Affiliated With: SELF INSURED
SERVICES COMPANY
Plan Type: Group Health
SELF INSURED SERVICES
COMPANY (SISCO)
SELF INSURED SERVICES
COMPANY (SISCO)
PO Box 28
Dubuque IA 52004
(800) 457-4726
HEALTHCORP
(800) 457-4726
(800) 457-4726
CRISTI CLEANING
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
CRL MAJOR MEDICAL CRS100 POK
Affiliated With: AMERICAN REPUBLIC
INSURANCE CO.
Plan Type: Group Health
CROCODILES NOT WATERLILIES
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC UM NOT APPLICABLE
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
CERES c/o World Insurance
CERES c/o World Insurance
PO Box 2804
Clinton IA 52733
(800) 247-2190
CHECK BENEFIT CARD
(800) 247-2190
CHECK BENEFIT CARD
CROWN EQUIPMENT
DIRECT CARE AMERICA
Affiliated With: THE CHANDLRE GROUP PO Box 2090 C
Plan Type: Group Health
STOW OH 44224
CHECK BENEFIT CARD
CHECK BENEFIT CARD
DIRECT CARE AMERICA
CHECK BENEFIT CARD
(800) 266-5896
(800) 266-5896
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-142
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CROWN HILL RANCHES INC
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS INC
Plan Type: Group Health
CROWN POINT CABINETRY
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
8002218942
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
Crum and Forster
Crum and Forster
Crum and Forster
(213) 797-3098
CompPartners Inc
(949) 253-3117
Plan Type: Workers' Compensation
PO Box 23010
Tucson AZ 85734
MBA OF WYOMING
MBA OF WYOMING
(800) 293-3131
CRUM ELECTRIC
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
MOUNTAIN STATES REVIEW
CSU LOS ANGELES INTL STUDENT
SRVCS
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CSU SCHOOLS
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
CHECK BENEFIT CARD
PO Box 7186
BOISE ID 83707
(800) 953-1801
PO Box 94
WORLAND WY 82401
(800) 953-1801
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-143
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CUMBERLAND HEALTHCARE
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
CUMMINS CONSTRUCTION COMPANY
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
NHBC
8990 E. Raintree Dr.
Scottsdale AZ 85260
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NHBC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(888) 621-7900
(888) 621-7900
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
CUMMINS CUMBERLAND
Affiliated With: PREFERRED HEALTH
PLAN INC 962550088
Plan Type: Group Health
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
(502) 992-4535
CURA Group The
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
CUSTOM DESIGN BENEFITS CINCOM
Affiliated With: GLOBALCARE INC
Plan Type: Group Health
GLOBALCARE, INC.
GLOBALCARE, INC.
UM NOT APPLICABLE
6875 Shiloh Rd E
ALPHARETTA GA 30005
(678) 341-1922
CUSTOM DESIGN BENEFITS - NEFF
PACKAGING
Affiliated With: GLOBALCARE INC
Plan Type: Group Health
(678) 341-1922
GLOBALCARE, INC.
GLOBALCARE, INC.
6875 Shiloh Rd E
ALPHARETTA GA 30005
(678) 341-1922
UM NOT APPLICABLE
(678) 341-1922
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-144
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The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CUSTOMATION
Affiliated With: ASSURECARE
Plan Type: Group Health
CLAIMS SUBMISSION
ASSURECARE
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ASSURECARE
UTILIZATION REVIEW
(800) 968-6616
CARELINE
(763) 383-4800
GLOBALCARE
GLOBALCARE
CHECK BENEFIT CARD
6875 Shiloh Rd E
ALPHARETTA GA 30005
(678) 341-1811
4040 HUNSAKER STE 110
LANSING MI 38823
(800) 968-6616
CYPRESS-CREATIVE FORMING
Affiliated With: GLOBALCARE
Plan Type: Group Health
(678) 341-1811
DAHL - CHASE PATHOLOGY
ASSOCIATES
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NEW YORK
Plan Type: Group Health
DAHL-CHASE DIAGNOSTIC SERVICES
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NEW YORK
Plan Type: Group Health
NORTH AMERICAN
ADMINISTRATORS-NY
NORTH AMERICAN
ADMINISTRATORS-NY
PO Box 9501
AMHERST NY 14226
(800) 397-2122
CHECK BENEFIT CARD
(800) 397-2122
NORTH AMERICAN
ADMINISTRATORS-NY
NORTH AMERICAN
ADMINISTRATORS-NY
PO Box 9501
AMHERST NY 14226
(800) 397-2122
CHECK BENEFIT CARD
(800) 397-2122
DAK AMERICAS LLC
Affiliated With: CORPORATE
BENEFITS SERVICE INC
Plan Type: Group Health
CHECK BENEFIT CARD
DALLAS BAPTIST
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
TRUE CHOICE USA
TRUE CHOICE USA
PO Box 700307
DALLAS TX 75370
(800) 785-2446
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8002779476
CHECK BENEFIT CARD
(800) 785-2446
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-145
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GENEX SERVICES, INC.
GENEX SERVICES, INC.
CompIQ Corporation
CompIQ Corporation
CHECK BENEFIT CARD
35 Tesla Way #100
Irvine CA 92618
(949) 923-4021
CLAIMS SUBMISSION
GENEX SERVICES, INC.
DALLAS NATIONAL
Affiliated With: GENEX SERVICES, INC. 440 E. SWEDESFORD RD STE 3050
Plan Type: Workers' Compensation
WAYNE PA 19087
Dallas National Insurance Company
Affiliated With: CompIQ #13910
Plan Type: Workers' Compensation
UTILIZATION REVIEW
(949) 923-4021
DALLAS THEOLOGICAL SEMINARY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
TRUE CHOICE USA
TRUE CHOICE USA
PO Box 700307
DALLAS TX 75370
(800) 785-2446
CHECK BENEFIT CARD
(800) 785-2446
DALLAS VA MEDICAL CENTER 3168
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
DALLAS VA MEDICAL CENTER
Attn: FEE BASIS 136E
4500 S LANCASTER
DALLAS TX 75216
DALLAS VA MEDICAL CENTER
CHECK BENEFIT CARD
DALTON STATE COLLEGE
UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
DALTON STATE UNIV AIH0058047
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-146
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The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
DALTON STATE UNIV AIH0058057
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
CLAIMS SUBMISSION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
CHECK BENEFIT CARD
(843) 622-6001
(843) 622-6001
DANA CORPORATION
Affiliated With: AMERICAN HEALTH
GROUP
Plan Type: Group Health
AMERICAN HEALTH GROUP
DANA NON UNION RETIREE VEBA
TRUST
Affiliated With: INTERPLAN HEALTH
GROUP
Plan Type: Group Health
INTERPLAN HEALTH GROUP
Attn: Supervisor of the Claims Dept
PO Box 2388 C
STOW OH 44224
AMERICAN HEALTH GROUP
AMERICAN HEALTH GROUP
INTERPLAN HEALTH GROUP
(800) 266-5896
INTERPLAN HEALTH GROUP
(888) 610-0082
570 Longbow
MAUMEE OH 43537
(800) 266-5896
DANVILLE VA MEDICAL CENTER 3154
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
DANVILLE VA MEDICAL CENTER
Attn: FEE BASIS (136A7)
1900 E MAIN ST
DANVILLE IL 61832
DANVILLE VA MEDICAL CENTER
CHECK BENEFIT CARD
DARIN CAMARENA HEALTH CENTER
Affiliated With: HEALTHCOMP THIRD
PARTY ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
DARTON COLLEGE UNDERGRAD
MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-147
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
DAVIDSON HOTEL COMPANIES
Affiliated With: BENEFIT PLANNERS
LTD
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
DAYTON SUPERIOR
Affiliated With: FISERV HEALTH
KANSAS - 11297
Plan Type: Group Health
FISERV HEALTH INC
FISERV HEALTH INC
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
AVIDYN HEALTH
(214) 647-6194
BENEFIT CONCEPTS, INC.
BENEFIT CONCEPTS, INC.
CHECK BENEFIT CARD
1021 W. 8TH AVE STE 200
KING OF PRUSSIA PA 19406
(800) 220-2600
PAYOR NAME
DAVE KINGSTON PRODUCE
AFFILIATED COMPANIES
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
Dayton Superior Corporation
Affiliated With: Brokerage Concepts
Inc/Benefit Concepts Inc
Plan Type: Group Health
UTILIZATION REVIEW
(800) 235-7160
(800) 220-2600
DAYTON VA MEDICAL CENTER 3194
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
DAYTON VA MEDICAL CENTER
Attn: FEE BASIS 136
DAYTON VA MEDICAL CENTER
CHECK BENEFIT CARD
DAYWEST HEALTHCARE SERVICES
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
TALL TREE ADMINISTRATORS
TALL TREE ADMINISTRATORS
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
(801) 274-8100
CORVEL
(801) 269-8723
4100 W 3RD ST
DAYTON OH 45428
(801) 274-8100
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-148
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
DBSI REALTY CORPORATION
Affiliated With: EMPLOYEE BENEFIT
MANAGEMENT SERVICES
Plan Type: Group Health
DCI BIOLOGICALS, INC
Affiliated With: CORPORATE BENEFIT
SERVICE OF AMERICA
Plan Type: Group Health
* DCR Services Inc.
Affiliated With: JSL ADMINISTRATORS
INC
Plan Type: Group Health
CLAIMS SUBMISSION
EBMS
PO Box 21367
BILLINGS MT 59104-1367
UTILIZATION REVIEW
EBMS CARELINK
(406) 245-3575
MERITAIN HEALTH
MERITAIN HEALTH
PO Box 1065
AMHERST NY 14226
(877) 777-6076
GUIDED2HEALTH
(952) 593-6447
JSL ADMINISTRATORS, INC.
JSL ADMINISTRATORS, INC.
CHECK BENEFIT CARD
PO BOX 71489
Newnan GA 30271
(770) 683-1024
(877) 777-6076
(770) 683-1024
MACHIGONNE BENEFIT
ADMINISTRATORS
CHECK BENEFIT CARD
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
HEALTH CARE STRATEGIES
8005821535
PO Box 2365
SOUTH BURLINGTON VT 05407
(800) 587-3272
DEAD RIVER COMPANY
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
MACHIGONNE BENEFIT
ADMINISTRATORS
DEAD RIVER COMPANY
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
DEAD RIVER COMPANY JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EBMS
PO BOX 3859
PORTLAND ME 04104-3859
(800) 587-3272
EBPA
EBPA
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
CHECK BENEFIT CARD
(802) 846-8060
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-149
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
DEALERS ELECTRICAL SUPPLY
COMPANY
Affiliated With: BENEFIT PLANNERS
Plan Type: Group Health
DEAN A MCGEE EYE INSTITUTE
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
GROUP & PENSION
ADMINISTRATORS INC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GROUP & PENSION
ADMINISTRATORS INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
PO Box 749075
DALLAS TX 75374-9075
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
FMH BENEFIT SERVICES, INC. A
DIVISION OF CORESOURCE, INC.
FMH BENEFIT SERVICES, INC. A
DIVISION OF CORESOURCE, INC.
HCM
(800) 990-9058
PO Box 25946
OVERLAND PARK KS 66225-5946
(800) 990-9058
DEARDEN'S
Affiliated With: AFFORDABLE BENEFIT
ADMINISTRATORS, INC. (ABA)
Plan Type: Group Health
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
DEBRUCE GRAIN
Affiliated With: FMH BENEFIT
SERVICES INC A DIVISION OF
CORESOURCE
Plan Type: Group Health
DECATHLON USA FORMALLY MVP
SPORTS
Affiliated With: AMERICA'S CHOICE
HEALTHPLANS LLC
Plan Type: Group Health
DECATUR PARK DISTRICT
Affiliated With: CONSOCIATE GROUP
Plan Type: Group Health
PO Box 10787
BURBANK CA 91510
(800) 990-9058
AMERICA'S CHOICE HEALTHPLANS,
LLC
13111 Northwest Fwy, Ste 510
Houston TX 77040
AMERICA'S CHOICE HEALTHPLANS, AMERICAN HEALTH
HOLDINGS INC
LLC
(888)
578-1812
(877) 224-3627
(877) 224-3627
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-150
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
DECATUR PUBLIC SCHOOL DISTRICT CONSOCIATE, INC. C/O CCN
Affiliated With: CONSOCIATE, INC.
PO Box 3000
Plan Type: Group Health
SCOTTSDALE AZ 85271-3000
DECO PAPER PRODUCTS
Affiliated With: PREFERRED HEALTH
PLAN INC 962550088
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONSOCIATE, INC. C/O CCN
UTILIZATION REVIEW
CHECK BENEFIT CARD
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
UM NOT APPLICABLE
(502) 992-4535
Definiti / P G & E
Affiliated With: COMP IQ
Plan Type: Workers' Compensation
Definiti
Definiti
77 Beale St
San Francisco CA 94105
(415) 973-8017
DEFT, INC
Affiliated With: EBA&M
Plan Type: Group Health
EBA&M
EBA&M
PO Box 5079
WESTLAKE VILLAGE CA 91359
(800) 776-1545
HINES & ASSOCIATES
(800) 528-2498
THE EPOCH GROUP
THE EPOCH GROUP
ADMINISTRATIVE CONCEPTS INC
UM NOT APPLICABLE
(800) 776-1545
DELAVAL INC
Affiliated With: THE EPOCH GROUP,
L.C.
Plan Type: Group Health
THE EPOCH GROUP
DELAWARE VALLEY COLLEGE
Affiliated With: ADMINISTRATIVE
CONCEPTS, INC.
Plan Type: Group Health
ADMINISTRATIVE CONCEPTS INC
Attn: Customer Service Dept
997 Old Eagle School Rd. #215
WAYNE PA 19087-1706
PO Box 12170
OVERLAND PARK KS 66282
(888) 293-9229
(888) 293-9229
DELTA FOREMOST CHEMICAL
Affiliated With: PITTMAN &
ASSOCIATES, INC.
Plan Type: Group Health
PITTMAN & ASSOCIATES, INC.
PITTMAN & ASSOCIATES, INC.
PITTMAN & ASSOCIATES, INC.
PO Box 111047
MEMPHIS TN 38111
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-151
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
DEMIRCO COMPANY
Affiliated With: CONSOCIATE, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
CONSOCIATE, INC. C/O CCN
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONSOCIATE, INC. C/O CCN
CHECK BENEFIT CARD
COMBINED BENEFIT
ADMINISTRATORS
COMBINED BENEFIT
ADMINISTRATORS
Bluegrass Health Network
(800) 264-7502
PO Box 3000
SCOTTSDALE AZ 85271-3000
DENIZ PACKING, INC.
Affiliated With: COMBINED BENEFIT
ADMINIS./VALUE ADDED BENEFITS
Plan Type: Group Health
COMBINED BENEFIT
ADMINISTRATORS
Desa International
Affiliated With: Underwriters Safety &
Claims Inc.
Plan Type: Group Health
Underwriters Safety & Claims, Inc.
Underwriters Safety & Claims, Inc.
PO Box 23507
Louisville KY 40223-0507
(800) 678-1536
Deseret Mutual Benefit Administrators
Affiliated With: Deseret Mutual Benefit
Administrators
Plan Type: Group Health
UTILIZATION REVIEW
4704 W. Jennifer Ave. #104
FRESNO CA 93722
(800) 678-1536
Deseret Healthcare
Deseret Healthcare
PO Box 45530
Salt Lake City UT 84145-0530
(800) 777-3622
Deseret Mutual Benefit
Administrators
(800) 777-3622
(800) 777-3622
(801) 533-3420
DESERT LUMBER
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
DESERT ORTHOPAEDIC TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-152
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
DESERT RADIOLOGIST - TRAVEL
SIERRA HEALTH & LIFE / HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE / HEALTH
PLAN
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
* DESJARDIN
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
* DESOTO COUNTY DBA SORRELLS
BROTHERS PACKING CO.
Affiliated With: HERITAGE
CONSULTANTS INC
Plan Type: Group Health
STAR HEALTHCARE NETWORK
STAR HEALTHCARE NETWORK
850 Seventh Ave STE 803
New York NY 10019
(212) 581-8228
UM NOT APPLICABLE
(212) 581-8228
HERITAGE CONSULTANTS INC
HERITAGE CONSULTANTS INC
PO Box 1730
AUBURNDALE FL 33823
8639674139
HERITAGE CONSULTANTS INC
8639674139
8639674139
DETROIT VA MEDICAL CENTER 3155
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
DETROIT VA MEDICAL CENTER
Attn: FEE BASIS 001B-SS
4646 JOHN R
DETROIT MI 48201
DETROIT VA MEDICAL CENTER
CHECK BENEFIT CARD
DEVON ENERGY
Affiliated With: BENEFIT PLANNERS
Plan Type: Group Health
Benefit Planners
Benefit Planners
CHECK BENEFIT CARD
PO Box 690450
SAN ANTONIO TX 78269
(800) 292-5386
(800) 292-5386
DHS INC
Affiliated With: CAROLINA BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-153
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
DHSI - California Pacific Medical Center CONTACT EMPLOYER
(CPMC)
Affiliated With: Fair Isaac Corp /
Diversified Healthcare Systems
Plan Type: Workers' Compensation
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
CHECK BENEFIT CARD
UTILIZATION REVIEW
DHSI - Creative Risk Funding
Affiliated With: Diversified Healthcare
Systems
Plan Type: Workers' Compensation
CONTACT EMPLOYER
CONTACT EMPLOYER
CHECK BENEFIT CARD
DIAGNOS-TECHS, INC
Affiliated With: ALTERNATIVE
INSURANCE RESOURCES
Plan Type: Group Health
ALTERNATIVE INSURANCE
RESOURCES
ALTERNATIVE INSURANCE
RESOURCES
CHECK BENEFIT CARD
PO Box 660787
BIRMINGHAM AL 35266
(202) 871-3229
(202) 871-3229
DICKINSON COLLEGE
Affiliated With: ADMINISTRATIVE
CONCEPTS, INC.
Plan Type: Group Health
ADMINISTRATIVE CONCEPTS INC
Attn: Customer Service Dept
997 Old Eagle School Rd. #215
WAYNE PA 19087-1706
ADMINISTRATIVE CONCEPTS INC
UM NOT APPLICABLE
(888) 293-9229
(888) 293-9229
DIGESTIVE HEALTH SPECIALISTS
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS,
INC.
Plan Type: Group Health
DILCON COMMUNITY SCHOOL
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
HEALTHCARE MANAGEMENT
ADMINISTRATORS INC
HEALTHCARE MANAGEMENT
ADMINISTRATORS INC
PO Box 85008
BELLEVUE WA 98015
(800) 869-7093
HEALTHCARE MANAGEMENT
ADMINISTRATORS INC
(425) 289-5142
SRT ADMINISTRATORS, INC.
CHECK BENEFIT CARD
(800) 869-7093 Ext 117
SRT ADMINISTRATORS, INC.
PO Box 25160
SCOTTSDALE AZ 85255-0102
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-154
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
DINGLEY PRESS IPN
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
DINGLEY PRESS JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
DINGLEY PRESS SCAN DIRECT
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
DIOCESE OF CHEYENNE
Affiliated With: MBA OF WYOMING
13039
Plan Type: Group Health
DIPLOMATIC PAINTING & BUILDING
SERVICES COMPANY
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
DIPLOMATIC PAINTING & BUILDING
SERVICES COMPANY
Affiliated With: FCE BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
COMPREHENSIVE BENEFITS
ADMINISTRATOR
PO Box 2365
SOUTH BURLINGTON VT 05407
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
COMPREHENSIVE BENEFITS
ADMINISTRATOR
UTILIZATION REVIEW
HEALTH CARE STRATEGIES
(800) 582-1535
(800) 846-8060
(800) 846-8060
COMPREHENSIVE BENEFITS
ADMINISTRATOR
COMPREHENSIVE BENEFITS
ADMINISTRATOR
PO Box 2365
SOUTH BURLINGTON VT 05407
(800) 846-8060
HEALTH CARE STRATEGIES
(800) 582-1535
(800) 846-8060
COMPREHENSIVE BENEFITS
ADMINISTRATOR
COMPREHENSIVE BENEFITS
ADMINISTRATOR
PO Box 2365
SOUTH BURLINGTON VT 05407
(800) 846-8060
HEALTH CARE STRATEGIES
(800) 582-1535
(800) 846-8060
MBA OF MARYLAND
MBA OF MARYLAND
PO Box 98
WORLAND WY 82401
(307) 347-6151
MOUNTAIN STATES REVIEW
(307) 347-7979
(307) 347-6151
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC UM NOT APPLICABLE
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
FCE BENEFIT ADMINISTRATORS
FCE BENEFIT ADMINISTRATORS
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
UM NOT APPLICABLE
(800) 899-9355
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-155
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
DIRECT MEDIA, INC.
Affiliated With: T R PAUL INC
Plan Type: Group Health
CLAIMS SUBMISSION
T R PAUL INC.
PO Box 5508
NEWTON CT 06470-5508
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
T R PAUL INC.
UTILIZATION REVIEW
CHECK BENEFIT CARD
8006788161 Ext 244
8006788161 Ext 244
DISMAS CHARITIES INC
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
DIVERSIFIED ADMIN. CORP.
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
PO Box 437017
Louisville KY 40253
(800) 832-8212
CHECK BENEFIT CARD
(800) 832-8212
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
DIVERSIFIED COMMUNICATIONS
Affiliated With: COURESOURCE, INC
Plan Type: Group Health
CORESOURCE, INC.
CORESOURCE, INC.
PO Box 83301
LANCASTER PA 17608-3301
(800) 223-3843
CORESOURCE, INC.
(800) 223-3843
(800) 223-3843
DIVERSIFIED CONTRACTORS, INC.
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
Diversified Health Care Service (DHSI)
Affiliated With: Diversified Health Care
Service
Plan Type: Workers' Compensation
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
Diversified Health Care Services, Inc.
Diversified Health Care Services, Inc.
201 East Sandpointe, Suite 320
Santa Ana CA 92707
(714) 918-2590 Ext 104
Diversified Health Care Services,
Inc.
(714) 918-2590 Ext 104
(714) 918-2590 Ext 104
Participates in California MPN Select
Network
DIVERSIFIED HEALTHCARE
SERVICES, INC.
Plan Type: Workers' Compensation
DIVERSIFIED HEALTHCARE
SERVICES, INC.
DIVERSIFIED HEALTHCARE
SERVICES, INC.
201 East Sandpointe, Suite 320
Santa Ana CA 92707
(714) 918-2590 Ext 104
Participates in California Select Network
(714) 918-2590 Ext 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.
DIVERSIFIED HEALTHCARE
SERVICES, INC.
(714) 918-2590 Ext 104
Info as of 12/13/2007
Page PIRCA-156
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Diversified Healthcare Systems
Affiliated With: Fair Isaac Corporation
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
CONTACT EMPLOYER
UTILIZATION REVIEW
DIXON BROS, INC
Affiliated With: WESTERN HEALTH
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
DLZ CORPORATION
Affiliated With: BUSINESS
ADMINISTRATORS AND
CONSULTANTS
Plan Type: Group Health
BAC
BAC
6331 E LIVINGSTON AVE
REYNOLDSBURG OH 43068
(614) 863-8780
BAC
(614) 863-8780
CONTACT EMPLOYER
CONTACT EMPLOYER
CHECK BENEFIT CARD
CHECK BENEFIT CARD
DMI
Affiliated With: CompIQ #13910
Plan Type: Workers' Compensation
(614) 863-8780
CompIQ Corporation
35 Tesla Way #100
Irvine CA 92618
(800) 293-3131
DOBLER SONS
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
DOLESE BROS CO
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
8002218942
CHECK BENEFIT CARD
(800) 825-3540
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-157
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
DONAHUE SCHRIBER
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
Donatos Pizzeria Corporation
Affiliated With: Health Design Plus
Plan Type: Group Health
CLAIMS SUBMISSION
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
UTILIZATION REVIEW
HINES & ASSOCIATES
(800) 528-2498
PO Box 3000
SCOTTSDALE AZ 85271-3000
Health Design Plus
Health Design Plus
PO Box 2582
HUDSON OH 44236
(877) 230-0990
CHECK BENEFIT CARD
(800) 434-1305
EBPA
CHECK BENEFIT CARD
(877) 230-0990
DORKS UNLIMITED JMS
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATORS
Plan Type: Group Health
EBPA
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
(800) 578-3272
(800) 578-3272
DORKS UNLIMITED WRAP % JMS
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATORS
Plan Type: Group Health
EBPA
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
EBPA
CHECK BENEFIT CARD
(800) 578-3272
(800) 578-3272
DOUG ANDRUS DISTRIBUTING
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
DOUGLAS COUNTY SCHOOL
DISTRICT
Affiliated With: HEALTHCOMP TPA
Plan Type: Group Health
HEALTHCOMP TPA
HEALTHCOMP TPA
CHECK BENEFIT CARD
PO Box 45018
Fresno CA 93718
(800) 442-7247
(800) 442-7247
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-158
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
DOUGLASS FERTILIZER CHEMICAL
INC
Affiliated With: HERITAGE
CONSULTANTS INC
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ALL RISK ADMINISTRATORS
ALL RISK ADMINISTRATORS
TRUSTMARK LIFE INSURANCE
CO.
(800) 725-6566
DOW ELECTRONICS, INC.
Affiliated With: ALL RISK
ADMINISTRATORS
Plan Type: Group Health
ALL RISK ADMINISTRATORS
DOWELL ENTERPRISES INC
Affiliated With: FISERV HEALTH KANSAS
Plan Type: Group Health
FISERV HEALTH KANSAS
FISERV HEALTH KANSAS
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
DOWN EAST TOYOTA BUICK
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NEW YORK
Plan Type: Group Health
UTILIZATION REVIEW
8010 Blind Pass Rd.
PASS A GRILL BEACH FL 33706
(800) 235-7160
NORTH AMERICAN
ADMINISTRATORS-NY
NORTH AMERICAN
ADMINISTRATORS-NY
PO Box 9501
AMHERST NY 14226
(800) 397-2122
CHECK BENEFIT CARD
(800) 397-2122
DOWNEAST COMMUNITY HOSPITAL
Affiliated With: PATIENT ADVOCATES
Plan Type: Group Health
PATIENT ADVOCATES LLC
DR SYSTEMS
Affiliated With: CENBEN USA INC
Plan Type: Group Health
CENBEN USA
Attn: Melissa Joseph
PATIENT ADVOCATES LLC
PATIENT ADVOCATES LLC
CENBEN USA
CHECK BENEFIT CARD
PO Box 1959
Gray ME 04039
(614) 797-5204
4079 Executive Pkwy
Westerville OH 43081
(614) 797-5204
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-159
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
DRIVERS CHOICE
Affiliated With: CONSUMER HEALTH
SOLUTIONS
Plan Type: Group Health
DRIVETIME AUTOMOTIVE
Affiliated With: BENEFIT PLANNERS
LTD
Plan Type: Group Health
DRYWALL SYSTEMS PLUS
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
CONSUMER HEALTH SOLUTIONS
333 SOUTH PINE ST
SPARTANBURG SC 29302
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONSUMER HEALTH SOLUTIONS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(877) 573-9541
(877) 573-9541
BENEFIT PLANNERS LTD
BENEFIT PLANNERS LTD
PO Box 690450
SAN ANTONIO TX 78269
(800) 218-1004
BENEFIT PLANNERS LTD
(800) 218-1004
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
CHECK BENEFIT CARD
PO Box 437017
Louisville KY 40253
(800) 832-8212
(800) 218-1004
(800) 832-8212
DUBLIN VAMC 3546
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
DUBLIN VAMC
Attn: FEE BASIS 04
1826 VETERANS BLVD
DUBLIN GA 31021
DUBLIN VAMC
CHECK BENEFIT CARD
Duhamel Broadcasting Enterprises
Affiliated With: Rapid City Regional
Hospital DBA Western Health
Plan Type: Group Health
Western Health
Western Health
529 Kansas City St Ste 200
Rapid City SD 57701
(605) 719-4600 or (888) 3411766
Western Health
(605) 719-4640 or (800) 2290892
DUNCAN EQUIPMENT COMPANY
Affiliated With: RESOURCEONE
ADMINISTRATORS
Plan Type: Group Health
(605) 719-4600 or (888) 3411766
RESOURCEONE ADMINSTRATORS
Attn: Mary Shepherd
RESOURCEONE ADMINSTRATORS
(800) 967-2077
MEDCAREONE CORP
(800) 816-1206
PO Box 489
BUCKEYSTOWN MD 21717
(800) 967-2077
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-160
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
DUNCAN EQUIPMENT COMPANY
Affiliated With: THE EPOCH GROUP
Plan Type: Group Health
CLAIMS SUBMISSION
THE EPOCH GROUP
6717 SHAWNEE MISSION PARKWAY
OVERLAND PARK KS 66202
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
THE EPOCH GROUP
(800) 255-6065
UTILIZATION REVIEW
THE EPOCH GROUP
(800) 255-6065
(800) 255-6065
DUNCAN-PARNELL
Affiliated With: PRIMARY
PHYSICIANCARE INC
Plan Type: Group Health
DUNELAND SCHOOL CORPORATION
Affiliated With: EMPLOYEE BENEFIT
CONSULTANTS INC
Plan Type: Group Health
DURA AUTOMOTIVE
Affiliated With: NGS AMERICAN
Plan Type: Group Health
PRIMARY PHYSICIANCARE, INC.
PRIMARY PHYSICIANCARE, INC.
PO Box 11088
CHARLOTTE NC 28220
(704) 527-8102
PRIMARY PHYSICIANCARE,
INC.
(704) 523-2758
(704) 527-8102
EMPLOYEE BENEFIT CONSULTANTS EMPLOYEE BENEFIT CONSULTANTS UM NOT APPLICABLE
(800) 367-9939
PO Box 928
(866) 296-4002
FINDLAY OH 45839
(866) 296-4002
NGS AMERICAN, INC.
NGS AMERICAN
PO Box 7676
DETROIT MI 48080
8005211555
NGS AMERICAN
8005211555
8005211555
DURHAM EXCHANGE CLUB
INDUSTRIES
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
DURHAM VAMC 3135
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
DURHAM VAMC
CHECK BENEFIT CARD
(800) 283-4927
DURHAM VAMC
Attn: FEE BASIS
508 FULTON ST
DURHAM NC 27705
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-161
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
DUVAL ASPHALT
Affiliated With: UNITED BENEFITS, INC.
Plan Type: Group Health
DYNAMIC POWER SOURCE, LLC
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
DYNAPOWER CORPORATION JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
DYNAPOWER CORPORATION WRAP
JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
DYNATEC CORP USA
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
DYSON KYSSNER MORAN
CORPORATION
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NY
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
EBPA
EBPA
CHECK BENEFIT CARD
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
(800) 832-8212
(802) 846-8060
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
CHECK BENEFIT CARD
(802) 846-8060
TALL TREE ADMINISTRATORS
TALL TREE ADMINISTRATORS
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
(801) 274-8100
CORVEL
(801) 269-8723
(801) 274-8100
NORTH AMERICAN
ADMINISTRATORS INC
NORTH AMERICAN
ADMINISTRATORS INC
PO Box 1065
AMHERST NY 14226
(877) 777-6076
AMERICAN HEALTH
HOLDINGS INC
(800) 337-0506
(877) 777-6076
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-162
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
DZILTH NA DITH HLE SCHOOL
Affiliated With: SRT ADMINISTRATORS
INC
Plan Type: Group Health
E GADS
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
SRT ADMINISTRATORS
PO Box 25160
SCOTTSDALE AZ 85255-0102
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SRT ADMINISTRATORS
(888) 690-2020
UTILIZATION REVIEW
HINES & ASSOCIATES
(800) 944-9401
(888) 690-2020
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
E GADS TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
E H OFTEDAL & SONS INC
Affiliated With: MANAGED BENEFITS
ADMINISTRATOR & INSURANCE
CONSULT
Plan Type: Group Health
MANAGED BENEFITS
ADMINISTRATOR & INSURANCE
CONSULTANTS
MANAGED BENEFITS
ADMINISTRATOR & INSURANCE
CONSULTANTS
PO Box 98
WORLAND WY 82401
(307) 347-6151
MOUNTAIN STATES REVIEW
(307) 347-7979
(307) 347-6151
EAGLE GROUP
Affiliated With: EBMS EMPLOYEE
BENEFIT MANAGEMENT SERVICES
Plan Type: Group Health
* Eagle Pass ISD (Travel)
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
EBMS
EBMS
PO Box 21367
BILLINGS MT 59104-1367
(406) 245-3575
EBMS CARELINK
(406) 245-3575
(406) 245-3575
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
CHECK BENEFIT CARD
(800) 827-7223
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-163
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
EAST BALT COMM
Affiliated With: SELF INSURED
SERVICES COMPANY SISCO
Plan Type: Group Health
EAST CAROLINA UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
EAST CENTRAL COLLEGE
Affiliated With: STUDENT ASSURANCE
SERVICES INC
Plan Type: Group Health
CLAIMS SUBMISSION
SELF INSURED SERVICES
COMPANY (SISCO)
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SELF INSURED SERVICES
COMPANY (SISCO)
UTILIZATION REVIEW
CHECK BENEFIT CARD
PO Box 389
DUBUQUE IA 52004-0389
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2408
Florence SC 29503-2408
(888) 722-1668
UM NOT APPLICABLE
(888) 722-1668
STUDENT ASSURANCE SERVICES
INC
STUDENT ASSURANCE SERVICES
INC
333 N. MAIN STREET
STILLWATER MN 55082
(800) 328-2739
CHECK BENEFIT CARD
(800) 328-2739
EAST CENTRAL ILLINOIS PIPE
TRADES H & W FUND
Affiliated With: MORRIS ASSOCIATES
Plan Type: Group Health
MORRIS ASSOCIATES
MORRIS ASSOCIATES
9045 E 59TH ST
INDIANAPOLIS IN 46250
(800) 950-6789
CHECK BENEFIT CARD
(800) 950-6789
EAST GEORGIA COLLEGE AIH0058087 PEARCE ADMINISTRATION
Affiliated With: MAKSIN MANAGEMENT PO Box 2271
CORP #14005
Florence SC 29503
Plan Type: Group Health
(843) 622-6001
PEARCE ADMINISTRATION
EAST GEORGIA COLLEGE AIH0058097 PEARCE ADMINISTRATION
Affiliated With: MAKSIN MANAGEMENT PO Box 2271
CORP #14005
Florence SC 29503
Plan Type: Group Health
(843) 622-6001
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-164
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
EAST ORANGE VA MEDICAL CENTER EAST ORANGE VA MEDICAL
3119
CENTER
Affiliated With: HEALTH NET FEDERAL Attn: FEE BASIS 04
SERVICES
385 TREEMONT AVE
Plan Type: Group Health
EAST ORANGE NJ 07018
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EAST ORANGE VA MEDICAL
CENTER
EASTERN BENEFIT SYSTEMS, INC.
EASTERN BENEFIT SYSTEMS, INC.
EASTERN BENEFIT SYSTEMS, INC.
Plan Type: Group Health
200 Freeway Dr, East
East Orange 07018
(800) 524-0227
UTILIZATION REVIEW
CHECK BENEFIT CARD
BEECH STREET
(800) 227-7464
(800) 524-0227
CHECK BENEFIT CARD
EASTERN COLORADO VA HCS 3532
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
EASTERN COLORADO VA HC
SYSTEM
EASTERN NAZARENE COLLEGE
Affiliated With: CONSOLIDATED
HEALTH PLANS INC
Plan Type: Group Health
CONSOLIDATED HEALTH PLANS INC
CONSOLIDATED HEALTH PLANS INC CHECK BENEFIT CARD
195 STAFFORD ST
SPRINGFIELD MA 01104
(800) 633-7867
EASTERN COLORADO VA HC
SYSTEM
1055 CLERMONT ST
DENVER CO 80220
(800) 633-7867
EASTERN OREGON UNIVERSITY
USI ADMINISTRATORS
Affiliated With: FIRST UNDERWRITERS PO Box 3357
INC
FORT WORTH TX 76113
Plan Type: Group Health
USI ADMINISTRATORS
USI ADMINISTRATORS
EASTERN OREGON UNIVERSITY
INTERNATIONAL AND DOMESTIC
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 786-7930
AMERIBEN SOLUTIONS
(800) 786-7930
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
(800) 786-7930
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-165
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
EASTPOINT PROPERTIES
Affiliated With: HEALTH PLANS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTH PLAN INC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTH PLAN INC
UTILIZATION REVIEW
5087522480
CMS INC
(866) 325-1550
EATON CORPORATION
EATON CORPORATION
CHECK BENEFIT CARD
PO Box 8400
London KY 40742
(800) 891-6506
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
5087522480
Eaton Corporation
Affiliated With: Eaton Corporation
Plan Type: Group Health
(800) 891-6506
EATON METAL PRODUCTS
Affiliated With: CNIC HEALTH
SOLUTIONS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
EBAA IRON INC
Affiliated With: BOON CHAPMAN
BENEFIT ADMINISTRATORS 11895
Plan Type: Group Health
BOON CHAPMAN
BOON CHAPMAN
CHECK BENEFIT CARD
PO Box 9201
AUSTIN TX 78766
(512) 454-2681
(512) 454-2681
EBMS EMPLOYEE HEALTH PLAN
Affiliated With: EBMS EMPLOYEE
BENEFIT MANAGEMENT SERVICES
Plan Type: Group Health
CHECK BENEFIT CARD
EDEN MEMORIAL HOSPITAL
Affiliated With: BENEFIT & RISK
MANAGEMENT SERVICES
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8007773575
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-166
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
EDWARD HINES JR VAMC 3162
EDWARD HINES JR VAMC
Affiliated With: HEALTH NET FEDERAL Attn: FEE SERVICES
SERVICES
5TH AVE & ROOSEVELT RD
Plan Type: Group Health
HINES IL 60141
EDWARD M BERSTEIN &
ASOCIATES - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
EFFICIENT ENTERPRISES TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EDWARD HINES JR VAMC
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
UTILIZATION REVIEW
CHECK BENEFIT CARD
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
EIGHTH DISTRICT ELECTRICAL
BENEFIT FUND / ID MT WY
Affiliated With: EIGHTH DISTRICT
ELECTRICAL BENEFIT FUND
Plan Type: Group Health
EIGHTH DISTRICT ELECTRICAL
BENEFIT FUND/ CO UT
Affiliated With: EIGHTH DISTRICT
ELECTRICAL BENEFIT FUND
Plan Type: Group Health
EL CENTRO REGIONAL MEDICAL
CENTER
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
COMPUSYS
COMPUSYS
2156 W 2200 S
SALT LAKE CITY UT 84119-1326
(800) 628-6562
UM NOT APPLICABLE
(800) 628-6562
COMPUSYS
COMPUSYS
2156 W 2200 S
SALT LAKE CITY UT 84119-1326
(800) 628-6562
UM NOT APPLICABLE
(800) 628-6562
TALL TREE ADMINISTRATORS
TALL TREE ADMINISTRATORS
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
8774534201
UM NOT APPLICABLE
8774534201
Excludes Imperial County
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-167
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
EL PASO FIRST HEALTH PLANS
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
EL PASO VAMC 3174
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
* Elastic Therapy Inc.
Affiliated With: JSL ADMINISTRATORS
INC
Plan Type: Group Health
CLAIMS SUBMISSION
NHBC
8990 E. Raintree Dr.
Scottsdale AZ 85260
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NHBC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(888) 621-7900
(888) 621-7900
EL PASO VAMC
Attn: FEE BASIS - 04
5001 N PEIDRAS
EL PASO TX 79930
EL PASO VAMC
CHECK BENEFIT CARD
JSL ADMINISTRATORS, INC.
JSL ADMINISTRATORS, INC.
PO Box 2857
FAYETTEVILLE NC 28302
(910) 480-3100
DOCTORS DIRECT
HEALTHCARE
(910) 485-0510
(910) 480-3100
Electric Insurance Company
Affiliated With: Electric Insurance
Company
Plan Type: Workers' Compensation
First Health
CONTACT EMPLOYER
First Health
Electrical Construction Industry Health
and Welfare Fund
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ELECTRICAL WHOLESALE SUPPLY
CO., INC.
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
PO Box 11930
Tucson AZ 85734
(888) 322-2524
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-168
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
ELECTROLUX HOME PRODUCTS INC DIRECT CARE AMERICA
GEORGIA
PO Box 2090 C
Affiliated With: THE CHANDLER GROUP STOW OH 44224
Plan Type: Group Health
(800) 266-5896
ELIZABETH CITY STATE UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
ELK HILLS SCHOOL
Affiliated With: K-12 STUDENT
INSURANCE, A DIVISION OF UICI
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
DIRECT CARE AMERICA
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 266-5896
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2408
Florence SC 29503-2408
(888) 722-1668
CHECK BENEFIT CARD
(888) 722-1668
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
ELKVIEW GENERAL HOSPITAL
Affiliated With: THE KEMPTON GROUP
INC
Plan Type: Group Health
ELLA
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
THE KEMPTON GROUP
THE KEMPTON GROUP
PO Box 54889
OKLAHOMA CITY OK 73154
(405) 521-1711
CHECK BENEFIT CARD
(405) 521-1711
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 767-0700
ELM ELECTRIC WRAP JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
CHECK BENEFIT CARD
(802) 846-8060
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-169
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ELWYN, INC
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
CLAIMS SUBMISSION
FCE BENEFIT ADMINISTRATORS INC
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
UM
NOT APPLICABLE
FCE BENEFIT ADMINISTRATORS INC
(800) 899-9355
(800) 899-9355
EM Management
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
EMERGENCY MEDICINE PHYSICIANS
Affiliated With: CORESOURCE INC
Plan Type: Group Health
CORESOURCE INC
CORESOURCE INC
PO Box 2920
CLINTON OH 52733-2920
(866) 682-3152
CORESOURCE INC
(866) 831-5677
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(866) 682-3152
EMERITUS ASSISTED LIVING
Affiliated With: EBMS EMPLOYEE
BENEFIT MANAGEMENT SERVICES
Plan Type: Group Health
CHECK BENEFIT CARD
Emerson Electric
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
EMERSON ELECTRIC CO. FOR INSINK-ERATOR
Affiliated With: EMERSON ELECTRIC
CO. FOR IN-SINK-ERATOR
Plan Type: Group Health
WAUSAU BENEFITS, INC.
WAUSAU BENEFITS, INC.
CHECK BENEFIT CARD
8007773575
PO Box 8013
WAUSAU WI 54402-8013
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-170
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
EMERSON TELECOMMUNICATION
PRODUCTS INC
Affiliated With: THE EPOCH GROUP L
C
Plan Type: Group Health
EMINENCE SPEAKER, LLC
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
EMPIRE FIRE & MARINE
Affiliated With: INSURERS
ADMINISTRATIVE CORPORATION
#11337
Plan Type: Group Health
Empire Fire and Marine
Affiliated With: Insurers Administrative
Corporation
Plan Type: Group Health
EMPLOYEE BENEFIT CLAIMS OF WI,
INC.
Affiliated With: BROKERAGE
SERVICES, INC.
Plan Type: Group Health
EMPLOYEE BENEFIT MANAGEMENT
SERVICES
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
8003659036
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
Insurers Administrative Corporation
(IAC)
Insurers Administrative Corporation
(IAC)
Med-Valu
(800) 522-2161
PO Box 828
Park Ridge IL 60068-0828
(800) 843-3106
(800) 832-8212
(800) 843-3106
Benefits/Eligibility
Benefits/Eligibility
PO Box 39119
Phoenix AZ 85069-9119
(800) 843-3106
CHECK BENEFIT CARD
(800) 843-3106
FIRST ADMINISTRATORS INC
IntraCorp
PO Box 8150
RAPID CITY SD 57709-8150
8004687299 Ext 23320
IntraCorp
8004687299 Ext 23320
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-171
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
EMPLOYEE BENEFIT PLAN
ADMINISTRATION IPN
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATION
Plan Type: Group Health
CLAIMS SUBMISSION
EMPLOYEE BENEFIT PLAN
ADMINISTRATION
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EMPLOYEE BENEFIT PLAN
ADMINISTRATION
UTILIZATION REVIEW
HEALTHCARE STRATEGIES
(800) 582-1535
(800) 268-7298
(603) 773-4521
EMPLOYEE BENEFIT PLAN
ADMINISTRATION JMS
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATION
Plan Type: Group Health
EMPLOYEE BENEFIT PLAN
ADMINISTRATION
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
EMPLOYEE BENEFIT PLAN
ADMINISTRATION
HEALTHCARE STRATEGIES
(800) 582-1535
(800) 268-7298
(603) 773-4521
EMPLOYEE BENEFIT PLAN
ADMINISTRATION NATIONAL WRAP
SCANDIRECT
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
EMPLOYEE BENEFIT PLAN
ADMINISTRATION
EMPLOYEE BENEFIT PLAN
ADMINISTRATION
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
(800) 268-7298
HEALTHCARE STRATEGIES
(800) 582-1535
(603) 773-4521
ENCINITAS UNION SCHOOL DISTRICT THE PLAN HANDLERS, INC.
Affiliated With: CBIZ/SCEET
930 Canterbury Pl.
Plan Type: Group Health
ESCONDIDO CA 92025
THE PLAN HANDLERS, INC.
THE PLAN HANDLERS, INC.
ENCORE PRODUCTIONS
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
ENCORE PRODUCTIONS - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-172
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ENDICOTT COLLEGE
Affiliated With: PIONEER
MANAGEMENT SYSTEMS
Plan Type: Group Health
CLAIMS SUBMISSION
PIONEER MANAGEMENT SYSTEMS
INC
330 WHITNEY AVE
HOLYOKE MA 01041
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PIONEER MANAGEMENT SYSTEMS
INC
UTILIZATION REVIEW
PIONEER MANAGEMENT
SYSTEMS INC
8004234586
8004234586
ENERGY LABORATORIES/EBMS
Affiliated With: EMPLOYEE BENEFIT
MANAGEMENT SERVICES
Plan Type: Group Health
ENERGY WEST
Affiliated With: WELLS FARGO THIRD
PARTY ADMINISTRATOR
Plan Type: Group Health
ENGINEERED DATA PRODUCTS
HOLDINGS LLC
Affiliated With: CINC HEALTH
SOLUTIONS
Plan Type: Group Health
EBMS
EBMS
PO Box 21367
BILLINGS MT 59104-1367
(800) 777-3575
CHECK BENEFIT CARD
(800) 777-3575
ACORDIA NATIONAL
ACORDIA NATIONAL
CHECK BENEFIT CARD
(888) 685-7774
(888) 685-7774
CNIC HEALTH SOLUTIONS
CNIC HEALTH SOLUTIONS
PO Box 3559
ENGLEWOOD CO 80155-3559
(800) 426-7453
CNIC HEALTH SOLUTIONS
(800) 426-7453
(800) 426-7453
ENGINEERED QUALITY PLASTICS
Affiliated With: THE EPOCH GROUP L
C
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ENGLEWOOD AREA FIRE CONTROL
DISTRICT
Affiliated With: SELF INSURED PLANS
LLC
Plan Type: Group Health
SELF INSURED PLANS LLC
SELF INSURED PLANS LLC
MedWatch
(800) 432-8421
1016 COLLIER CENTER STE 200
NAPLES FL 34103
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-173
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ENNIS, INC
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
GROUP & PENSION
ADMINISTRATORS
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GROUP & PENSION
ADMINISTRATORS INC
UTILIZATION REVIEW
HEALTH WATCH
(800) 827-7223
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
ENNS PACKING COMPANY, INC.
Affiliated With: COMBINED BENEFIT
ADMINIS./VALUE ADDED BENEFITS
Plan Type: Group Health
COMBINED BENEFIT
ADMINISTRATORS
COMBINED BENEFIT
ADMINISTRATORS
COMBINED BENEFIT
ADMINISTRATORS
ENSIGN US DRILLING %
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
CHECK BENEFIT CARD
PO Box 7186
BOISE ID 83707
(800) 786-7930
4704 W. Jennifer #104
FRESNO CA 93722
(800) 786-7930
ENSIGN US DRILLING PEPM
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 786-7930
CHECK BENEFIT CARD
(800) 786-7930
ENVIROSOURCE INC
Affiliated With: CORESOURCE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ENZYMATIC THERAPY, INC
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS
Plan Type: Group Health
MIDWEST SECURITY
ADMINISTRATORS INC
MIDWEST SECURITY
ADMINISTRATORS INC
UM NOT APPLICABLE
2700 Midwest Dr.
ONALASKA WI 54650
(608) 783-8718
(608) 783-8718
EOSCS (TMC 2)
EOSCS (TMC 2)
EOSCS (TMC 2)
Plan Type: Workers' Compensation
230 N. Golden Circle, Suite 103
Santa Ana CA 92705
(714) 245-4762
EOSCS (TMC 2)
(714) 245-4762
(714) 245-4762
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-174
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Epic
Affiliated With: Innovative Risk
Management
Plan Type: Workers' Compensation
EPISCOPAL CHURCH HOME
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
CONTACT EMPLOYER
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
UTILIZATION REVIEW
CONTACT EMPLOYER
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
(800) 832-8212
EPT MCGILL BEARING
Affiliated With: THE EPOCH GROUP
#10469
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ERIE VAMC 3125
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
ERIE VAMC
Attn: FEE BASIS 174E
135 E 38TH ST
ERIE PA 16504
ERIE VAMC
CHECK BENEFIT CARD
UNITED MEDICAL RESOURCES
UNITED MEDICAL RESOURCES
CHECK BENEFIT CARD
PO Box 145804
CINCINNATI OH 45250
(513) 619-3227
* ERLANGER TUBULAR CORP
Affiliated With: UNITED MEDICAL
RESOURCES
Plan Type: Group Health
Term Effective: 12/31/2007
Eskaton
Affiliated With: HEALTHCOMP
Plan Type: Group Health
(513) 619-3227
HEALTHCOMP
HEALTHCOMP
PO Box 45018
Fresno CA 93718
(559) 499-2450
HEALTHCOMP
(559) 499-2450
(559) 499-2450
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-175
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ESKAY CORPORATION
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
CLAIMS SUBMISSION
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PRINCIPAL FINANCIAL GROUP
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 533-5044
(800) 533-5044
EVANSVILLE OPC VA 3309
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
EVANSVILLE OPC VA
Attn: FEE BASIS
500 E WALNUT ST
EVANSVILLE IN 47713
EVANSVILLE OPC VA
CHECK BENEFIT CARD
EVERCOM SYSTEMS
Affiliated With: GROUP AND PENSION
ADMINISTRATORS INC
Plan Type: Group Health
GROUP & PENSION
ADMINISTRATORS INC
GROUP & PENSION
ADMINISTRATORS INC
CHECK BENEFIT CARD
PO Box 749075
DALLAS TX 75374-9075
(800) 827-7223
(800) 827-7223
EVEREST / AMcDonaldsCCA
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
Everest ACCA San Francisco
Affiliated With: Everest ACCA
Plan Type: Workers' Compensation
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
Everest National
Affiliated With: Everest SRS
Plan Type: Workers' Compensation
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
EVEREST NATIONAL INSURANCE CO.
Affiliated With: EVEREST NATIONAL
INSURANCE CO.
Plan Type: Workers' Compensation
EVEREST NATIONAL INSURANCE
CO.
EVEREST NATIONAL INSURANCE
CO.
65 Enterprise Suite 235
Aliso Viejo CA 92656
(949) 330-6892
EVEREST NATIONAL
INSURANCE CO.
(949) 330-6892
Plan Type: Workers' Compensation
(949) 330-6892
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-176
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
EVOLUTION BUSINESS SOLUTIONS
Affiliated With: TALL TREE
AADMINISTRATORS
Plan Type: Group Health
EXCEL CORPORATION
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
EXPERIENCE WORKS, INC.
Affiliated With: PERFORMAX BCI
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
CLAIMS SUBMISSION
CHECK BENEFIT CARD
UTILIZATION REVIEW
(800) 533-5044
Brokerage Concepts, Inc.
Brokerage Concepts, Inc.
PO Box 61505
KING OF PRUSSIA PA 19406
(888) 554-7629
PERFORMAX / AMERICAN
HEALTH HOLDING
(614) 818-3222
(888) 554-7629
EZCORP, INC.
Affiliated With: BOON CHAPMAN
BENEFIT ADMINISTRATORS
Plan Type: Group Health
F RODGERS SPECIALTY
CONTRACTORS INC
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
F. A. Richard & Associates, Inc.
Affiliated With: F. A. Richard &
Associates, Inc.
Plan Type: Workers' Compensation
BOON CHAPMAN
BOON CHAPMAN
PO Box 9201
AUSTIN TX 78766
(800) 252-9653
PRIME DX
(800) 477-4625
(800) 252-9653
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
FARA - F. A. Richard & Associates, Inc.
1625 W. Causeway Approach
Mandeville LA 70471
FARA - F. A. Richard & Associates, Inc. FARA - F. A. Richard &
Associates, Inc.
(985) 624-6740
(985) 624-6740
(985) 624-6740
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-177
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
F.A. RICHARD & ASSOCIATES, INC.
Affiliated With: FARA BENEFIT
SERVICES
Plan Type: Group Health
FABRICUT, INC.
Affiliated With: MERCER
ADMINISTRATION
Plan Type: Group Health
Fair Isaac Corporation
Affiliated With: Fair Isaac Corporation
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
FARA BENEFIT SERVICES C/O CCN
PO Box 5190
TAMPA FL 33675-5190
MERCER ADMINISTRATION
MERCER ADMINISTRATION
701 Market St Ste 1350
St Louis MO 63101
(800) 394-6888
FAIRWAY MOLDS INC
Affiliated With: AFFORDABLE BENEFIT
ADMINISTRATORS, INC. (ABA)
Plan Type: Group Health
CHECK BENEFIT CARD
(314) 982-5616
CONTACT EMPLOYER
* Fairfield University International Students PIONEER MANAGEMENT SYSTEMS
Affiliated With: PIONEER
123 INTERSTATE DR
MANAGEMENT SYSTEMS
W SPRINGFIELD MA 01089
Plan Type: Group Health
(413) 534-8658
FAIRMONT HOTELS RESORTS
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
FARA BENEFIT SERVICES C/O CCN
CONTACT EMPLOYER
CONTACT EMPLOYER
PIONEER MANAGEMENT SYSTEMS
UM NOT APPLICABLE
(413) 534-8658
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
CHECK BENEFIT CARD
(800) 533-5044
AFFORDABLE BENEFIT
ADMINISTRATORS INC
AFFORDABLE BENEFIT
ADMINISTRATORS INC
PO Box 10787
BURBANK CA 91510-0787
(818) 842-0147
AFFORDABLE BENEFIT
ADMINISTRATORS INC
(818) 842-0147
(818) 842-0147
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-178
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* Falvey Linen
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
CLAIMS SUBMISSION
GISC, INC
20 WINTER ST
PEMBROKE MA 02359
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GISC, INC
UTILIZATION REVIEW
(800) 242-4472
GISC TOTALCARE
(800) 999-1077
GLOBALCARE, INC.
GLOBALCARE, INC.
AVIDYN HEALTH
(214) 647-6194
(800) 242-4472
FAMILY HEALTH PLAN
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
GLOBALCARE, INC.
FAMILY HOME HEALTH AGENCY
Affiliated With: FISERV HEALTH
Plan Type: Group Health
FISERV HEALTH INC
FISERV HEALTH INC
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
FANCOR INC
Affiliated With: FMH BENEFIT
SERVICES INC
Plan Type: Group Health
FMH BENEFIT SERVICES, INC. A
DIVISION OF CORESOURCE, INC.
FMH BENEFIT SERVICES, INC. A
DIVISION OF CORESOURCE, INC.
PO Box 25946
OVERLAND PARK KS 66225-5946
(800) 990-9058
6875 Shiloh Rd E
ALPHARETTA GA 30005
HCM
(800) 990-9058
FANNING/HOWEY ASSOCIATES, INC.
Affiliated With: BUSINESS
ADMINISTRATORS & CONSULTANTS
Plan Type: Group Health
BAC
BAC
6331 E LIVINGSTON AVE
REYNOLDSBURG OH 43068
(614) 863-8780 Ext 3102
BAC
(614) 863-8780
FANSTEEL
CBCA Administrators Inc
Affiliated With: CBCA Administrators, Inc. PO Box 902
Plan Type: Group Health
Beattyville KY 41311
CBCA Administrators Inc
CBCA Administrators Inc
FARA Avondale
Affiliated With: F. A. Richard &
Associates, Inc.
Plan Type: Workers' Compensation
FARA - F. A. Richard & Associates, Inc. FARA - F. A. Richard &
Associates, Inc.
(985) 624-6740
(985) 624-6740
(614) 863-8780 Ext 3102
FARA - F. A. Richard & Associates, Inc.
1625 W. Causeway Approach
Mandeville LA 70471
(985) 624-6740
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-179
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
FARA Ingalls
Affiliated With: F. A. Richard &
Associates, Inc.
Plan Type: Workers' Compensation
FARGO VAMC 3707
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
FARA - F. A. Richard & Associates, Inc.
1625 W. Causeway Approach
Mandeville LA 70471
(985) 624-6740
HEALTH NET FEDERAL SERVICES
HEALTH NET FEDERAL SERVICES
2025 AEROJET RD
RANCHO CORDOVA CA 95742
(916) 985-1259
CHECK BENEFIT CARD
(916) 985-1259
FARLEY AND SON
Affiliated With: PATIENT ADVOCATES
LLC
Plan Type: Group Health
PATIENT ADVOCATES LLC
Farmer John
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
FARMER NATIONAL BANK
Affiliated With: THE CHANDLER
GROUP #13352
Plan Type: Group Health
FAULTLESS LINEN
Affiliated With: FMH BENEFIT
SERVICES, INC.
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
FARA
- F. A. Richard &
FARA - F. A. Richard & Associates, Inc.
Associates, Inc.
(985) 624-6740
(985) 624-6740
PATIENT ADVOCATES LLC
PATIENT ADVOCATES LLC
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
DIRECT CARE AMERICA
DIRECT CARE AMERICA
CHECK BENEFIT CARD
PO Box 2090 C
STOW OH 44224
(800) 266-5896
PO Box 1959
Gray ME 04039
(800) 266-5896
FMH / HCM
FMH / HCM
(800) 990-9058
FMH / HCM
(800) 990-9058
(800) 990-9058
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-180
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
FAYETTE R III SCHOOLS
Affiliated With: GROUP BENEFIT
SERVICES, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTHLINK
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GROUP BENEFIT SERVICES, INC.
PO Box 419104
SAINT LOUIS MO 63141-9104
UTILIZATION REVIEW
GROUP BENEFIT SERVICES,
INC.
FAYETTEVILLE ARKANSAS VAMC
3103
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
FAYETTEVILLE ARKANSAS VAMC
Attn: FEE BASIS 04FB
1100 NORTH COLLEGE
FAYETTEVILLE AR 72703
FAYETTEVILLE ARKANSAS VAMC
CHECK BENEFIT CARD
FAYETTEVILLE NC VAMC 3136
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
FAYETTEVILLE NC VAMC
Attn: FEE BASIS BUSINESS OFFICE
(04)
2300 RAMSEY ST
FAYETTEVILLE NC 28301
FAYETTEVILLE NC VAMC
CHECK BENEFIT CARD
FAYETTEVILLE STATE UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
PO Box 2408
Florence SC 29503-2408
(888) 722-1668
FCCI Insurance Group
Affiliated With: FCCI Insurance Group
Plan Type: Workers' Compensation
(888) 722-1668
FCCI Insurance Group
FCCI Insurance Group
6300 University Pkwy
Sarasota FL 34240
(800) 226-3224
FCCI Insurance Group
(800) 226-3224
(800) 226-3224
FEATHER RIVER HOSPITAL
Affiliated With: ADVENTIST HEALTH
SYSTEM/WEST
Plan Type: Group Health
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH SYSTEM WEST CHECK BENEFIT CARD
PO Box 619031
ROSEVILLE CA 95661-9002
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-181
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
FEATHERLITE COACHES, INC
Affiliated With: HEALTH DATA
SERVICES
Plan Type: Group Health
* FEDERAL ASSIST
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
Federal Government
Affiliated With: GLOBALHEALTH AND
GENERATION HEALTHCARE
Plan Type: Group Health
FEDERATED INNSURANCE
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
12717
Plan Type: Group Health
CLAIMS SUBMISSION
Auxiant
PO Box 75008
Cedar Rapids IA 52401
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Auxiant
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 475-2232
(800) 475-2232
STAR HEALTHCARE NETWORK
STAR HEALTHCARE NETWORK
850 Seventh Ave STE 803
New York NY 10019
(212) 581-8228
UM NOT APPLICABLE
(212) 581-8228
GLOBALHEALTH
GLOBALHEALTH
7001 NE 10th St
Oklahoma City OK 73104
(405) 280-5600
GLOBALHEALTH
(405) 230-8781
NHBC
NHBC
CHECK BENEFIT CARD
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
(405) 280-5600
(888) 621-7900
FEDERATED MUTUAL INSURANCE
COMPANY
Affiliated With: FEDERATED MUTUAL
INSURANCE COMPANY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
FEHR GRAHAM & ASSOCIATES
Affiliated With: SELF INSURED
SERVICE COMPANY SISCO
Plan Type: Group Health
SISCO
SISCO
CHECK BENEFIT CARD
PO Box 389
DUBUQUE IA 52004-0389
(800) 457-4726
(800) 457-4726
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-182
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Feintool US Operations Inc
Affiliated With: Underwriters Safety &
Claims Inc.
Plan Type: Group Health
FELICIAN COLLEGE
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
CLAIMS SUBMISSION
First Health
PO Box 8399
Scottsdale AZ 85252-8399
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Underwriters Safety & Claims Inc.
(800) 678-1536
UTILIZATION REVIEW
Underwriters Safety & Claims Inc
(800) 678-1536
(800) 678-1536
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
PO Box 809026
DALLAS TX 75038
(800) 767-0700
CHECK BENEFIT CARD
(800) 767-0700
Ferrellgas
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
FH-Savings-Corporate Benefit Services
of America
Affiliated With: FH-Savings-Corporate
Benefit Services of America
Plan Type: Group Health
Corporate Beneifit Services of America
Corporate Beneifit Services of America Corporate Beneifit Services of
America
(800) 925-2272
(800) 925-2272
FI PPO
Affiliated With: OSF HEALTHPLANS,
INC.
Plan Type: Group Health
Fidelity Mortgage
Affiliated With: Carolina Benefit
Administrators
Plan Type: Group Health
400 Highway 169 South, Ste 800
Minneapolis MN 55426-1141
CONTACT EMPLOYER
(800) 925-2272
OSF HealthPlans, Inc.
OSF HealthPlans, Inc.
PO Box 1229
Peoria IL 61601-5128
(800) 673-5222
OSF HealthPlans, Inc.
(800) 284-2273
(800) 673-5222
CAROLINA BENEFIT
ADMINISTRATORS
CAROLINA BENEFIT
ADMINISTRATORS
333 SOUTH PINE ST
SPARTANBURG SC 29302
(800) 476-2295
CHECK BENEFIT CARD
(800) 476-2295
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-183
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Fidelty Security Life
Affiliated With: Insurers Administrative
Corporation #962500302
Plan Type: Group Health
FIMCO SERVICES LLC
Affiliated With: FISERV HEALTH KANSAS
Plan Type: Group Health
CLAIMS SUBMISSION
Benefits/Eligibility
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Benefits/Eligibility
(800) 843-3106
(800) 843-3106
FISERV HEALTH KANSAS
FISERV HEALTH KANSAS
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
TRUSTMARK LIFE INSURANCE
CO.
(800) 725-6566
(800) 235-7160
FINCOM/FL ALUMINUM DIRECT CARE AMERICA
CONTROLLED POWER
PO Box 2090 C
Affiliated With: THE CHANDLER GROUP STOW OH 44224
Plan Type: Group Health
(800) 266-5896
DIRECT CARE AMERICA
FINDLAY MANAGEMENT GOUP INC. TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
FINDLAY MANAGEMENT GROUP INC
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
UTILIZATION REVIEW
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 266-5896
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 742-7345
(702) 242-7700
Firemans Fund Insurance Company
CONTACT EMPLOYER
Affiliated With: Firemans Fund Insurance Attn:
Company
Plan Type: Workers' Compensation
CONTACT EMPLOYER
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CONTACT EMPLOYER
Info as of 12/13/2007
Page PIRCA-184
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
FIRST AMERICAN BANK
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MUTUAL ASSURANCE
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 825-3540
(800) 825-3540
FIRST COMMUNITY BANK
WAUSAU BENEFITS, INC.
Affiliated With: WAUSAU BENEFITS INC Attn: LeAnn Fichtner
Plan Type: Group Health
PO Box 8046
WAUSAU WI 54401-8046
WAUSAU BENEFITS, INC.
CHECK BENEFIT CARD
(715) 841-7802
(715) 841-7802
First Health Group Corp.
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
America's TPA
America's TPA
CHECK BENEFIT CARD
PO Box 398220
Bloomington MN 55439
(952) 896-4888
Plan Type: Workers' Compensation
FIRST NATIONAL BANK HOLDINGS
COMPANY - PEPM
Affiliated With: AMERICA'S TPA
Plan Type: Group Health
FIRST NATIONAL BANK HOLDINGS
COMPANY - TRAVEL
Affiliated With: AMERICA'S TPA
Plan Type: Group Health
(952) 896-4888
America's TPA
America's TPA
PO Box 398220
Bloomington MN 55439
(952) 896-4888
CHECK BENEFIT CARD
(952) 896-4888
FIRST NATIONAL BANK OF ARDMORE CHECK BENEFIT CARD
Affiliated With: FISERVE HEALTH
KANSAS
Plan Type: Group Health
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-185
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* FIRST SUPPORT SERVICES INC
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
FIRST UNITED BANK & TRUST
Affiliated With: EQUITABLE PLAN
SERVICES
Plan Type: Group Health
FISERV
Affiliated With: BENEFIT PLANNERS
Plan Type: Group Health
CLAIMS SUBMISSION
FCE BENEFIT ADMINISTRATORS INC
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
FCE BENEFIT ADMINISTRATORS INC
(800) 899-9355
(800) 899-9355
EQUITABLE PLAN SERVICES
EQUITABLE PLAN SERVICES
PO Box 720460
OKLAHOMA CITY OK 73172
(405) 755-2929
CHECK BENEFIT CARD
(405) 755-2929
Benefit Planners
Benefit Planners
PO Box 690450
SAN ANTONIO TX 78269
(800) 292-5386
CHECK BENEFIT CARD
(800) 292-5386
FITZ VOGT AND ASSOCIATES LTD
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATORS
Plan Type: Group Health
EBPA
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
EBPA
CHECK BENEFIT CARD
(800) 578-3272
(800) 578-3272
FLEETWOOD ENTERPRISES
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
CHECK BENEFIT CARD
(800) 533-5044
FLEETWOOD ENTERPRISES
FLEETWOOD ENTERPRISES
FLEETWOOD ENTERPRISES
Plan Type: Workers' Compensation
3125 Myers Street
Riverside CA 92513
(909) 351-3664
FLEETWOOD ENTERPRISES
(909) 351-3664
(909) 351-3664
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-186
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
SIERRA HEALTH & LIFE / HEALTH
PLAN
FLETCHER JONES MANAGEMENT
INC - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE PO Box 15645
/ HEALTH PLAN OF NEVADA
LAS VEGAS NV 89114
Plan Type: Group Health
(702) 242-7700
FLETCHER JONES MANAGEMENT,
INC. - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE / HEALTH
PLAN
(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
FLEXIBLE TECHNOLOGIES INC
Affiliated With: P5 HEALTH PLAN
SOLUTIONS
Plan Type: Group Health
CHECK BENEFIT CARD
FLINT GROUP
Affiliated With: NGS AMERICAN INC
Plan Type: Group Health
NGS AMERICAN
NGS AMERICAN
PO Box 7676
DETROIT MI 48080
8005211555
NGS AMERICAN
8005211555
CADENT ADMINSTRATORS, INC.
CHECK BENEFIT CARD
PEARCE ADMINISTRATION
UM NOT APPLICABLE
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8005514049
8005211555
FLORIDA COMPREHENSIVE HEALTH
ASSOCIATION
Affiliated With: CADENT
ADMINISTRATORS INC
Plan Type: Group Health
CADENT ADMINSTRATORS, INC.
FLORIDA KEYS COMMUNITY
COLLEGE
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
1004 118th Ave N
St Petersburg FL 33716
(843) 622-6001
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-187
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Florida League of Cities
Affiliated With: Florida League of Cities
Plan Type: Group Health
CLAIMS SUBMISSION
Florida League of Cities
PO Box 538140
Orlando FL 32853-8140
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Florida League of Cities
(800) 756-3042
UTILIZATION REVIEW
Florida League of Cities
(877) 676-3890
(800) 756-3042
FLORISTS TRANSWORLD DELIVERY
(FTD)
Affiliated With: GALLAGHER BENEFIT
ADMINISTRATORS INC
Plan Type: Group Health
GALLAGHER BENEFIT
ADMINISTRATORS INC
GALLAGHER BENEFIT
ADMINISTRATORS INC
750 WARRENVILLE RD STE 200
LISLE IL 60532
(866) 471-6037
CHECK BENEFIT CARD
(866) 471-6037
FOOD EMPLOYERS & BAKERY &
CONFECTIONERY BEN. FUND
CHECK BENEFIT CARD
HEALTHSCOPE BENEFITS INC
HEALTHSCOPE BENEFITS INC
CHECK BENEFIT CARD
PO Box 619055
DALLAS TX 75261
(877) 240-0142
FOOD EMPLOYERS & BAKERY &
CONFECTIONERY BENEFIT FUND
Affiliated With: FOOD EMPLOYERS &
BAKERY & CONFECTIONERY BEN.
FUND
Plan Type: Group Health
FOOD EMPLOYERS & BAKERY &
CONFECTIONERY BEN. FUND
FOOD GIANT SUPERMARKETS INC
Affiliated With: HEALTHSCOPE
BENEFITS INC #11491
Plan Type: Group Health
2221 Rosecrans Ave. #203
EL SEGUNDO CA 90245-4911
(877) 240-0142
FOOTHILL DEANZA COMMUNITY
COLLEGE DISTRICT - FACULTY
Affiliated With: CORESOURCE, MN
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
Foreign Mission Division - 1G97000012
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
International Medical Group, Inc.
International Medical Group, Inc.
CHECK BENEFIT CARD
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
PO Box 39710
COLORADO SPRINGS CO 80949
(317) 655-4500 Outside US
(800) 628-4664 Inside US
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-188
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
FOREST OIL CORP
Affiliated With: ASSURECARE
Plan Type: Group Health
CLAIMS SUBMISSION
ASSURECARE
340 Quadrangle Dr
Bolingbrook IL 60440
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ASSURECARE
UTILIZATION REVIEW
(800) 759-1311
Careline UR
(763) 383-4800
(800) 759-1311
FORMOST PACKAGING
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS
INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
FORT CALLEY UNIVERSITY
UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
FORT VALLEY STATE UNIV
AIH0058107
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
(843) 622-6001
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
FORT VALLEY STATE UNIV
AIH0058117
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
Forte
Affiliated With: Forte
Plan Type: Workers' Compensation
Forte
Forte
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(843) 622-6001
(800) 580-1642
Forte
(800) 580-2273
(800) 580-1642
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-189
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
FORTIS REMOTE REPRICING
Affiliated With: ASSURANT HEALTH
Plan Type: Group Health
FOSECO HOLDINGS INC
Affiliated With: UNDERWRITERS
SAFETY & CLAIMS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
ASSURANT HEALTH
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ASSURANT HEALTH
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 743-8469
(800) 743-8469
Underwriters Safety & Claims, Inc.
Underwriters Safety & Claims, Inc.
Underwriters Safety & Claims,
Inc.
FOSTER ASSOCIATES INC
CHECK BENEFIT CARD
Affiliated With: THE LOOMIS COMPANY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
FOUNTAINBLEAU RESORTS TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
11405 Park Rd.
LOUISVILLE KY 40223
(702) 242-7700
FOX BROTHERS
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
4040 HUNSAKER STE 110
LANSING MI 38823
(800) 968-6616
CARELINE
(763) 383-4800
NHBC
NHBC
CHECK BENEFIT CARD
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
(800) 968-6616
FOX EVERETT INSURANCE PEPM
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
FRANCIS DRILLING FLUIDS LTD
Affiliated With: GILSBAR, INC.
Plan Type: Group Health
(888) 621-7900
GILSBAR
GILSBAR
PO Box 998
COVINGTON LA 70434
(985) 898-1673
CHECK BENEFIT CARD
(985) 898-1673
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-190
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
PEARCE ADMINISTRATION
FRANCIS MARION UNIVERSITY
AMH9029757
PO Box 2437
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503-2437
CORP #14005
(843) 622-6001
Plan Type: Group Health
FRANCIS TUTTLE TECHNOLOGY
CENTER
Affiliated With: EQUITABLE PLAN
SERVICES
Plan Type: Group Health
FRANCISCAN FRIARS-HCH ADMIN.
NM
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
CHECK BENEFIT CARD
(843) 622-6001
EQUITABLE PLAN SERVICES
EQUITABLE PLAN SERVICES
PO Box 720460
OKLAHOMA CITY OK 73172
(405) 755-2929
CHECK BENEFIT CARD
(405) 755-2929
HCH ADMINISTRATORS
HCH ADMINISTRATORS
FRANCISCAN FRIARS-SERVANTS OF CBCA Administrators Inc
THE PARACLETE
PO Box 902
Affiliated With: CBCA Administrators, Inc. Beattyville KY 41311
Plan Type: Group Health
CBCA Administrators Inc
CBCA Administrators Inc
FRANK CAPURRO SONS
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Frank Gates Service Company
Affiliated With: Frank Gates Service
Company
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
Affiliated With: HCH ADMINISTRATION
Plan Type: Group Health
HCH ADMINISTRATORS
PO Box 1986
PEORIA IL 61656
8002218942
CONTACT EMPLOYER
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CONTACT EMPLOYER
Info as of 12/13/2007
Page PIRCA-191
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
FRANK R HOWARD MEMORIAL
HOSPITAL
Affiliated With: ADVENTIST HEALTH
SYSTEM/WEST
Plan Type: Group Health
FRANKLIN & MARSHALL COLLEGE
Affiliated With: ADMINISTRATIVE
CONCEPTS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
ADVENTIST HEALTH SYSTEM WEST
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
ADVENTIST HEALTH SYSTEM WEST
PO Box 619031
ROSEVILLE CA 95661-9002
ADMINISTRATIVE CONCEPTS INC
Attn: Customer Service Dept
997 Old Eagle School Rd. #215
WAYNE PA 19087-1706
ADMINISTRATIVE CONCEPTS INC
UM NOT APPLICABLE
(888) 293-9229
(888) 293-9229
FRASER PAPERS
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
FRASIER TIMBER UNLIMITED
Affiliated With: NORTH AMERICAN
ADMINISTRATORS-NY
Plan Type: Group Health
NORTH AMERICAN
ADMINISTRATORS-NY
NORTH AMERICAN
ADMINISTRATORS-NY
PO Box 9501
AMHERST NY 14226
(800) 828-6922
NORTH AMERICAN
ADMINISTRATORS-NY
(800) 828-6922
(800) 828-6922
FRC ELECTRICAL INDUSTRIES
Affiliated With: THE EPOCH GROUP
10469
Plan Type: Group Health
FREDS PLUMBING AND HEATING
WRAP JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
THE EPOCH GROUP, LC
THE EPOCH GROUP, LC
PO Box 12170
OVERLAND PARK KS 66282
(800) 255-6065
SHORMAN SOLUTIONS
(800) 255-6065
(800) 255-6065
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
CHECK BENEFIT CARD
(802) 846-8060
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-192
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
FREEDOM GRAPHICS SYSTEMS, INC CBSA
Affiliated With: CORPORATE BENEFIT 400 Highway 169 South, Ste 800
SERVICE OF AMERICA
Minneapolis MN 55426-1141
Plan Type: Group Health
(952) 593-6438
FREEDOM LIFE INSURANCE CO. OF
AMERICA
Affiliated With: FREEDOM LIFE
INSURANCE CO. OF AMERICA
Plan Type: Group Health
FREEDOM LIFE INSURANCE CO. OF
AMERICA
FREEDOM PLASTICS
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC
Plan Type: Group Health
MIDWEST SECURITY
ADMINISTRATORS, INC.
FREMONT COUNTY SCHOOL
DISTRICT 14
110 W 7TH ST STE 300
FORT WORTH TX 76120
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CBSA
(952) 593-6438
UTILIZATION REVIEW
GUIDED2HEALTH
(952) 593-6447
FREEDOM LIFE INSURANCE CO. OF FREEDOM LIFE INSURANCE
CO. OF AMERICA
AMERICA
(800) 387-9027
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
PO Box 574
ONALASKA WI 54650
Affiliated With: MANAGED BENEFITS
ADMINISTRATOR AND INSURANCE
CONSU
Plan Type: Group Health
FREMONT MILLWORK CO.
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
FREMONT MOTOR COMPANIES
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
(541) 312-8512
MOUNTAIN STATES REVIEW
MBA OF WYOMING
MBA OF WYOMING
PO Box 94
WORLAND WY 82401
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-193
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
FRESNO VA MEDICAL CENTER 3188
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
Fringe MIni-Med Hospital - Hospital &
Professional
Affiliated With: CONSOLIDATED
HEALTH PLANS
Plan Type: Group Health
Fringe Mini-Med Professional Only
Affiliated With: CONSOLIDATED
HEALTH PLANS
Plan Type: Group Health
FRISBIE MEMORIAL HOSPITAL
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTH NET FEDERAL SERVICES
2025 AEROJET RD
RANCHO CORDOVA CA 95742
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTH NET FEDERAL SERVICES
UTILIZATION REVIEW
CHECK BENEFIT CARD
(916) 985-1259
(916) 985-1259
CONSOLIDATED HEALTH PLANS
CONSOLIDATED HEALTH PLANS
195 STAFFORD ST
SPRINGFIELD MA 01104
(800) 633-7867
UM NOT APPLICABLE
(800) 633-7867
CONSOLIDATED HEALTH PLANS
CONSOLIDATED HEALTH PLANS
195 STAFFORD ST
SPRINGFIELD MA 01104
(800) 633-7867
UM NOT APPLICABLE
(800) 633-7867
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(508) 752-2480
CARE MANAGEMENT
SERVICES
(866) 325-1550
(508) 752-2480
FROST INDUSTRIES
Affiliated With: FCE BENEFIT
ADMINISTRATORS
Plan Type: Group Health
FRY STEEL
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
FCE BENEFIT ADMINISTRATORS
FCE BENEFIT ADMINISTRATORS
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
CHECK BENEFIT CARD
(800) 899-9355
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
PO Box 3000
SCOTTSDALE AZ 85271-3000
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-194
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
FT WAYNE VA MEDICAL CENTER
CHECK BENEFIT CARD
BAS
BAS
CHECK BENEFIT CARD
17475 JOVANNA DR
HOMEWOOD IL 60430
(709) 799-7400
PAYOR NAME
CLAIMS SUBMISSION
FT WAYNE VA MEDICAL CENTER 3159 FT WAYNE VA MEDICAL CENTER
Affiliated With: HEALTH NET FEDERAL Attn: FEE BASIS 136A
SERVICES
2121 LAKE AVE
Plan Type: Group Health
FT WAYNE IN 46805
Full -O-Pep Appliances
Affiliated With: BENEFIT
ADMINISTRATIVE SYSTEMS
Plan Type: Group Health
FULLER THEOLOGICAL SEMINARY
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
UTILIZATION REVIEW
(709) 799-7400
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
FULLERTON COLLEGE/NORTH
AMERIBEN SOLUTIONS
ORANGE COUNTY COMMUNITY
PO Box 7186
COLLEGE DISTRICT
BOISE ID 83707
Affiliated With: AMERIBEN SOLUTIONS
(800)
786-7930
Plan Type: Group Health
Term Effective: 8/31/2007
AMERIBEN SOLUTIONS
(800) 786-7930
AMERIBEN SOLUTIONS
(800) 786-7930
FUNDIS TRUCKING COMPANY
Affiliated With: CDS GROUP HEALTH
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
FURST- MCNESS COMPANY
Affiliated With: AMERICAS TPA
Plan Type: Group Health
America's TPA
America's TPA
PO Box 398220
Bloomington MN 55439
(952) 896-1255
7753526901
CHECK BENEFIT CARD
(952) 896-1255
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-195
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
FUSION
Affiliated With: THE CHANDLER
GROUP #13352
Plan Type: Group Health
CLAIMS SUBMISSION
DIRECT CARE AMERICA
PO Box 2090 C
STOW OH 44224
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 266-5896
(800) 266-5896
FUTURE CARE MEDCHECK
DIVERSIFIED HEALTHCARE SVCS
Plan Type: Group Health
201 SANDPOINTE
SANTA ANA CA 92707
G & C INDUSTRIES
Affiliated With: ASSURECARE
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
DIRECT CARE AMERICA
DIVERSIFIED HEALTHCARE SVCS
DIVERSIFIED HEALTHCARE
SVCS
ASSURECARE
ASSURECARE
4040 HUNSAKER STE 110
LANSING MI 38823
(800) 968-6616
CARELINE
(763) 383-4800
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 968-6616
G E JOHNSON CONSTRUCTION CO
INC
Affiliated With: P5 HEALTH PLAN
SOLUTIONS
Plan Type: Group Health
CHECK BENEFIT CARD
GAB Robbins
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
GADSDEN ELEMENTARY SCHOOL
DISTRICT
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
SRT ADMINISTRATORS
SRT ADMINISTRATORS
CHECK BENEFIT CARD
8014742555
PO Box 25160
SCOTTSDALE AZ 85255-0102
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-196
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GAFTEK, LLC
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
CLAIMS SUBMISSION
GROUP INSURANCE SERVICE
CENTER
20 WINTER ST
PEMBROKE MA 02359
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GROUP INSURANCE SERVICE
CENTER
UTILIZATION REVIEW
GISC TOTALCARE
(800) 242-4472
(800) 242-4472
(800) 242-4472
GAINESVILLE COLLEGE AIH 0058127
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
GAINESVILLE COLLEGE AIH0058137
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
GAINESVILLE COLLEGE
UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
Gainey Corporation
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
GALAXY SCIENTIFIC CORPORATION
Affiliated With: AMERIHEALTH
ADMINISTRATORS
Plan Type: Group Health
AMERIHEALTH ADMINISTRATORS
AMERIHEALTH ADMINISTRATORS
720 BLAIR MILL RD
HORSHAM PA 19044
(800) 480-5032
AMERIHEALTH
ADMINISTRATORS
(800) 952-3404
(800) 480-5032
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-197
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Gallagher Bassett Managed Care
Services
Affiliated With: Gallagher Bassett
Managed Care Services
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
First Health
PO Box 23812
Tucson AZ 85734
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
First Health
UTILIZATION REVIEW
CONTACT EMPLOYER
(800) 370-0594
(800) 370-0594
Gallagher Bassett Services, Inc.
Affiliated With: Gallagher Bassett
Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
GALLIKER DAILY COMPANY
Affiliated With: MCA
ADMINISTRATORS, INC.
Plan Type: Group Health
MCA ADMINISTRATORS INC
MCA ADMINISTRATORS INC
CHECK BENEFIT CARD
820 PARISH ST
PITTSBURGH PA 15220
(800) 922-4966
GAMING PARTNERS INTERNATIONAL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
(800) 922-4966
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
GAMING PARTNERS
INTERNATIONAL - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
GARDNER DENVER - TSHCC
Affiliated With: SELF INSURED
SERVICES COMPANY SISCO
Plan Type: Group Health
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
SELF INSURED SERVICES
COMPANY (SISCO) C/O CCN
SELF INSURED SERVICES
COMPANY (SISCO)
CHECK BENEFIT CARD
PO Box 3000
SCOTTSDALE AZ 85271-3000
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-198
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GARGIULIO INC
Affiliated With: SELF INSURED PLANS
LLC
Plan Type: Group Health
Garland Company The
Affiliated With: SUPERIEN HEALTH
NETWORK
Plan Type: Group Health
CLAIMS SUBMISSION
SELF INSURED PLANS LLC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SELF INSURED PLANS LLC
1016 COLLIER CENTER STE 200
NAPLES FL 34103
SUPERIEN HEALTH NETWORK
UTILIZATION REVIEW
MedWatch
(800) 432-8421
EBC
EBC Review
CHECK BENEFIT CARD
PO Box 2388
STOW OH 44224
(800) 634-8816
Refer to Intercorp
GARY WILLIAMS ENERGY
CORPORATION
Affiliated With: AMERICAN
ADMINISTRATIVE GROUP
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
GASDEN LAWN & LANDSCAPE
Affiliated With: PACIFIC LIFE &
ANNUITY
Plan Type: Group Health
PACIFIC LIFE & ANNUITY COMPANY
PACIFIC LIFE & ANNUITY COMPANY CHECK BENEFIT CARD
PO Box 295
Onalaska WI 54650
(800) 542-6642
Gases Plus
Affiliated With: Rapid City Regional
Hospital DBA Western Health
Plan Type: Group Health
GBS CORP
Affiliated With: BUSINESS
ADMINISTRATORS & CONSULTANTS
Plan Type: Group Health
(800) 542-6642
Western Health
Western Health
529 Kansas City St Ste 200
Rapid City SD 57701
(605) 719-4600 or (888) 3411766
Western Health
(605) 719-4640 or (800) 2290892
(605) 719-4600 or (888) 3411766
BUSINESS ADMINISTRATORS &
CONSULTANTS INC
BUSINESS ADMINISTRATORS &
CONSULTANTS INC
6331 E LIVINGSTON AVE
REYNOLDSBURG OH 43068
(614) 863-8780
BUSINESS ADMINISTRATORS
& CONSULTANTS INC
(614) 863-8780
(614) 863-8780
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-199
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GE Young and Co
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
GE/ERC
First Health
Plan Type: Workers' Compensation
PO Box 23812
Tucson AZ 85734
GELCO CONSTRUCTION
Affiliated With: EBMS EMPLOYEE
BENEFIT MANAGEMENT SERVICES
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
UTILIZATION REVIEW
CONTACT EMPLOYER
CONTACT EMPLOYER
First Health
(800) 370-0594
EBMS
EBMS
PO Box 21367
BILLINGS MT 59104-1367
(800) 777-3575
EBMS
(800) 777-3575
MBA OF WYOMING
MBA OF WYOMING
CHECK BENEFIT CARD
(800) 777-3575
GEM CITY BONE AND JOINT
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
MOUNTAIN STATES REVIEW
GEMINI INDUSTRIES INC
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
PO Box 94
WORLAND WY 82401
(800) 825-3540
GEMINUS CORPORATION
Affiliated With: MENNONITE MUTUAL
AID ASSOC. AND MMA INS. CO./MMA
Plan Type: Group Health
MENNONITE MUTUAL AID & ASSOC
& MMA INSURANCE
MENNONITE MUTUAL AID & ASSOC MENNONITE MUTUAL AID &
ASSOC & MMA INSURANCE
& MMA INSURANCE
PO Box 483
GOSHEN IN 46527
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-200
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GEMPERLE ENTERPRISES
Affiliated With: COMBINED BENEFITS
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
COMBINED BENEFIT
ADMINISTRATORS
4704 W. Jennifer Ave. #104
FRESNO CA 93722
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
COMBINED BENEFIT
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(559) 275-3984
(559) 275-3984
GEN PROBE INC
CBCA ADMINISTRATORS, INC.
Affiliated With: CBCA Administrators, Inc. PO Box 9498
Plan Type: Group Health
MINNEAPOLIS MN 55440-9498
CBCA Administrators Inc
CBCA Administrators Inc
GENDEX DEL MEDICAL IMAGING
Affiliated With: BENEFIT PLAN
ADMINISTRATORS, INC.
Plan Type: Group Health
BENEFIT PLAN ADMINISTRATORS,
INC.
BENEFIT PLAN ADMINISTRATORS,
INC.
BENEFIT PLAN
ADMINISTRATORS, INC.
GENERAL CONFERENCE 7TH DAY
ADVENTISTS INTERAMERICA DIV
Affiliated With: ADVENTIST RISK
MANAGEMENT INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
GENERAL ELECTRIC
Affiliated With: COVENTRY HEALTH
CARE
Plan Type: Group Health
Coventry Health Care
Coventry Health Care
CHECK BENEFIT CARD
120 E Kensinger Dr
Cranberry Township PA 16066
(724) 778-5362
GENERAL GROWTH PROPERTIES
INC
Affiliated With: ALLIED BENEFIT
SYSTEMS INC
Plan Type: Group Health
One Huntington Quadrangle #4N
MELVILLE NY 11747
(724) 778-5362
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-201
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GENERAL MONITORS
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
GENERAL PLASTICS MFG
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CDN
UM NOT APPLICABLE
TRUSTEED PLANS SERVICE
CORPORATION
TRUSTEED PLANS SERVICE
CORPORATION
AMERICAN HEALTH HOLDINGS
(888) 877-7994
PO Box 1894
TACOMA WA 98401-1894
(800) 426-9786
CLAIMS SUBMISSION
CDN
UTILIZATION REVIEW
PO Box 10999
SCOTTSDALE AZ 85271
(800) 426-9786
GENERAL RUBBER AND PLASTIC OF
LOUISVILLE INC
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
(800) 533-5044
Genesis Managed Care
Genesis Managed Care
Genesis Managed Care
(704) 321-3909
Genesis Managed Care
(704) 321-3909
Plan Type: Workers' Compensation
PO Box 17076
Charlotte NC 28227
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
CHECK BENEFIT CARD
(704) 321-3909
GENEX Services Exclusive - CCN
Transition
Affiliated With: GENEX Services, Inc.
Plan Type: Workers' Compensation
Participates in California Select Network
GENEX Services Exclusive AUTO
Affiliated With: GENEX Services, Inc.
Plan Type: Workers' Compensation
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-202
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Genex Services, Inc.
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
CONTACT EMPLOYER
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
CONTACT EMPLOYER
UTILIZATION REVIEW
GENEX Services, Inc. EPP
Affiliated With: GENEX Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
GENLYTE THOMAS GROUP, LLC
Affiliated With: EASTERN BENEFIT
SYSTEMS, INC
Plan Type: Group Health
EASTERN BENEFIT SYSTEMS, INC.
EASTERN BENEFIT SYSTEMS, INC.
CHECK BENEFIT CARD
200 Freeway Dr, East
East Orange 07018
(800) 524-0227
GEORGE FOX UNIVERSITY
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS
Plan Type: Group Health
(800) 524-0227
PERSONAL INSURANCE
ADMINISTRATORS
PERSONAL INSURANCE
ADMINISTRATORS
30401 Agoura Rd #250
Agoura Hills CA 91376
(800) 468-4343
CHECK BENEFIT CARD
(800) 468-4343
GEORGE J FOSTER CO INC. CITIZEN
PUBLISHING
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
GEORGE SCHMITT & CO.
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
HEALTH PLAN INC
HEALTH PLAN INC
PO Box 5199
WESTBOROUGH MA 01581
(508) 752-2480
CARE MANAGEMENT
SERVICES
(886) 325-1550
(508) 752-2480
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-203
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
GEORGIA COLLEGE & STATE
PEARCE ADMINISTRATION
UNIVERSITY UNDERGRAD
Attn: WHIT WALTERS
Affiliated With: MAKSIN MANAGEMENT 419 S. COIT ST
CORP
FLORENCE SC 29501
Plan Type: Group Health
(800) 222-6491
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
(800) 222-6491
GEORGIA COLLEGE AND STATE
PEARCE ADMINISTRATION
UNIVERSITY AIH0058167
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
GEORGIA COLLEGE AND STATE
UNIVERSITY AIH0058177
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
(843) 622-6001
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
(843) 622-6001
Plan Type: Group Health
UTILIZATION REVIEW
UM NOT APPLICABLE
CHECK BENEFIT CARD
(843) 622-6001
CHECK BENEFIT CARD
GEORGIA CROWN DISTRIBUTING CO. CONSOLIDATED BENEFITS
Affiliated With: GEORGIA CROWN
820 PARISH ST
DISTRIBUTING CO.
PITTSBURGH PA 15220
Plan Type: Group Health
CONSOLIDATED BENEFITS
CHECK BENEFIT CARD
PEARCE ADMINISTRATION
GEORGIA HIGHLANDS COLLEGE
AIH0058197
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
PEARCE ADMINISTRATION
GEORGIA HIGHLANDS COLLEGE
IAH0058187
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-204
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
GEORGIA HIGHLANDS COLLEGE
PEARCE ADMINISTRATION
UNDERGRAD MANDATORY
Attn: WHIT WALTERS
Affiliated With: MAKSIN MANAGEMENT 419 S. COIT ST
CORP
FLORENCE SC 29501
Plan Type: Group Health
(800) 222-6491
GEORGIA INSTITUTE OF
TECHNOLOGY AIH0000286
Affiliated With: MAKSIN MANAGEMENT
CORPORATION
Plan Type: Group Health
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 222-6491
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
(888) 722-1668
(800) 722-1668
GEORGIA INSTITUTE OF
TECHNOLOGY AIH0058207
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
(843) 622-6001
(843) 622-6001
PEARCE ADMINISTRATION
GEORGIA INSTITUTE OF
TECHNOLOGY AIH0058217
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
GEORGIA INSTITUTE OF
TECHNOLOGY UNDERGRAD
Attn: WHIT WALTERS
MANDATORY
419 S. COIT ST
Affiliated With: MAKSIN MANAGEMENT
FLORENCE SC 29501
CORP
(800)
222-6491
Plan Type: Group Health
PEARCE ADMINISTRATION
Georgia Pacific
Affiliated With: GENEX Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
CONTACT EMPLOYER
Attn:
CHECK BENEFIT CARD
(843) 622-6001
UM NOT APPLICABLE
(800) 222-6491
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CONTACT EMPLOYER
Info as of 12/13/2007
Page PIRCA-205
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
PEARCE ADMINISTRATION
GEORGIA PERIMETER COLLEGE
AIH0058237
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
GEORGIA PERIMETER COLLEGE
UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
CHECK BENEFIT CARD
(843) 622-6001
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
GEORGIA SOUTHERN UNIV
AIH0058247
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
(843) 622-6001
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
GEORGIA SOUTHERN UNIV
AIH0058257
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
GEORGIA SOUTHERN UNIVERSITY
UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(843) 622-6001
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
GEORGIA SOUTHWESTERN STATE
PEARCE ADMINISTRATION
UNIVERSITY AIH0058267
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-206
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
PEARCE ADMINISTRATION
GEORGIA SOUTHWESTERN STATE
UNIVERSITY AIH0058277
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
(843) 622-6001
PEARCE ADMINISTRATION
GEORGIA SOUTHWESTERN STATE
UNIVERSITY UNDERGRAD
Attn: WHIT WALTERS
MANDATORY
419 S. COIT ST
Affiliated With: MAKSIN MANAGEMENT
FLORENCE SC 29501
CORP
(800) 222-6491
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
GEORGIA STATE UNIVERSITY AIH0058287
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
GEORGIA STATE UNIVERSITY AIH0058297
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
UTILIZATION REVIEW
CHECK BENEFIT CARD
UM NOT APPLICABLE
(800) 222-6491
CHECK BENEFIT CARD
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
(843) 622-6001
GEORGIA STATE UNIVERSITY
UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
GERALD A. MARTIN, LTD.
Affiliated With: HEALTH DATA
SERVICES, INC. (HDS)
Plan Type: Group Health
HCH ADMINISTRATORS
HCH ADMINISTRATORS
HCH ADMINISTRATORS
PO Box 1986
PEORIA IL 61656
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-207
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GETTYSBURG COLLEGE
Affiliated With: ADMINISTRATIVE
CONCEPTS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
ADMINISTRATIVE CONCEPTS INC
Attn: Customer Service Dept
997 Old Eagle School Rd. #215
WAYNE PA 19087-1706
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ADMINISTRATIVE CONCEPTS INC
UTILIZATION REVIEW
UM NOT APPLICABLE
(888) 293-9229
(888) 293-9229
GETTYSBURG HEALTH
ADMINISTRATORS
Affiliated With: PREFERRED CARE INC
Plan Type: Group Health
PREFERRED CARE, INC.
PREFERRED CARE, INC.
1300 VIRGINIA DR STE 315
FT. WASHINGTON PA 19034
(215) 639-6208
CHECK BENEFIT CARD
(215) 639-6208
GIANGRECO MEDICAL GROUP INC
Affiliated With: PACIFIC LIFE &
AMUINITY COMPANY
Plan Type: Group Health
PACIFIC LIFE & ANNUITY COMPANY
GIANNINI PACKING CORP.
Affiliated With: COMBINED BENEFIT
ADMINIS./VALUE ADDED BENEFITS
Plan Type: Group Health
COMBINED BENEFIT
ADMINISTRATORS
GILBERT HOSPITAL
Affiliated With: ADVANCED BENEFIT
SOLUTIONS LLC
Plan Type: Group Health
PACIFIC LIFE & ANNUITY COMPANY CHECK BENEFIT CARD
PO Box 295
Onalaska WI 54650
COMBINED BENEFIT
ADMINISTRATORS
COMBINED BENEFIT
ADMINISTRATORS
ADVANCED BENEFIT SOLUTIONS
LLC
ADVANCED BENEFIT SOLUTIONS
LLC
PO Box 71490
PHOENIX AZ 85050
(888) 419-1094
ARIZONA FOUNDATION FOR
MEDICAL CARE
(800) 852-8001
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
4704 W. Jennifer #104
FRESNO CA 93722
(888) 419-1094
GILMAN ENGINEERING
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC
Plan Type: Group Health
MIDWEST SECURITY
ADMINISTRATORS, INC.
PO Box 574
ONALASKA WI 54650
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-208
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
Ginny's
Copying
Services
inc
(TRAVEL)
GROUP & PENSION
*
ADMINISTRATORS
Affiliated With: GROUP & PENSION
ADMINISTRATORS
12770 MERIT DR STE 200
Plan Type: Group Health
DALLAS TX 75251
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GROUP & PENSION
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 827-7223
(800) 827-7223
GIUMARRA VINEYARDS
Affiliated With: PINNACLE CLAIMS
MANAGEMENT INC
Plan Type: Group Health
PINNACLE CLAIMS MANAGEMENT
INC
PINNACLE CLAIMS MANAGEMENT
INC
PO Box 2220
NEWPORT BEACH CA 92658
(800) 777-7898
UM NOT APPLICABLE
(800) 777-7898
GLACIER FISH COMPANY
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
TRUSTEED PLANS SERVICE
CORPORATION
TRUSTEED PLANS SERVICE
CORPORATION
PO Box 1894
TACOMA WA 98401-1894
(800) 426-9786
AMERICAN HEALTH HOLDINGS
(888) 877-7994
(800) 426-9786
GLEN OAK VEBA TRUST
Professional Benefit Administrators, Inc. Professional Benefit Administrators, Inc. CHECK BENEFIT CARD
Affiliated With: PROFESSIONAL
900 Jorie Blvd Ste 250
(630) 655-3755
BENEFIT ADMINISTRATORS INC (PBA) Oakbrook IL 60523
Plan Type: Group Health
(630) 655-3755
GLENDALE ADVENTIST MEDICAL
CENTER-EPO PLAN
Affiliated With: ADVENTIST HEALTH
SYSTEM/WEST
Plan Type: Group Health
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH SYSTEM WEST CHECK BENEFIT CARD
Global
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
International Medical Group, Inc.
International Medical Group, Inc.
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
PO Box 619031
ROSEVILLE CA 95661-9002
CHECK BENEFIT CARD
(317) 655-4500 Outside US
(800) 628-4664 Inside US
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-209
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GLOBAL EMERGENCY MEDICAL
SERVICES, INC. (GEMS)
Affiliated With: GLOBAL EMERGENCY
MEDICAL SERVICES, INC. (GEMS)
Plan Type: Group Health
GLOBAL EXCEL MANAGEMENT
Affiliated With: GLOBAL EXCEL
MANAGEMENT
Plan Type: Group Health
* GLOBAL EXCHANGE INC
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
Global Missions Associated
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
Global Select Worldwide
Affiliated With: International Medical
Group Inc
Plan Type: Group Health
Globalcare Individuals
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
CLAIMS SUBMISSION
GLOBALCARE
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GLOBALCARE
UTILIZATION REVIEW
GLOBALCARE
6875 SHILOH RD E
ALPHARETTA GA 30005
GLOBAL EXCEL MANAGEMENT
GLOBAL EXCEL MANAGEMENT
73 QUEEN ST
LENNOXVILLE QC J1M 1J3
(819) 566-2901
GLOBAL EXCEL MANAGEMENT
(819) 566-2901
STAR HEALTHCARE NETWORK
STAR HEALTHCARE NETWORK
UM NOT APPLICABLE
850 Seventh Ave STE 803
New York NY 10019
(212) 581-8228
(819) 566-2901
(212) 581-8228
International Medical Group, Inc.
International Medical Group, Inc.
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
CHECK BENEFIT CARD
(317) 655-4500 Outside US
(800) 628-4664 Inside US
International Medical Group, Inc.
International Medical Group, Inc.
2960 N Meridian St
Indianapolis IN 46208
(800) 628-4664
International Medical Group, Inc.
(800) 628-4664
International Medical Group, Inc.
International Medical Group, Inc.
CHECK BENEFIT CARD
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
(800) 628-4664
(317) 655-4500 Outside US
(800) 628-4664 Inside US
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-210
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Globalcare Scholars
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
CLAIMS SUBMISSION
International Medical Group, Inc.
407 N Fulton St
Indianapolis IN 46202-3684
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
International Medical Group, Inc.
UTILIZATION REVIEW
CHECK BENEFIT CARD
(317) 655-4500 Outside US
(800) 628-4664 Inside US
(317) 655-4500 Outside US
(800) 628-4664 Inside US
GLOBAL EMERGENCY MEDICAL
SERVICES, INC.
GLOBAL EMERGENCY
MEDICAL SERVICES, INC.
Medical Mutual of Ohio
(800) 533-4755
Medical Mutual of Ohio
(800) 258-2873
G M WHITE CONSTRUCTION, INC
G M WHITE CONSTRUCTION, INC
CHECK BENEFIT CARD
867 MIDDLE RD
ACUSHNET MA 02743
(508) 763-8868
GLOBALCARE/WEYCO
Affiliated With: GLOBAL EMERGENCY
MEDICAL SERVICES, INC. (GEMS)
Plan Type: Group Health
GLOBAL EMERGENCY MEDICAL
SERVICES, INC.
GM
Affiliated With: Medical Mutual of Ohio
Plan Type: Group Health
CHECK BENEFIT CARD
GM WHITE CONSTRUCTION INC
Affiliated With: ULTRABENEFITS
Plan Type: Group Health
2001 Westside Pkwy #120
ALPHARETTA GA 30004
(508) 763-8868
GMP HEALT & WELFARE FUND / THE
INTERNATIONAL STAFF
Affiliated With: THE CHANDLER
GROUP 13352
Plan Type: Group Health
GMP INTERNATIONAL
Affiliated With: ASSURECARE
Plan Type: Group Health
DIRECT CARE AMERICA
DIRECT CARE AMERICA
PO Box 2090 C
STOW OH 44224
(800) 266-5896
CHECK BENEFIT CARD
(800) 266-5896
ASSURECARE
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
Careline UR
(763) 383-4800
(800) 422-2026
GMP RETIRED
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
Careline UR
(763) 383-4800
(800) 422-2026
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-211
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GNS and Associates
Affiliated With: Benesight
Plan Type: Group Health
CLAIMS SUBMISSION
Benesight
PO Box 360
Pueblo CO 81002-0360
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Benesight
(800) 467-9448
UTILIZATION REVIEW
First Health
(800) 321-8388
(800) 467-9448
GODWIN PUMPS OF AMERICA INC
Affiliated With: INSURANCE ADMIN OF
AMERICA INC
Plan Type: Group Health
GOLDEN GATE UNIVERSITY
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
IAA
IAA
PO Box 5082
MT LAUREL NJ 08054
(800) 283-2524
HEALTHCARE STRATEGIES
INC
(800) 582-1535
(800) 283-2524
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 786-7930
AMERIBEN SOLUTIONS
(800) 786-7930
(800) 786-7930
GOLDEN RULE INSURANCE
COMPANY
Affiliated With: GOLDEN RULE
INSURANCE COMPANY
Plan Type: Group Health
GOLDEN STATE BULB GROWERS, INC
Affiliated With: TRANSWESTERN
INSURANCE
Plan Type: Group Health
GOLDEN RULE INSURANCE
COMPANY
GOLDEN RULE INSURANCE
COMPANY
712 11TH ST.
LAWRENCEVILLE IL 62439
(317) 297-4189
CHECK BENEFIT CARD
(317) 297-4189
TRANSWESTERN INSURANCE
ADMINISTRATORS, INC.
TRANSWESTERN INSURANCE
ADMINISTRATORS, INC.
955 N Street
Fresno CA 93721
(559) 499-2000
CHECK BENEFIT CARD
(559) 499-2000
Goldkist
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CONTACT EMPLOYER
Info as of 12/13/2007
Page PIRCA-212
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GOLTEN MARINE CO.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
Term Effective: 8/31/2007
GOOD VOCATIONS HEALTH &
BENEFIT SYSTEMS
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
* Good Will Hinckley
Affiliated With: PATIENT ADVOCATES
LLC
Plan Type: Group Health
GOODFELLOW CORP - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
UTILIZATION REVIEW
HINES & ASSOCIATES
(800) 528-2498
PO Box 3000
SCOTTSDALE AZ 85271-3000
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
PATIENT ADVOCATES LLC
PATIENT ADVOCATES LLC
UM NOT APPLICABLE
PO Box 1959
Gray ME 04039
(800) 290-8559
(800) 283-4927
(800) 290-8559
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
GOODWILL CENTRAL FLORIDA
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
GOODWILL EASTER SEALS OF THE
MIAMI INC.
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC UM NOT APPLICABLE
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-213
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GOODWILL FORT WORTH
Affiliated With: FCE BENEFIT
ADMINISTRATOR
Plan Type: Group Health
GOODWILL INDUSTRIAL SERVICES
CORPORATION
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
GOODWILL INDUSTRIES OF
CENTRAL INDIANA
Affiliated With: HEALTH AND
WELFARE BENEFIT SYSTEMS INC
Plan Type: Group Health
Goodwill Industries of Lower South
Carolina
Affiliated With: CORESOURCE
Plan Type: Group Health
GOODWILL INDUSTRIES OF NORTH
GEORGIA
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
GOODWILL INDUSTRIES OF NORTH
LOUISIANA
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
CLAIMS SUBMISSION
FCE BENEFIT ADMINISTRATORS
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
FCE BENEFIT ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 899-9355
(800) 899-9355
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH & WELFARE BENEFIT
(800) 283-4927
3241 ELECTRIC RD BLDG D STE 2-B
ROANOKE VA 24018
(800) 283-4927
(800) 283-4927
(800) 283-4927
CORESOURCE
CORESOURCE
PO Box 2920
CLINTON OH 52733-2920
(866) 280-4120
UM NOT APPLICABLE
(866) 280-4120
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC UM NOT APPLICABLE
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-214
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* GOODWILL LOWER SOUTH
CAROLINA
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
GOODWILL OF NORTH FLORIDA DBA
GINFL SERVICES
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
GOODWILL SERVICES INC.
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
CLAIMS SUBMISSION
FCE BENEFIT ADMINISTRATORS INC
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
FCE BENEFIT ADMINISTRATORS INC
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC UM NOT APPLICABLE
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
HEALTH WATCH
(972) 238-7900
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
(800) 283-4927
Goose Creek Travel
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
(800) 827-7223
GORDON COLLEGE
Affiliated With: CONSOLIDATED
HEALTH PLANS INC
Plan Type: Group Health
GORDON COLLEGE AIH0058307
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
CONSOLIDATED HEALTH PLANS INC
CONSOLIDATED HEALTH PLANS INC CHECK BENEFIT CARD
195 STAFFORD ST
SPRINGFIELD MA 01104
(800) 633-7867
(800) 633-7867
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-215
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
GORDON COLLEGE UNDERGRAD
PEARCE ADMINISTRATION
MANDATORY
Attn: WHIT WALTERS
Affiliated With: MAKSIN MANAGEMENT 419 S. COIT ST
CORP
FLORENCE SC 29501
Plan Type: Group Health
(800) 222-6491
GORDON CONWELL THEOLOGICAL
SEMINARY
Affiliated With: PIONEER
MANAGEMENT SYSTEMS
Plan Type: Group Health
GOWAN COMPANY
Affiliated With: HEALTHCOMP TPA
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 222-6491
PIONEER MANAGEMENT SYSTEMS
PIONEER MANAGEMENT SYSTEMS
123 INTERSTATE DR
W SPRINGFIELD MA 01090
(877) 868-9060
CHECK BENEFIT CARD
(877) 868-9060
HEALTHCOMP
HEALTHCOMP
PO Box 45018
Fresno CA 93718
(800) 442-7247
HEALTHCOMP
(800) 755-7247
(800) 442-7247
GOWAN MILLING COMPANY
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
GRADY MEMORIAL HOSPITAL
Affiliated With: WATERSTONE
BENEFITS ADMINISTRATORS, INC.
Plan Type: Group Health
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
CHECK BENEFIT CARD
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
(888) 440-0971
(888) 440-0971
GRAEAGLE CONSTRUCTION &
DEVELOPMENT LLC
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-216
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GRAFOXATION
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
GRAHAM ENTERPRISES - PEPM
Affiliated With: GLOBALCARE
Plan Type: Group Health
CLAIMS SUBMISSION
PREFERRED HEALTH PLANS INC.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PREFERRED HEALTH PLANS INC.
UTILIZATION REVIEW
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
GLOBALCARE
GLOBALCARE
UM NOT APPLICABLE
6875 SHILOH RD E
ALPHARETTA GA 30005
(678) 341-1811
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
(678) 341-1811
GRAHAM ENTERPRSES - % OF
SAVINGS
Affiliated With: GLOBALCARE
Plan Type: Group Health
GLOBALCARE
GLOBALCARE
6875 SHILOH RD E
ALPHARETTA GA 30005
(678) 341-1811
UM NOT APPLICABLE
(678) 341-1811
GRAND JUNCTION VAMC 3533
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
GRAND JUNCTION VAMC
Attn: FEE BASIS
WILLIAM ST off HWY 12 WEST
FORT HARRISON MT 59636
GRAND JUNCTION VAMC
CHECK BENEFIT CARD
GRAND SIERRA CONSULTING
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
GRANGER MEDICAL CLINIC
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-217
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GRANITE STATE GLASS
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTH PLAN INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(508) 752-2480
(508) 752-2480
* GRANT PRIDECO
Affiliated With: BENEFIT PLANNERS
Plan Type: Group Health
Benefit Planners
Benefit Planners
PO Box 690450
SAN ANTONIO TX 78269
(800) 292-5386
CHECK BENEFIT CARD
(800) 292-5386
Gray Insurance Company The
The Gray Insurance Company
Affiliated With: Gray Insurance Company 1717 East Loop Ste 333
The
Houston TX 77029
Plan Type: Workers' Compensation
(800) 293-3131
The Gray Insurance Company
(713) 671-2534
The Gray Insurance Company
(713) 671-2534
GRAY TELEVISION INC
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
(800) 533-5044
GRAYLIFT INC
Affiliated With: COMBINED BENEFIT
ADMINIS./VALUE ADDED BENEFITS
Plan Type: Group Health
COMBINED BENEFITS
ADMINIS./VALUE ADDED BENEFITS
GREASEWOOD SPRINGS
COMMUNITY SCHOOL
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
SRT ADMINISTRATORS, INC.
COMBINED BENEFITS
ADMINIS./VALUE ADDED BENEFITS
COMBINED BENEFITS
ADMINIS./VALUE ADDED
BENEFITS
SRT ADMINISTRATORS, INC.
CHECK BENEFIT CARD
4704 W. Jennifer Ave. #104
FRESNO CA 93722
PO Box 25160
SCOTTSDALE AZ 85255-0102
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-218
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Great American Insurance
Affiliated With: Fair Isaac
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
CONTACT EMPLOYER
UTILIZATION REVIEW
Participates in California Select Network
Great American Insurance Company
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
GREAT BASIN GOLD
Affiliated With: TRUSTEED PLANS
SERVICE CORP
Plan Type: Group Health
TRUSTEED PLANS SERVICE
CORPORATION
TRUSTEED PLANS SERVICE
CORPORATION
AMERICAN HEALTH GROUP
(888) 877-7994
PO Box 1894
TACOMA WA 98401-1894
(253) 564-5850
(253) 564-5850
Great Lakes Dredge and Dock Company
Affiliated With: American Administrative
Group
Plan Type: Group Health
American Administrative Group Inc.
American Administrative Group Inc.
PO Box 5227
LISLE IL 60532
ECS Payor ID 37283
(877) 782-6828
American Administrative Group
Inc.
(800) 538-5222
(877) 782-6828
GREAT PLAINS
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
GREAT PLAINS REGIONAL MEDICAL
CTR
Affiliated With: WATERSTONE
BENEFITS ADMINISTRATORS, INC.
Plan Type: Group Health
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC UM NOT APPLICABLE
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
(888) 440-0971
CHECK BENEFIT CARD
(888) 440-0971
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-219
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GREAT WESTERN MALTING
Affiliated With: HEALTHCOMP TPA
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTHCOMP
PO Box 45018
Fresno CA 93718
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTHCOMP
(800) 442-7247
UTILIZATION REVIEW
HEALTHCOMP
(800) 755-7247
(800) 442-7247
GREAT WHITE ENERGY SERVICES,
LLC
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
3121 QUAIL SPRINGS PKWY
OKLAHOMA CITY OK 73134
(800) 825-3540
MUTUAL ASSURANCE
ADVANTAGE
(800) 825-3540
(800) 825-3540
GREATER LA HCS (SEPULVEDA
VAMC) 3189
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
GREATER LA HCS (SEPULVEDA
VAMC)
Attn: BLDG 1, ROOM A165
16111 PLUMMER ST
SEPULVEDA CA 91343
GREATER LA HCS (SEPULVEDA
VAMC)
CHECK BENEFIT CARD
Greater NY New Jersey
Affiliated With: Greater New York
Company
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
GREEN MOUNTAIN
COMMUNICATIONS INC
Affiliated With: GROUP INSURANCE
SERVICE CENTER INC
Plan Type: Group Health
GROUP INSURANCE SERVICE
CENTER, INC
GROUP INSURANCE SERVICE
CENTER, INC
CHECK BENEFIT CARD
20 WINTER ST
PEMBROKE MA 02359
(781) 829-8595 Ext 136
GREENE CONCRETE CUTTING
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
(781) 829-8595 Ext 136
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-220
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GREENWOOD CONSTRUCTION
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
8002615511
GREER AND SONS
Affiliated With: CAROLINA BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
GREY WOLF DRILLING
Affiliated With: BUSINESS
ADMINISTRATORS AND
CONSULTANTS
Plan Type: Group Health
BUSINESS ADMINISTRATORS &
CONSULTANTS INC
BUSINESS ADMINISTRATORS &
CONSULTANTS INC
CHECK BENEFIT CARD
PO Box 107
REYNOLDSBURG OH 43068
(800) 521-2654
GRIFFIN TELEVISION OKC, LLC
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
(800) 521-2654
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
GRIFFITH ENERGY SERVICES
Affiliated With: CORPORATE BENEFIT
SERVICE OF AMERICA
Plan Type: Group Health
GRISWOLD INDUSTRIES, INC.
Affiliated With: EMPLOYEE BENEFITS
ADMIN. & MANAGEMENT (EBA&M)
Plan Type: Group Health
MERITAIN HEALTH
MERITAIN HEALTH
PO Box 1065
AMHERST NY 14226
(877) 777-6076
GUIDED2HEALTH
(952) 593-6447
(877) 777-6076
EMPLOYEE BENEFITS
ADMINISTRATION & MGMT. (EBA&M)
HINES & ASSOCIATES
EMPLOYEE BENEFITS
ADMINISTRATION & MGMT. (EBA&M) (800) 528-2498
PO Box 5079
WESTLAKE VILLAGE CA 91359
(805) 497-4581
(805) 497-4581
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-221
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GRIZZARD BENEFITS TRUST
Affiliated With: MARKETING SERVICES
GROUP, INC. BENEFITS TRUST
Plan Type: Group Health
GROB SYSTEMS INC
Affiliated With: MEDICAL CLAIMS
SERVICE INC
Plan Type: Group Health
CLAIMS SUBMISSION
PIAG HEALTH GUARD TRUST
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PIAG HEALTH GUARD TRUST
UTILIZATION REVIEW
PIAG HEALTH GUARD TRUST
5020 Highlands Pkwy.
SMYRNA GA 30082
MEDICAL CLAIMS SERVICES, INC.
MEDICAL CLAIMS SERVICES, INC.
1 WALL ST STE 2A
RAVENSWOOD WV 26164
(888) 225-0522
AMERICAN HEALTH
HOLDINGS INC
(800) 592-9858
(888) 225-0522
GROSSMONT CUYAMACA
COMMUNITY COLLEGE DISTRICT
Affiliated With: BENEFIT AND RISK
MANAGEMENT SERVICES
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
HEALTH WATCH
(972) 238-7900
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
(972) 238-7900
GROUP ADMINISTRATORS LTD
Affiliated With: GROUP
ADMINISTRATORS LTD
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
GROUP HEALTH MANAGERS
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
GLOBALCARE
GLOBALCARE
6875 SHILOH RD E
ALPHARETTA GA 30005
(678) 341-1811
GROUP HEALTH MANAGERS
(866) 807-6193
(678) 341-1811
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-222
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GROUP INSURANCE SERVICE
CENTER
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
GROUP MANAGEMENT SERVICES DLORAH, INC. GMS-402
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
GROUP MANAGEMENT SERVICES EL DORADO CLAIMS SERVICES GMS-452
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
GROUP MANAGEMENT SERVICES MARSHALL ENGINES INC. GMS-435
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
GROUP MANAGEMENT SERVICES TASLER
Affiliated With: GLOBALCARE
Plan Type: Group Health
GROUP360 INC.
Affiliated With: THE EPOCH GROUP
#10469
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
GLOBALCARE
GLOBALCARE
6875 Shiloh Rd E
ALPHARETTA GA 30005
(910) 485-0510
UTILIZATION REVIEW
CHECK BENEFIT CARD
HINES & ASSOCIATES
(800) 670-7718
(678) 341-1811
GLOBALCARE
GLOBALCARE
6875 Shiloh Rd E
ALPHARETTA GA 30005
(678) 341-1811
HINES & ASSOCIATES
(800) 670-7718
(678) 341-1811
GLOBALCARE
GLOBALCARE
6875 Shiloh Rd E
ALPHARETTA GA 30005
(678) 341-1811
HINES & ASSOCIATES
(800) 670-7718
GLOBALCARE
GLOBALCARE
UM NOT APPLICABLE
6875 Shiloh Rd E
ALPHARETTA GA 30005
(678) 341-1922
(678) 341-1811
(678) 341-1922
THE EPOCH GROUP
THE EPOCH GROUP
10795 Watson Rd
St. Louis MO 63129
(800) 365-9036
INTRACORP
(800) 716-8506
(800) 365-9036
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-223
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GROUPE SEB USA DBA ROWENTA
Affiliated With: EASTERN BENEFITS
SYSTEMS INC
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
IntraCorp
IntraCorp
GTGS, INC.
(310) 313-6855
GSL ELECTRIC
Affiliated With: EVEREST
ADMINISTRATORS, INC.
Plan Type: Group Health
EVEREST ADMINISTRATORS, INC.
GTGS, INC.
GTGS, INC.
GTGS, INC.
Plan Type: Workers' Compensation
11945 W. Washington Blvd.
Culver City CA 90066
(310) 313-6855
UTILIZATION REVIEW
PO Box 19002
PROVO UT 84605-9002
(310) 313-6855
Guarantee Life Insurance Company
Affiliated With: Insurers Administrative
Corporation #962500302
Plan Type: Group Health
GUARANTEE LIFE INSURANCE
COMPANY
Affiliated With: INSURERS
ADMINISTRATIVE CORPORATION
#11337
Plan Type: Group Health
GUARDIAN INDUSTRIES
Affiliated With: NGS AMERICAN INC
Plan Type: Group Health
Benefits/Eligibility
Benefits/Eligibility
PO Box 828
Park Ridge IL 60068-0828
(800) 843-3106
CHECK BENEFIT CARD
(800) 522-2161
Insurers Administrative Corporation
(IAC)
Insurers Administrative Corporation
(IAC)
Med-Valu
(800) 522-2161
PO Box 828
Park Ridge IL 60068-0828
(800) 843-3106
(800) 843-3106
(800) 843-3106
NGS AMERICAN
NGS AMERICAN
PO Box 7676
DETROIT MI 48080
8005211555
NGS AMERICAN
8005211555
8005211555
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-224
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
GUERNSEY COUNTY
Affiliated With: HEALTHSCOPE
BENEFITS INC
Plan Type: Group Health
GULF COAST ENTERPRISES
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
CLAIMS SUBMISSION
CENTRAL BENEFITS
PO Box 619053
DALLAS TX 75261-9053
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CENTRAL BENEFITS
(800) 223-2900
UTILIZATION REVIEW
QUANTUM HEALTH
(800) 257-2038
(800) 223-2900
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC UM NOT APPLICABLE
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
GULF INDUSTRIES, INC. / SIGNAL
COMMUNICATION CORP.
Affiliated With: FARA BENEFIT
SERVICES, INC.
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
GULFPORT VAMC 3104
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
HEALTH NET FEDERAL SERVICES
Attn: FEE BASIS 136F
400 VETERANS AVE
BILOXI MS 39531
HEALTH NET FEDERAL SERVICES
CHECK BENEFIT CARD
(214) 387-3232
(214) 387-3232
GULLEY ENTERPRISES INC
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
MOUNTAIN STATES REVIEW
MBA OF WYOMING
MBA OF WYOMING
GYPSUM MANAGEMENT AND
SUPPLY COMPANY
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
340 Quadrangle Dr
Bolingbrook IL 60440
(800) 759-7422
Careline UR
(763) 383-4800
PO Box 94
WORLAND WY 82401
(800) 759-7422
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-225
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
H S DEVELOPERS
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS INC
Plan Type: Group Health
H C DUKE AND SON INC
Affiliated With: HEALTH DATA
SERVICES INC (HDS) 12791
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
8002218942
HCH ADMINISTRATION INC
HCH ADMINISTRATION INC
PO Box 1986
PEORIA IL 61656
(800) 447-3227
HCH ADMINISTRATION INC
(877) 876-5969
(800) 447-3227
H K CONTRACTORS INC
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
HAA PREFERRED PARTNERS LLC
Affiliated With: HAA PREFERRED
PARTNERS LLC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
HAAS CABINET CO INC
Affiliated With: PREFERRED HEALTH
PLAN INC 962550088
Plan Type: Group Health
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
DIRECT CARE AMERICA
DIRECT CARE AMERICA
CHECK BENEFIT CARD
PO Box 2090 C
STOW OH 44224
(800) 266-5896
HALL CHINA
Affiliated With: THE CHANDLER
GROUP #13352
Plan Type: Group Health
(502) 992-4535
(800) 266-5896
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-226
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HALL MANAGEMENT GROUP
Affiliated With: HEALTHCOMP
ADMINISTRATORS INC
Plan Type: Group Health
HALLMARK AVIATION GROUP
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
HAMILTON STORAGE TECH INC..
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
HAMMEL, GREEN & ABRAHAMSON,
INC.
Affiliated With: PREFERREDONE
ADMINISTRATIVE SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
PO Box 2128
STOCKTON CA 95201
(209) 939-3426
UTILIZATION REVIEW
CHECK BENEFIT CARD
DELTA TEAM CARE
(800) 336-0123
(209) 939-3426
GISC, INC
GISC, INC
20 WINTER ST
PEMBROKE MA 02359
(800) 242-4472
GISC TOTALCARE
(800) 999-1077
(800) 242-4472
PREFERREDONE ADMINISTRATIVE
SERVICES
PO Box 59212
MINNEAPOLIS MN 55459
PREFERREDONE ADMINISTRATIVE PREFERREDONE
ADMINISTRATIVE SERVICES
SERVICES
(800)
997-1750
(800) 997-1750
(800) 997-1750
HAMMOND LUMBER COMPANY
Affiliated With: PATIENT ADVOCATE
LLC
Plan Type: Group Health
PATIENT ADVOCATES LLC
PATIENT ADVOCATES LLC
PATIENT ADVOCATES LLC
HAMPSHIRE COLLEGE
Affiliated With: PIONEER
MANAGEMENT SYSTEMS
Plan Type: Group Health
PIONEER MANAGEMENT SYSTEMS
PIONEER MANAGEMENT SYSTEMS
CHECK BENEFIT CARD
123 INTERSTATE DR
W SPRINGFIELD MA 01090
(877) 868-9060
PO Box 1959
Gray ME 04039
(877) 868-9060
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-227
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HAMPTON VAMC 3548
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
HAMPTON VAMC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HAMPTON VAMC
CHECK BENEFIT CARD
CHECK BENEFIT CARD
UTILIZATION REVIEW
100 EMANCIPATION DR
HAMPTON VA 23667
HANCOCK PARK ASSOCIATES CORP
Affiliated With: GROUP
ADMINISTRATORS LTD
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
HANFORD COMMUNITY MEDICAL
CENTER
Affiliated With: ADVENTIST HEALTH
SYSTEM/WEST
Plan Type: Group Health
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH SYSTEM WEST CHECK BENEFIT CARD
HANFORD JOINT UNION HIGH
SCHOOL DISTRICT
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
PO Box 1147
STOCKTON CA 95201
(800) 556-7265
DELTA TEAMCARE
(877) 464-1441
SELF INSURED PLANS LLC
SELF INSURED PLANS LLC
CHECK BENEFIT CARD
1016 COLLIER CENTER WAY STE 200
NAPLES FL 34110
(239) 403-7884
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
HANNIBAL CARBIDE TOOL INC
Affiliated With: SELF INSURED PLANS
Plan Type: Group Health
PO Box 619031
ROSEVILLE CA 95661-9002
(800) 556-5918
(239) 403-7884
Hanover Insurance Company AUTO
Affiliated With: The Hanover Insurance
Company
Plan Type: Auto
Citizens Insurance Co.
CONTACT EMPLOYER
PO Box 290
Howell MI 48844
Citizens Insurance Co.
(800) 322-9025
(800) 322-9025
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-228
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Hanover Insurance Company WC
Affiliated With: Hanover Insurance
Company
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
UTILIZATION REVIEW
CONTACT EMPLOYER
-Also recognized as Citizens Insurance
Company of America, Massachusetts
Bay Insurance Company and Hanover
American Insurance Company
Harbor Furniture MFG
Affiliated With: Carolina Benefit
Administrators
Plan Type: Group Health
CAROLINA BENEFIT
ADMINISTRATORS
CAROLINA BENEFIT
ADMINISTRATORS
333 SOUTH PINE ST
SPARTANBURG SC 29302
(800) 476-2295
CHECK BENEFIT CARD
(800) 476-2295
HARBOR VIEW HOTEL
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
HARD ROCK
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
HARD ROCK - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
HARDWOOD PRODUCTS COMPANY
Affiliated With: PATIENT ADVOCATE
LLC
Plan Type: Group Health
PATIENT ADVOCATES LLC
PATIENT ADVOCATES LLC
CHECK BENEFIT CARD
PO Box 1959
Gray ME 04039
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-229
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HARDWOODS SPECIALTY
PRODUCTS US LP
Affiliated With: EBMS (EMPLOYEE
BENEFIT MANAGEMENT SERVICES)
Plan Type: Group Health
HARLAN SPRAGUE DAWLEY
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NEW YORK
Plan Type: Group Health
CLAIMS SUBMISSION
EBMS
PO Box 21367
BILLINGS MT 59104-1367
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EBMS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 777-3575
(800) 777-3575
NORTH AMERICAN
ADMINISTRATORS
NORTH AMERICAN
ADMINISTRATORS
PO Box 730
AMHERST NY 14226
(800) 397-2122
CHECK BENEFIT CARD
(800) 397-2122
HARLEY MARINE SERVICES
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
HARLFINGER COMPANIES
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
GISC, INC
GISC, INC
20 WINTER ST
PEMBROKE MA 02359
(800) 242-4472
GISC TOTALCARE
(800) 999-1077
HARLFINGER COMPANIES / HARPAK,
LD PLASTICS, FBM
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
HAROLD'S STORES INC
Affiliated With: THE EPOCH GROUP
#10469
Plan Type: Group Health
Term Effective: 8/31/2007
(800) 242-4472
GISC, INC
GISC, INC
20 WINTER ST
PEMBROKE MA 02359
(800) 242-4472
GISC TOTALCARE
(800) 999-1077
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 242-4472
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-230
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HARPER COMPANIES
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
HARPER CORPORATE SERVICES
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
TALL TREE ADMINISTRATORS
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
TALL TREE ADMINISTRATORS
UTILIZATION REVIEW
(801) 274-8100
CORVEL
(801) 269-8723
GROUP & PENSION
ADMINISTRATORS INC
GROUP & PENSION
ADMINISTRATORS INC
HEALTH WATCH
(972) 238-7900
12770 MERIT DR STE 200
DALLAS TX 75251
(972) 238-7900
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
(801) 274-8100
(972) 238-7900
HARRINGTON
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
HELLER ASSOCIATES
GLOBALCARE
2755 Bristol St STE 250
COSTA MESA CA 92626
8008601111 Ext 1722
GLOBALCARE
8008601111 Ext 1722
HARRIS MORAN SEED
Affiliated With: HEALTHCOMP
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
HARRY GRODSKY CO INC
Affiliated With: T R PAUL INC.
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Hartford The
Affiliated With: Hartford The
Plan Type: Workers' Compensation
The Hartford
The Hartford
CONTACT EMPLOYER
PO Box 4020
Wheaton IL 60189
(800) 762-0666
(800) 762-0666
HARTT TRANSPORTATION
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-231
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HARTUNG INDUSTRIES INC
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS
#11608
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTHCARE MANAGEMENT
ADMINISTRATORS
220 120TH Ave NE Bldg D
Bellevue WA 98005
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTHCARE MANAGEMENT
ADMINISTRATORS
(425) 462-1000
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(425) 462-1000
HARVARD-WESTLAKE SCHOOL
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
HARVEST FORD
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
HAWK CORPORATION
Affiliated With: NGS AMERICAN INC
Plan Type: Group Health
UTILIZATION REVIEW
HEALTHCARE MANAGEMENT
ADMINISTRATORS
(425) 462-1000
PO Box 3000
SCOTTSDALE AZ 85271-3000
(541) 312-8512
NGS AMERICAN
NGS AMERICAN
PO Box 7676
DETROIT MI 48080
8005211555
NGS AMERICAN
8005211555
8005211555
HCA THE HEALTHCARE COMPANY
HEALTH RISK MANAGEMENT, INC.
Affiliated With: HCA THE HEALTHCARE PO Box 1479
COMPANY
MINNEAPOLIS MN 55440
Plan Type: Group Health
HEALTH RISK MANAGEMENT, INC.
HEALTH RISK MANAGEMENT,
INC.
HCA The Healthcare Company
Affiliated With: HCA
Plan Type: Workers' Compensation
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
Attn:
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-232
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HCJB Radio
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
HCP PACKAGING USA INC
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
CLAIMS SUBMISSION
International Medical Group, Inc.
2960 N Meridian St
Indianapolis IN 46208
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
International Medical Group, Inc.
(317) 655-4500 Outside US
(800) 628-4664 Inside US
UTILIZATION REVIEW
International Medical Group, Inc.
(317) 655-4500 Outside US
(800) 628-4664 Inside US
(317) 655-4500 Outside US
(800) 628-4664 Inside US
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
Health and Welfare Luggage Industry
Affiliated With: Amalgamated Life
Insurance Co.
Plan Type: Group Health
Health & Welfare - Luggage Industry
Amalgamated Life Insurance Co.
Amalgamated Life Insurance Co.
(800) 356-0850
ACS/Health Net Inc
Health Net Inc
PO Box 14225
Lexington KY 40512
(800) 289-2818
First Health
(800) 932-6690
PO Box 2045
Scottsdale AZ 85252-2045
ECS Payor ID 13550
(212) 539-5681
Health Net Arizona
Affiliated With: Health Net Inc
Plan Type: Group Health
(800) 289-2818
Exclude all psych/cd services
Excludes specific hospitals
Health Net California
Affiliated With: Health Net Inc
Plan Type: Group Health
Health Net Commercial Claims
Health Net Inc
PO Box 14702
Lexington KY 40512
(800) 641-7761
First Health
(800) 932-6690
(800) 641-7761
Excludes specific hospitals
Health Net New York Out of Area Plans
Affiliated With: Health Net Inc
Plan Type: Group Health
Health Net Inc
Health Net Inc
PO Box 14700
Lexington KY 40512
(888) 747-7823
First Health
(800) 932-6690
(888) 747-7823
Exclude all psych/cd services
Excludes specific hospitals
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-233
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HEALTH NET NORTHEAST - IPI
BRICKLAYERS TRAVEL
Affiliated With: HEALTH NET INC
Plan Type: Group Health
CLAIMS SUBMISSION
Health Net Inc
1 Far Mill Crossing
Shelton CT 06484
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Health Net Inc
UTILIZATION REVIEW
UM NOT APPLICABLE
(203) 402-4899
(203) 402-4899
Include Access to all PSYCH Hospitals
Health Net Northeast Travel Member
Benefit
Affiliated With: Health Net Inc
Plan Type: Group Health
Health Net Inc
Health Net Inc
PO Box 14700
Lexington KY 40512
(888) 747-7823
Health Net Inc
(888) 747-7823
Health Net Inc
Health Net Inc
UM NOT APPLICABLE
1 Far Mill Crossing
Shelton CT 06484
(203) 402-4899
(888) 747-7823
Exclude all psych/cd services
Excludes specific hospitals
HEALTH NET NORTHEASTIPI/BRICKLAYERS TRAVEL
Affiliated With: HEALTH NET INC.
Plan Type: Group Health
(203) 402-4899
Include Access to all PSYCH Hospitals
Health Net Oregon
Affiliated With: Health Net Inc
Plan Type: Group Health
Health Net Inc
Health Net Inc
PO Box 14130
Lexington KY 40512
(888) 802-7001
First Health
(800) 932-6690
(888) 802-7001
Exclude all psych/cd services
Excludes specific hospitals
Health Net Oregon Travel Benefit
Affiliated With: Health Net Inc
Plan Type: Group Health
Health Net Inc
Health Net Inc
PO Box 14130
Lexington KY 40512
(888) 802-7001
Health Net Inc
(888) 802-7001
GLOBALCARE, INC.
GLOBALCARE, INC.
(888) 802-7001
Exclude all psych/cd services
Excludes specific hospitals
HEALTH PLAN OF NEVADA
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
GLOBALCARE, INC.
6875 Shiloh Rd E
ALPHARETTA GA 30005
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-234
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HEALTH PLAN OF UPPER OHIO
VALLEY
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
GLOBALCARE, INC.
6875 Shiloh Rd E
ALPHARETTA GA 30005
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GLOBALCARE, INC.
8008601111
UTILIZATION REVIEW
Health Plan of Upper Ohio Valley
(740) 695-3585
6783411722
GLOBAL EMERGENCY MEDICAL
SERVICES (GEMS) C/O CCN
GLOBALCARE
HEALTH PLAN INC
HEALTH PLAN INC
CHECK BENEFIT CARD
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(800) 343-7674
HEALTH PLAN SOUTHEAST
Affiliated With: GLOBAL EMERGENCY
MEDICAL SERVICES, INC. (GEMS)
Plan Type: Group Health
GLOBAL EMERGENCY MEDICAL
SERVICES (GEMS) C/O CCN
HEALTH PLANS INC % OF SAVI NGS
Affiliated With: HEALTHPLANS INC
Plan Type: Group Health
PO Box 5190
TAMPA FL 33675-5190
(800) 343-7674
HEALTH PLANS INC. - PEPM
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(508) 752-2480
CMS
(866) 325-1550
(508) 752-2480
HEALTH PLUS OF MICHIGAN
Affiliated With: GLOBALCARE INC
Plan Type: Group Health
GLOBALCARE, INC.
GLOBALCARE, INC.
6875 SHILOH RD E
ALPHARETTA GA 30005
6783411722
HINES & ASSOCIATES
(800) 944-9401
6783411722
HEALTH SYSTEMS OF KENTUCKY
Affiliated With: FISERV HEALTH KANSAS
Plan Type: Group Health
Healthco
Affiliated With: MERITAIN HEALTH
Plan Type: Group Health
FISERV HEALTH KANSAS
FISERV HEALTH KANSAS
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
AVIDYN HEALTH
(866) 802-1328
(800) 235-7160
MERITAIN HEALTH
MERITAIN HEALTH
PO Box 1090
EVANSVILLE IN 47706
(800) 455-1938
EMPLOYERS RISK SERVICES
(800) 705-3765
(800) 455-1938
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-235
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HEARTWOOD CREATIONS
Affiliated With: ASSURECARE
Plan Type: Group Health
CLAIMS SUBMISSION
ASSURECARE
340 Quadrangle Dr
Bolingbrook IL 60440
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ASSURECARE
(800) 759-1311
UTILIZATION REVIEW
Careline UR
(763) 383-4800
(800) 759-1311
ASSOCIATED THIRD PARTY
ADMINISTRATORS
CHECK BENEFIT CARD
ACS/Health Net Inc
Health Net Inc
PO Box 14225
Lexington KY 40512
(800) 289-2818
Health Net Inc
(800) 289-2818
HEAT AND FROST INSULATORS AND
ASBESTOS WRKS H W FUND
Affiliated With: ASSOCIATED THIRD
PARTY ADMINISTRATORS
Plan Type: Group Health
ASSOCIATED THIRD PARTY
ADMINISTRATORS
Heath Net Arizona Travel Member
Benefit
Affiliated With: Health Net Inc
Plan Type: Group Health
PO Box 2590
PASADENA CA 91102-2590
(800) 289-2818
Exclude all psych/cd services
Excludes specific hospitals
HEIDELBERG USA
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
HEIDELBERG USA
Affiliated With: CORESOURCE INC
Plan Type: Group Health
CORESOURCE
CORESOURCE
CORESOURCE
HEIL, HEIL, SMART & GOLEE
Affiliated With: BENEFIT
ADMINISTRATIVE SYSTEMS, LTD.
Plan Type: Group Health
BENEFIT ADMINISTRATIVE
SYSTEMS LTD
BENEFIT ADMINISTRATIVE
SYSTEMS LTD
BENEFIT ADMINISTRATIVE
SYSTEMS LTD
PO Box 2920
CLINTON OH 52733-2920
17475 JOVANNA DR
HOMEWOOD IL 60430
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-236
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HELICAL PRODUCTS
Affiliated With: COMBINED BENEFIT
ADMINISTRATORS
Plan Type: Group Health
HELLENIC COLLEGE / HOLY GREEK
ORTHODOX SCHOOL
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
Term Effective: 8/31/2007
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
2092753984
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
PO Box 809026
DALLAS TX 75038
(800) 767-0700
CHECK BENEFIT CARD
(800) 767-0700
HELPING HANDS SACTUARY OF
IDAHO INC.
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
CRITIQUE
CRITIQUE
CHECK BENEFIT CARD
HENKE SASS WOLF OF AMERICA INC
Affiliated With: ULTRABENEFITS, INC.
Plan Type: Group Health
ULTRABENEFITS INC
ULTRABENEFITS INC
CHECK BENEFIT CARD
PO Box 763
WESTBORO MA 01581
(866) 858-7223
PO Box 651109
S SALT LAKE UT 84165-1109
(866) 858-7223
HENKE SASS WOLF OF AMERICA INC
Affiliated With: ULTRABENEFITS, INC.
Plan Type: Group Health
ULTRABENEFITS INC
ULTRABENEFITS INC
PO Box 763
WESTBORO MA 01581
(866) 858-7223
CHECK BENEFIT CARD
(866) 858-7223
HENRY MAYO NEWHALL MEMORIAL
HOSPITAL
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATORS
Plan Type: Group Health
EMPLOYEE BENEFIT
ADMINISTRATORS
EMPLOYEE BENEFIT
ADMINISTRATORS
424 N FIRST AVE
ARCADIA CA 91006
(626) 294-2800
EMPLOYEE BENEFIT
ADMINISTRATORS
(626) 294-2800
(626) 294-2800
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-237
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HERBST LAZAR BELL INC
Affiliated With: ALLIED BENEFIT
SYSTEMS INC
Plan Type: Group Health
HERCULES INDUSTRIES
Affiliated With: HEALTHCOMP THIRD
PARTY ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
3129068000
HEALTHCOMP THIRD PARTY
ADMINISTRATORS INC
HEALTHCOMP THIRD PARTY
ADMINISTRATORS INC
PO Box 45018
FRESNO CA 93721
(800) 442-7247
CHECK BENEFIT CARD
(800) 442-7247
HEWITT CONTRACTING COMPANY,
INC.
Affiliated With: HEALTHDATAINSIGHTS
DBA MCPPO
Plan Type: Group Health
Hewitt, Coleman and Associates, Inc.
HEALTHDATAINSIGHTS DBA MVPPO
7083 Grand National Dr. #104
ORLANDO FL 32819
HEALTHDATAINSIGHTS DBA MVPPO PPHA
(407) 246-1848
(800) 952-5277
(800) 952-5277
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
UM NOT APPLICABLE
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
(800) 816-6049
Plan Type: Workers' Compensation
HIAWATHA COMMUNITY HOSPTIAL
Affiliated With: WATERSTONE
BENEFIT ADMINISTRATORS
Plan Type: Group Health
(800) 816-6049
* HICKORY SPRINGS
MANUFACTURING CO
Affiliated With: WELLS FARGO THIRD
PARTY ADMINISTRATOR
Plan Type: Group Health
ACORDIA NATIONAL
ACORDIA NATIONAL
CHECK BENEFIT CARD
(888) 685-7774
(888) 685-7774
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-238
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HILL BROTHERS CHEMICAL CO.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
HILL VIEW RETIREMENT CENTER
Affiliated With: EMPLOYEE BENEFIT
CONSULTANTS
Plan Type: Group Health
HILLCREST FAMILY SERVICE
Affiliated With: SISCO/Cottingham &
Butler
Plan Type: Group Health
CLAIMS SUBMISSION
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
UTILIZATION REVIEW
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
PO Box 3000
SCOTTSDALE AZ 85271-3000
EMPLOYEE BENEFIT CONSULTANTS EMPLOYEE BENEFIT CONSULTANTS MEDICAL COST MANAGEMENT
(800) 367-9938
PO Box 928
(800) 472-6630
FINDLAY OH 45839
(800) 472-6630
SISCO
SISCO
PO Box 389
DUBUQUE IA 52004-0389
(800) 547-4726
CHECK BENEFIT CARD
(800) 547-4726
Hinz Claim Management Inc
Hinz Claim Management, Inc.
Plan Type: Workers' Compensation
2815 Old Jacksonville Rd Ste 204
Springfield IL 62704
CONTACT EMPLOYER
CONTACT EMPLOYER
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 786-7930
AMERIBEN SOLUTIONS
(800) 786-7930
HMA Administrators, LLC
HMA Administrators, LLC
CHECK BENEFIT CARD
7 Wells Avenue, Suite 24
Newton MA 02459
(617) 581-6655 Ext 228
(217) 698-1280
HM ELECTRONICS, INC.
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
(800) 786-7930
HMA ADMINISTRATORS, LLC
Affiliated With: HMA
ADMINISTRATORS, LLC
Plan Type: Group Health
(617) 581-6655 Ext 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.
Info as of 12/13/2007
Page PIRCA-239
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HMA DIRECT
Affiliated With: BROKERAGE
CONCEPTS INC/BENEFIT CONCEPTS
INC
Plan Type: Group Health
HMO
Affiliated With: OSF HEALTHPLANS,
INC.
Plan Type: Group Health
HOBBY LOBBY
Affiliated With: HEALTH DATA
SERVICES
Plan Type: Group Health
HOFFINGER INDUSTRIES
Affiliated With: EBA&M
Plan Type: Group Health
CLAIMS SUBMISSION
BENEFIT CONCEPTS, INC.
PO Box 60608
King of Prussia PA 19406
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BENEFIT CONCEPTS, INC.
UTILIZATION REVIEW
UM NOT APPLICABLE
(610) 337-2600
(610) 337-2600
OSF HealthPlans, Inc.
OSF HealthPlans, Inc.
PO Box 1229
Peoria IL 61601-5128
(800) 673-5222
OSF HealthPlans, Inc.
(800) 284-2273
FISERV HEALTH INC
FISERV HEALTH INC
CHECK BENEFIT CARD
PO Box 690450
SAN ANTONIO TX 78269
(210) 558-2100
(800) 673-5222
(210) 558-2100
EBA&M
EBA&M
PO Box 5079
WESTLAKE VILLAGE CA 91359
(800) 776-1545
HINES & ASSOCIATES
(800) 528-2498
EBA&M
EBA&M
CHECK BENEFIT CARD
PO Box 5079
WESTLAKE VILLAGE CA 91359
(714) 668-8920
(800) 776-1545
HOFFINGER INDUSTRIES, INC.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT (EBA&M)
Plan Type: Group Health
HOGAN AND HARTSON LLP
Affiliated With: CORESOURCE, INC.
Plan Type: Group Health
(714) 668-8920
CORESOURCE INC
CORESOURCE INC
PO Box 2920
CLINTON OH 52733-2920
(800) 354-5233
CHECK BENEFIT CARD
(800) 354-5233
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-240
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HOLDEN BUSINESS FORMS
Affiliated With: ASSURECARE
Plan Type: Group Health
CLAIMS SUBMISSION
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ASSURECARE
(800) 422-2026
UTILIZATION REVIEW
Careline UR
(763) 383-4800
(800) 422-2026
AMERICAN EMPLOYERS GROUP
C/O CCN
CHECK BENEFIT CARD
NORTH AMERICA
ADMINISTRATORS, L.P.
NORTH AMERICA
ADMINISTRATORS, L.P.
EBPA
EBPA
CHECK BENEFIT CARD
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
HOLIDAY INN/BEST INN
Affiliated With: AMERICAN
EMPLOYERS GROUP
Plan Type: Group Health
AMERICAN EMPLOYERS GROUP
C/O CCN
HOLLADAY PROPERTY SERVICES
MIDWEST, INC.
Affiliated With: NORTH AMERICA
ADMINISTRATORS, L.P.-TENNESSEE
Plan Type: Group Health
NORTH AMERICA
ADMINISTRATORS, L.P.
HOLYOKE HOSPITAL WRAP JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
PO Box 3000
SCOTTSDALE AZ 85271-3000
PO Box 1984
NASHVILLE TN 37202
(802) 846-8060
HOME STREET BANK
Affiliated With: HEALTHCOMP
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
HOMER T HAYWARD LUMBER
COMPANY
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
DELTA HEALTH SYSTEMS
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8004427247
DELTA HEALTH SYSTEMS
CHECK BENEFIT CARD
PO Box 1147
STOCKTON CA 95201
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-241
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HOMETOWN HEALTH NETWORK
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
GLOBALCARE, INC.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GLOBALCARE, INC.
GLOBALCARE, INC.
UTILIZATION REVIEW
6875 Shiloh Rd E
ALPHARETTA GA 30005
HONOLULU VAMC 3183
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
HONOLULU VAMC
Attn: FEE 043MD
459 PATTERSON RD
HONOLULU HI 96819
HONOLULU VAMC
CHECK BENEFIT CARD
HOOVER MATERIALS HANDLING
GROUP
Affiliated With: ADMINISTRATIVE
SOLUTIONS, INC.
Plan Type: Group Health
ADMINISTRATIVE SOLUTIONS INC
ADMINISTRATIVE SOLUTIONS INC
CHECK BENEFIT CARD
PO Box 2490
ALPHARETTA GA 30023
(678) 339-0211
(678) 339-0211
HOOVER PRECISION PRODUCTS
Affiliated With: GROUP RESOURCES,
INC.
Plan Type: Group Health
GROUP RESOURCES, INC.
GROUP RESOURCES, INC.
GROUP RESOURCES, INC.
HOPE UNIVERSITY
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 786-7930
AMERIBEN SOLUTIONS
(800) 786-7930
5161 Brook Hollow Pkwy. #200
NORCROSS GA 30071
(800) 786-7930
HORIZON GOODWILL INDUSTRIES
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-242
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Horizon Managed Care
Affiliated With: CompIQ #13910
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
Horizon Managed Care
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Horizon Managed Care
UTILIZATION REVIEW
(916) 631-1220
Horizon Managed Care
(916) 631-1220
Mountain States Administrative
Services
Mountain States Administrative
Services
Hines and Associates
(847) 214-2780
7202 E ROSEWOOD STE 200
TUCSON AZ 85710
(520) 722-7133
2868 Prospect Park Dr
Rancho Cordova CA 95670
(800) 293-3131
Participates in California Select Network
HORIZON MOVING SYSTEM
Affiliated With: MOUNTAIN STATES
ADMINISTRATIVE SERVICES
Plan Type: Group Health
(520) 722-7133
* Horizon Transport Inc
Affiliated With: MENNONITE MUTUAL
AID
Plan Type: Group Health
HORNE'S LODGING PROPERTIES
Affiliated With: SRT ADMINISTRATORS
Plan Type: Group Health
MMA
MMA
PO Box 483
GOSHEN IN 46527
(800) 348-7468
CHECK BENEFIT CARD
(800) 348-7468
SRT ADMINISTRATORS
SRT ADMINISTRATORS
PO Box 25160
SCOTTSDALE AZ 85255-0102
(888) 690-2020
HINES & ASSOCIATES
(800) 944-9401
CONTACT EMPLOYER
CONTACT EMPLOYER
THE LOOMIS COMPANY
CHECK BENEFIT CARD
(888) 690-2020
Hortica Insurance Company
Affiliated With: GENEX Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
Hospitality Partners Health & Welfare
THE LOOMIS COMPANY
Trust
850 N PARK RD
Affiliated With: THE LOOMIS COMPANY WYOMISSING PA 19610
Plan Type: Group Health
(866) 473-6615
(866) 473-6615
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-243
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HOT SPRINGS COUNTY
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
CLAIMS SUBMISSION
MOUNTAIN STATES REVIEW
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MBA OF WYOMING
MBA OF WYOMING
COASTAL HEALTHCARE
ADMINISTRATORS
COASTAL HEALTHCARE
ADMINISTRATORS
UTILIZATION REVIEW
PO Box 94
WORLAND WY 82401
HOUSING AUTHORITY OF THE
COUNTY OF MONTEREY
Affiliated With: COASTAL TPA INC
Plan Type: Group Health
COASTAL HEALTHCARE
ADMINISTRATORS
HOUSING AUTHORITY-COUNTY OF
MONTEREY WRAP
Affiliated With: COASTAL TPA, INC.
Plan Type: Group Health
COASTAL TPA, INC.
COASTAL TPA, INC.
PO Box 80308
SALINAS CA 93912
(800) 564-7475
HINES & ASSOCIATES
(800) 592-8097
MERCER ADMINISTRATION
MERCER ADMINISTRATION
CHECK BENEFIT CARD
PO Box 4542
IOWA CITY IA 52244
(800) 290-7303
HOUSING BENEFITS PLAN
Affiliated With: MARSH ADVANTAGE
AMERICA 10442
Plan Type: Group Health
HOUSTON BAPTIST UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
HOUSTON VA MEDICAL CENTER 3101
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
PO Box 80308
SALINAS CA 93912
(800) 564-7475
(800) 290-7303
TRUE CHOICE
TRUE CHOICE
PO Box 700307
DALLAS TX 75370
(800) 251-9665
UM NOT APPLICABLE
(800) 251-9665
HEALTH NET FEDERAL SERVICES
Attn: 04FRM (FEE BASIS)
2002 HOLCOMB BLVD
HOUSTON TX 77030
HEALTH NET FEDERAL SERVICES
CHECK BENEFIT CARD
(214) 387-3232
(214) 387-3232
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-244
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HOWARD BAER
Affiliated With: FISERV HEALTH
KANSAS
Plan Type: Group Health
CLAIMS SUBMISSION
FISERV HEALTH INC
300 W DOUGLAS STE 800
WICHITA KS 67202
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
FISERV HEALTH INC
UTILIZATION REVIEW
(800) 235-7160
AVIDYN HEALTH
(214) 647-4417
DIRECT CARE AMERICA
CHECK BENEFIT CARD
(800) 235-7160
HP PRODUCTS
DIRECT CARE AMERICA
Affiliated With: THE CHANDLER GROUP PO Box 2090 C
Plan Type: Group Health
STOW OH 44224
(800) 266-5896
(800) 266-5896
HRH Insurance
Affiliated With: Fair Isaac Corporation
Plan Type: Workers' Compensation
HRH Insurance
HRH Insurance
HRH Insurance
HUB FOLDING BOX
Affiliated With: ACCORDIA NATIONAL
Plan Type: Group Health
WELLS FARGO TPA, INC.
WELLS FARGO TPA, INC.
CHECK BENEFIT CARD
602 VIRGINIA ST EAST
CHARLESTON WV 25301
(800) 624-8605
(304) 353-8661
HUDSON VALLEY VA HEALTHCARE
SYSTEM 3198
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
HUDSON VALLEY VA HEALTHCARE
SYSTEM
Attn: FEE BASIS 136M
CAMPUS RT 9D
CASTLE POINT NY 12511
HUDSON VALLEY VA HEALTHCARE
SYSTEM
CHECK BENEFIT CARD
HUFCOR, INC.
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC
Plan Type: Group Health
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
PO Box 574
ONALASKA WI 54650
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-245
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HUISH DETERGENTS INC
Affiliated With: EBMS EMPLOYEE
BENEFIT MANAGEMENT SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
8007159414
AMERICAN INSURANCE
ADMINISTRATORS/ROSA
MONOSTORI
CHECK BENEFIT CARD
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
HUNTINGTON VAMC
Attn: FEE BASIS (136F)
1540 SPRING VALLEY DR
HUNTINGTON WV 25704
HUNTINGTON VAMC
CHECK BENEFIT CARD
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
HUMBOLDT STATE UNIVERSITY
Affiliated With: AMERICAN INSURANCE
ADMINISTRATORS
Plan Type: Group Health
AMERICAN INSURANCE
ADMINISTRATORS/ROSA
MONOSTORI
HUNTINGTON MEMORIAL HOSPITAL
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
DELTA HEALTH SYSTEMS
HUNTINGTON VAMC 3149
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
HUTCHISON & STEFFEN
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
3415 S. Sepulveda Blvd #200
LOS ANGELES CA 90034-6035
PO Box 1168
STOCKTON CA 95201
(702) 242-7700
HYDRAULIC CONTROLS
Affiliated With: HEALTHCOMP
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8004427247
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-246
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
HYDRITE CHEMICAL COMPANY
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
MIDWEST SECURITY
ADMINISTRATORS INC
2700 Midwest Dr.
ONALASKA WI 54650
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MIDWEST SECURITY
ADMINISTRATORS INC
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 236-8672
(800) 236-8672
HYDRO-GEAR, INC.
Affiliated With: CONSOCIATE, INC.
Plan Type: Group Health
CONSOCIATE, INC. C/O CCN
Hygeia Corporation
Affiliated With: Hygeia Corporation
Plan Type: Group Health
CONSOCIATE, INC. C/O CCN
CHECK BENEFIT CARD
Hygeia Corporation
Hygeia Corporation
121 Richmond St W Penthouse
Toronto, Ontario Canada M5H 2K1
(416) 595-1094 Ext 243
Hygeia Corporation
(416) 595-1094 Ext 243
PO Box 3000
SCOTTSDALE AZ 85271-3000
(416) 595-1094 Ext 243
I LOGIX
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
I.U.P.A.T. DISTRICT COUNCIL 78
HEALTH AND WELFARE FUND
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
IAC INTERNATIONAL
Affiliated With: INSURERS
ADMINISTRATIVE CORPORATION
Plan Type: Group Health
INSURERS ADMINISTRATIVE CORP.
C/O CCN
INSURERS ADMINISTRATIVE CORP. CHECK BENEFIT CARD
C/O CCN
PO Box 5190
TAMPA FL 33675-5190
(800) 843-3106
(800) 843-3106
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-247
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
IBC GROUP, INC.
Affiliated With: FLORIDA HEALTH
ADMINISTRATORS DBA FHA-TPA
DIVISION
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
CLAIMS SUBMISSION
COMPENSABILITY
FLORIDA HEALTH ADMINISTRATORS FLORIDA HEALTH ADMINISTRATORS CORVEL CORPORATION
(517) 784-0821
PO Box 327810
(954) 366-0111
Fort Lauderdale FL 33332
(954) 366-0111
IBEW WESTERN UTILITIES HEALTH & COMPUSYS
WELFARE TRUST FUND / ID MT OR
2156 W 2200 S
WA WY
SALT LAKE CITY UT 84119-1326
Affiliated With: IBEW WESTERN
(800) 628-6562
UTILITIES HEALTH & WELFARE
TRUST FUND
Plan Type: Group Health
IBEW WESTERN UTILITIES HEALTH
AND WELFARE FUND/ ID MT OR WA
WY
Affiliated With: IBEW WESTERN
UTILITIES HEALTH & WELFARE FUND
Plan Type: Group Health
IBEW-NECA Southwestern Health &
Benefit Fund
Affiliated With: IBEW-NECA
Southwestern Health & Benefit Fund
Plan Type: Group Health
IBS INDUSTRIES INC
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
COMPUSYS
UM NOT APPLICABLE
(800) 628-6562
COMPUSYS
COMPUSYS
2156 W 2200 S
SALT LAKE CITY UT 84119-1326
(800) 628-6562
UM NOT APPLICABLE
(800) 628-6562
IBEW-NECA Southwestern Health and
Benefit Fund
IBEW-NECA Southwestern Health and First Health
Benefit Fund
(800) 932-3869
4040 McEwen Ste 100
Dallas TX 75244-5092
(800) 527-0320
(800) 527-0320
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
IDAHO ASPHALT
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
SMITH ADMINISTRATORS
SMITH ADMINISTRATORS
3761 S. 700 E.
SALT LAKE CITY UT 84106
(801) 261-5511
SERVICE ASSOCIATES
(801) 261-5511
(801) 261-5511
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-248
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
IDAHO OPAL & GEM
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
IDAHO STATE UNIVERSITYSTUDENTS
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
IEC GROUP BENEFIT TRUST FUND
Affiliated With: MEDICAL BENEFITS
ADMINISTRATORS OF MD, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
SMITH ADMINISTRATORS
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SMITH ADMINISTRATORS
UTILIZATION REVIEW
(800) 261-5511
SERVICE ASSOCIATES
(800) 261-5511
TRUE CHOICE
CI
CHECK BENEFIT CARD
PO Box 700307
DALLAS TX 75370
(817) 479-2115
3761 S. 700 E.
SALT LAKE CITY UT 84106
(800) 261-5511
(800) 785-2446
STRATEGIC HEALTH
DEVELOPMENT CORP
STRATEGIC HEALTH
DEVELOPMENT CORP
9501 N. E. 2ND AVENUE
MIAMI SHORES FL 33138
(888) 532-3467
STRATEGIC HEALTH
DEVELOPMENT CORP
(888) 532-3467
CONTACT EMPLOYER
CONTACT EMPLOYER
CHECK BENEFIT CARD
STATE OF ILLINOIS
STATE OF ILLINOIS
604 William G. Stratton Office Building
Springfield IL 62706
(217) 785-1954
STATE OF ILLINOIS
(217) 785-1954
(888) 532-3467
IGA GROUP EMPLOYEE BENEFIT
TRUST
Affiliated With: MBA OF MARYLAND
Plan Type: Group Health
Illinois Industrial Commission (IIC)
Affiliated With: STATE OF ILLINOIS
Plan Type: Workers' Compensation
(217) 785-1954
IMCS PUERTO RICO
Affiliated With: INTERNATIONAL
MANAGED CARE SERVICES
Plan Type: Group Health
INTERNATIONAL MANAGED CARE
SERVICES
INTERNATIONAL MANAGED CARE
SERVICES
7205 Corporate Center Dr. #405
MIAMI FL 33126
(305) 463-9696
CHECK BENEFIT CARD
(305) 463-9696
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-249
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* IMI FABI (USA), INC.
Affiliated With: BENEFIT
ADMINISTRATIVE SYSTEMS, LTD.
Plan Type: Group Health
CLAIMS SUBMISSION
BENEFIT SYSTEMS & SERVICES,
INC.
760 Pasquinelli Dr. STE 320
WESTMONT IL 60559
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BENEFIT SYSTEMS & SERVICES,
INC.
UTILIZATION REVIEW
CHECK BENEFIT CARD
(630) 789-2093
(630) 789-2093
IMMUNOGEN, INC
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(508) 752-2480
CMS
(866) 325-1550
(508) 752-2480
IMPRESSIONS PRINTING
Affiliated With: AMERICAN TRUST
ADMINISTRATORS
Plan Type: Group Health
BENEFIT ADMINISTRATIVE
SYSTEMS
BENEFIT ADMINISTRATIVE
SYSTEMS
17475 JOVANNA DR
HOMEWOOD IL 60430
(708) 647-3434
CHECK BENEFIT CARD
(708) 647-3434
Indemni-Med Management
Affiliated With: Indemni-Med
Management
Plan Type: Workers' Compensation
* Independent Bank Group Inc. (TRAVEL)
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
Indemni-Med Management
Indemni-Med Management
2080 N Highway 360 Ste 345
Grand Prairie TX 75050
(972) 606-9100 Ext 1308
Indemni-Med Management
(Clinical Operations)
(972) 606-9108
(972) 606-9100 Ext 1308
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
CHECK BENEFIT CARD
(800) 827-7223
INDEPENDENT MEAT COMPANY
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-250
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
INDEPENDENT MEDICAL SYSTEMS
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
INDEPENDENT STAVE COMPANY INC FMH BENEFIT SERVICES, INC. A
DIVISION OF CORESOURCE, INC.
Affiliated With: FMH BENEFIT
SERVICES INC A DIVISION OF
PO Box 25946
CORESOURCE
OVERLAND PARK KS 66225-5946
Plan Type: Group Health
(800) 990-9058
FMH BENEFIT SERVICES, INC. A
DIVISION OF CORESOURCE, INC.
INDIAN ELECTRIC COOPERATIVE INC
Affiliated With: BMI HEALTHPLANS,
INC.
Plan Type: Group Health
BMI HEALTHPLANS
BMI HEALTHPLANS
PO Box 14379
SPRINGFIELD MO 65814
(918) 335-0450
INDIAN SUMMER CARPET MILLS
Affiliated With: AMERICAN
HEALTHCARE ALLIANCE
Plan Type: Group Health
INDIANA FURNITURE INDUSTRIES,
INC
Affiliated With: PREFERRED HEALTH
PLANS INC
Plan Type: Group Health
Indiana Lumbermens
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
UTILIZATION REVIEW
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 990-9058
HEALTH REVIEW, LLC
(918) 335-0450
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8165237779
8165237779
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
PO Box 437017
Louisville KY 40253
(800) 832-8212
CHECK BENEFIT CARD
(800) 832-8212
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CONTACT EMPLOYER
Info as of 12/13/2007
Page PIRCA-251
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
INDIANA STATE UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
INDIANA WESLEYAN UNIVERSITY
Affiliated With: PROFESSIONAL
BENEFIT ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
TRUE CHOICE USA
PO Box 700307
DALLAS TX 75370
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
TRUE CHOICE USA
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 785-2446
(800) 785-2446
Professional Benefit Administrators, Inc. Professional Benefit Administrators, Inc. ICM
(800) 728-0327
900 Jorie Blvd Ste 250
(800) 435-5694
Oakbrook IL 60523
(800) 435-5694
INDIANAPOLIS VA MEDICAL CENTER
3156
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
INDIANAPOLIS VA MEDICAL CENTER
Attn: FEE BASIS 136C3
1700 E 38TH ST
MARION IN 46953
INDIANAPOLIS VA MEDICAL CENTER CHECK BENEFIT CARD
INDUSTRIAL METAL SUPPLIES
Affiliated With: HEALTHCOMP
ADMINISTRATORS
Plan Type: Group Health
HEALTHCOMP
HEALTHCOMP
PO Box 45018
Fresno CA 93718
(559) 499-2450
INDUSTRIAL METAL SUPPLY
Affiliated With: HEALTHCOMP
ADMINISTARTORS INC.
Plan Type: Group Health
INDUSTRIAL MOTOR AND CONTROL
Affiliated With: THIRD PARTY
ADMINISTRATIVE SERVICES
Plan Type: Group Health
CHECK BENEFIT CARD
(559) 499-2450
HEALTHCOMP
HEALTHCOMP
PO Box 45018
Fresno CA 93718
(559) 499-2450
CHECK BENEFIT CARD
(559) 499-2450
THIRD PARTY ADMINISTRATIVE
SERVICES
THIRD PARTY ADMINISTRATIVE
SERVICES
7493 N Oracle Rd Ste 200
Tucson AZ 85704
(520) 670-0227
THIRD PARTY
ADMINISTRATIVE SERVICES
(520) 670-0227
(520) 670-0227
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-252
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
INDUSTRIAL SAFETY SUPPLY
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
CLAIMS SUBMISSION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
DIVERSIFIED ADMINISTRATION
CORPORATION
(888) 322-2524
UTILIZATION REVIEW
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
INDUSTRY BUYING GROUP
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
GLOBALCARE, INC.
Indy Plus
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
INETICO - PEPM
Affiliated With: INETICO, INC.
Plan Type: Group Health
GLOBALCARE, INC.
GLOBALCARE, INC.
International Medical Group, Inc.
International Medical Group, Inc.
CHECK BENEFIT CARD
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
6875 Shiloh Rd E
ALPHARETTA GA 30005
(317) 655-4500 Outside US
(800) 628-4664 Inside US
INETICO, INC.
INETICO, INC.
PO Box 10972
TAMPA FL 33679
(813) 258-2200
UM NOT APPLICABLE
(813) 258-2200
INETICO - TRAVEL WRAP
Affiliated With: INETICO, INC.
Plan Type: Group Health
INETICO, INC.
INETICO, INC.
3902 Henderson Blvd
Tampa FL 33679
(813) 258-2200
UM NOT APPLICABLE
(813) 258-2200
EVEREST ADMINISTRATORS, INC.
C/O CCN
CHECK BENEFIT CARD
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
INFINIA HEALTH CARE
Affiliated With: EVEREST
ADMINISTRATORS, INC.
Plan Type: Group Health
EVEREST ADMINISTRATORS, INC.
C/O CCN
INFINIA INC
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PO Box 3000
SCOTTSDALE AZ 85271-3000
(800) 533-5044
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-253
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
INFORMATION SYSTEMS SOLUTIONS CHECK BENEFIT CARD
INTERNATIONAL
Affiliated With: THE LOOMIS COMPANY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
INFRA-METALS CO
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
PAYOR NAME
INFINITY HEALTHCARE, INC.
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC
Plan Type: Group Health
INGLEWOOD UNIFIED SCHOOL
DISTRICT
Affiliated With: K-12 STUDENT
INSURANCE, A DIVISION OF UICI
Plan Type: Group Health
CLAIMS SUBMISSION
MIDWEST SECURITY
ADMINISTRATORS, INC.
UTILIZATION REVIEW
2700 Midwest Dr.
ONALASKA WI 54650
(800) 533-5044
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
INGOMAR PACKING
Affiliated With: COMBINED BENEFIT
ADMINIS./VALUE ADDED BENEFITS
Plan Type: Group Health
COMBINED BENEFIT
ADMINISTRATORS
COMBINED BENEFIT
ADMINISTRATORS
COMBINED BENEFIT
ADMINISTRATORS
INLAND SEAFOOD
Affiliated With: KHS, A KMG AMERICA
COMPANY
Plan Type: Group Health
KMG AMERICA
KMG AMERICA
CHECK BENEFIT CARD
PO Box 1000
LANCASTER SC 29721
(800) 822-1274
4704 W. Jennifer #104
FRESNO CA 93722
(800) 822-1274
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-254
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
INNERPAC INC - PERFORMAX
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NY
Plan Type: Group Health
INNOVATIVE ADMINISTRATIVE
SERVICES (WRAP)
Affiliated With: INNOVATIVE
ADMINISTRATIVE SERVICES
Plan Type: Group Health
INNOVIA FILMS INC
Affiliated With: BENEFIT
MANAGEMENT INC #962501916
Plan Type: Group Health
CLAIMS SUBMISSION
AMERICAN HEALTH HOLDINGS INC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AMERICAN HEALTH HOLDINGS INC
921 EASWIND
WESTERVILLE OH 43081
INNOVATIVE ADMINISTRATIVE
SERVICES
INNOVATIVE ADMINISTRATIVE
SERVICES
540 WALD AVE
IRVINE CA 92618
(949) 442-6600
UTILIZATION REVIEW
AMERICAN HEALTH
HOLDINGS INC
CHECK BENEFIT CARD
(949) 442-6600
BENEFIT MANAGEMENT INC.
BENEFIT MANAGEMENT INC.
PO Box 1090
GREAT BEND KS 67530
(800) 290-1368
CHECK BENEFIT CARD
(800) 290-1368
INSERVICES, INC.
INSERVICES, INC.
INSERVICES, INC.
(704) 945-2892
INSERVICES, INC.
(704) 945-2892
Plan Type: Workers' Compensation
4401 Barclay Downs Dr.
Charlotte NC 28209
EBPA
EBPA
CHECK BENEFIT CARD
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
(704) 945-2892
INSTITUTE OF PROFESSIONAL
PRACTICE JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
(802) 846-8060
INSURANCE PROGRAMMERS INC
CHECK BENEFIT CARD
Affiliated With: INSURANCE
PROGRAMMERS NE ELEC WORKERS
Plan Type: Group Health
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-255
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
INSURCORP
SIERRA HEALTH & LIFE/HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN OF NEVADA
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
INSURERS ADMINISTRATIVE
CORPORATION
Affiliated With: INSURERS
ADMINISTRATIVE CORPORATION
Plan Type: Group Health
INTEGRAL YOUTH SERVICES
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
Integrated Care Systems
Affiliated With: CompIQ #13910
Plan Type: Workers' Compensation
INSURERS ADMINISTRATIVE CORP.
C/O CCN
INSURERS ADMINISTRATIVE CORP. CHECK BENEFIT CARD
C/O CCN
PO Box 5190
TAMPA FL 33675-5190
(800) 843-3106
(800) 843-3106
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
CompIQ Corporation
CompIQ Corporation
35 Tesla Way #100
Irvine CA 92618
(949) 923-4021
CHECK BENEFIT CARD
(949) 923-4021
INTEGRATED HEALTHCARE
SOLUTIONS LLC PEPM
Affiliated With: INTEGRATED
HEALTHCARE SOLUTIONS LLC DBA
MVPPO
Plan Type: Group Health
INTEGRATED HEALTHCARE
SOLUTIONS LLC DBA MVPPO
INTEGRATED HEALTHCARE
SOLUTIONS LLC PERCENT
Affiliated With: INTEGRATED
HEALTHCARE SOLUTIONS LLC DBA
MVPPO
Plan Type: Group Health
INTEGRATED HEALTHCARE
SOLUTIONS LLC DBA MVPPO
INTEGRATED HEALTHCARE
SOLUTIONS LLC DBA MVPPO
INTEGRATED HEALTHCARE
SOLUTIONS LLC DBA MVPPO
INTEGRATED HEALTHCARE
SOLUTIONS LLC DBA MVPPO
INTEGRATED HEALTHCARE
SOLUTIONS LLC DBA MVPPO
7083 Grand National Dr. #104
ORLANDO FL 32819
7083 Grand National Dr. #104
ORLANDO FL 32819
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-256
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
INTEGRATED TECHNOLOGY CORP.
Affiliated With: DAN R. WAGNON &
ASSOCIATES, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
DAN R. WAGNON & ASSOCIATES,
INC.
3825 N. 24th St.
PHOENIX AZ 85016
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
DAN
R WAGNON AND
DAN R WAGNON AND ASSOCIATES
ASSOCIATES INC
INC
(800) 362-5894 Ext 230
6022402404 Ext 230
(800) 362-5894 Ext 230
6022402404 Ext 230
INTEGRITY CHRYSLER JEEP DODGE
MEGASTORE
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
INTERCONNECT DEVICES INC
Affiliated With: AMERICAN STERLING
Plan Type: Group Health
Term Effective: 10/31/2007
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
AMERICAN STERLING INSURANCE
SERVICES
AMERICAN STERLING INSURANCE
SERVICES
10975 Grandview Dr, Ste 100 Bldg 27
Overland Park KS 66210
(913) 498-9096
CHECK BENEFIT CARD
(913) 498-9096
Intermed
Affiliated With: CompIQ #13910
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
INTERMOUNTAIN CENTERS FOR
HUMAN DEVELOPMENT
Affiliated With: GILSAR INC
Plan Type: Group Health
GILSBAR
GILSBAR
PO Box 2947
COVINGTON LA 70434
(888) 472-4352
MedCom Services, Inc.
(800) 643-4416
INTERMOUNTAIN IRONWORKERS
HEALTH & WELFARE TRUST
Affiliated With: INTERMOUNTAIN
IRONWORKERS HEALTH & WELFARE
TRUST
Plan Type: Group Health
(888) 472-4352
IRONWORKERS INTERMOUNTAIN
HEALTH & WELFARE TRUST
IRONWORKERS INTERMOUNTAIN
HEALTH & WELFARE TRUST
CHECK BENEFIT CARD
PO Box 30124
SALT LAKE CITY UT 84130-0124
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-257
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
INTERMOUNTAIN LABORATORIES
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
International Brotherhood of
Boilermakers
Affiliated With: Boilermakers National
Health & Welfare Fund
Plan Type: Group Health
INTERNATIONAL COFFEE AND TEA,
LLC
Affiliated With: HEALTHCOMP TPA
Plan Type: Group Health
INTERNATIONAL COMMUNITY
SERVICES MA
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
Term Effective: 10/31/2007
INTERNATIONAL HEALTHCARE
Affiliated With: INTERNATIONAL
HEALTHCARE
Plan Type: Group Health
CLAIMS SUBMISSION
MBA OF WYOMING
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MBA OF WYOMING
UTILIZATION REVIEW
MBA OF WYOMING
PO Box 98
WORLAND WY 82401
International Brotherhood of
Boilermakers
International Brotherhood of
Boilermakers
PO Box 23825
Tucson AZ 85734
(913) 342-2882
International Brotherhood of
Boilermakers
(888) 560-8932
HEALTHCOMP TPA
HEALTHCOMP TPA
CHECK BENEFIT CARD
PO Box 45018
Fresno CA 93718
(559) 499-2450
(913) 342-2882
(559) 499-2450
STUDENT RESOURCES
STUDENT RESOURCES
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 237-0903 Ext 6352
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
INTERNATIONAL HEALTHCARE
INTERNATIONAL HEALTHCARE
INTERNATIONAL HEALTHCARE
INTERNATIONAL MANAGED CARE
SERVICES
INTERNATIONAL MANAGED
CARE SERVICES
303 H
CHULA VISTA CA 91910
DBA: SIMNSA HealthCare
INTERNATIONAL MANAGED CARE
SERVICES
Affiliated With: INTERNATIONAL
MANAGED CARE SERVICES
Plan Type: Group Health
INTERNATIONAL MANAGED CARE
SERVICES
7205 Corporate Center Dr. #405
MIAMI FL 33126
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-258
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* INTERNATIONAL MED CARE
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
International Mission Board - IMB
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
International Service Corp.
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
CLAIMS SUBMISSION
STAR HEALTHCARE NETWORK
850 Seventh Ave STE 803
New York NY 10019
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
STAR HEALTHCARE NETWORK
UTILIZATION REVIEW
UM NOT APPLICABLE
(212) 581-8228
(212) 581-8228
International Medical Group, Inc.
International Medical Group, Inc.
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
CHECK BENEFIT CARD
(317) 655-4500 Outside US
(800) 628-4664 Inside US
International Medical Group, Inc.
International Medical Group, Inc.
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
CHECK BENEFIT CARD
(317) 655-4500 Outside US
(800) 628-4664 Inside US
INTERNATIONAL UNION OF
INDUSTRIAL AND INDEPENDENT
WORKERS
Affiliated With: GREENTREE
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Intracorp
Affiliated With: Intracorp
Plan Type: Workers' Compensation
First Health
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
PO Box 11158
Scottsdale AZ 85271-1158
Includes Specialized Physical Therapy
Specific zip codes not approved for
California HCO program.
Intracorp Auto
Affiliated With: Intracorp
Plan Type: Auto
CONTACT EMPLOYER
Attn:
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-259
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Intratech Dental Products
Affiliated With: Underwriters Safety &
Claims Inc.
Plan Type: Group Health
INUNISON
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
Underwriters Safety & Claims, Inc.
PO Box 23507
Louisville KY 40223-0507
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Underwriters Safety & Claims, Inc.
(800) 678-1536
UTILIZATION REVIEW
Bluegrass Health Network
(800) 264-7502
(800) 678-1536
SMITH ADMINISTRATORS
SMITH ADMINISTRATORS
428 E WINCHESTER ST, STE 200
SALT LAKE CITY UT 84107
(801) 261-5511
SERVICE ADVOCATES
(801) 261-5511
(801) 261-5511
INVACARE
INVACARE
INVACARE
Plan Type: Workers' Compensation
One Invacare Way
Elyria OH 44036
(440) 329-6149
INVACARE
(440) 329-6149
(440) 329-6149
Investco Insurance Trust
Affiliated With: Trusteed Plans Service
Corporation
Plan Type: Group Health
IOWA CITY VAMC 3709
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
TRUSTEED PLANS SERVICE GROUP
PO Box 1894
TACOMA WA 98406-1705
TRUSTEED PLANS SERVICE GROUP QUALIS
8007838606
(800) 426-9786
(800) 426-9786
IOWA CITY VA MEDICAL CENTER
Attn: FEE 136B
HIGHWAY 6 WEST
IOWA CITY IA 52246
IPRO
CBCA Administrators Inc
Affiliated With: CBCA Administrators, Inc. PO Box 8130
Plan Type: Group Health
Scottsdale AZ 85252-8130
IOWA CITY VA MEDICAL CENTER
CHECK BENEFIT CARD
CBCA Administrators Inc
Capp Care
(800) 937-2277
(800) 831-7783
(800) 831-7783
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-260
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
IRIS USA INC
Affiliated With: HEALTH DATA
SERVICES INC HDS
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
UTILIZATION REVIEW
IRON MOUNTAIN VAMC 3163
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
IRON MOUNTAIN VAMC
Attn: FEE BASIS 585/170
325 E H ST
IRON MOUNTAIN MI 49801
IRON MOUNTAIN VAMC
IRON WORKERS DISTRICT COUNCIL
Affiliated With: PREFERRED CARE
Plan Type: Group Health
IRON WORKERS DISTRICT COUNCIL
C/O CCN
IRON WORKERS DISTRICT COUNCIL CHECK BENEFIT CARD
C/O CCN
IRON WORKERS LOCAL 395 TRUST
FUND
Affiliated With: IRON WORKERS
LOCAL 395 TRUST FUND
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
IRVINE VALLEY COLLEGE INTL
STUDENT SRVCS
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
IRVING VALLEY COLLEGE
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
PERSONAL INSURANCE
ADMINISTRATORS
PERSONAL INSURANCE
ADMINISTRATORS
CHECK BENEFIT CARD
30401 Agoura Rd #250
Agoura Hills CA 91376
(800) 468-4343
PO Box 5190
TAMPA FL 33675-5190
(800) 468-4343
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-261
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ISCAR METALS
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
GROUP & PENSION
ADMINISTRATORS
PO Box 749075
DALLAS TX 75374-9075
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GROUP & PENSION
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 827-7223
(210) 691-0500
ISEC INC
Affiliated With: EMPLOYEE BENEFIT
MANAGEMENT SERVICES (EBMS)
Plan Type: Group Health
EBMS
EBMS
PO Box 21367
BILLINGS MT 59104-1367
(800) 777-3575
EBMS CARELINK
(406) 245-3575
BENEFIT ADMINISTRATIVE
SYSTEMS LTD
BENEFIT ADMINISTRATIVE
SYSTEMS LTD
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(800) 777-3575
ISW EMPLOYEE LEASING COMPANY,
INC.
Affiliated With: BENEFIT
ADMINISTRATIVE SYSTEMS, LTD.
Plan Type: Group Health
BENEFIT ADMINISTRATIVE
SYSTEMS, LTD.
IT Strategies OOA
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
17475 Jovanna Dr. STE 1B
HOMEWOOD IL 60430
(702) 242-7700
I-TECH USA, INC
Affiliated With: BENEFIT
ADMINISTRATIVE SYSTEMS, LLC
Plan Type: Group Health
BENEFIT ADMINISTRATIVE
SYSTEMS
BENEFIT ADMINISTRATIVE
SYSTEMS
7 JOVANNA DR STE 1B
HOMEWOOD IL 60430
(800) 523-0582
CHECK BENEFIT CARD
(800) 523-0582
ITO PACKING
Affiliated With: COMBINED BENEFIT
ADMINIS./VALUE ADDED BENEFITS
Plan Type: Group Health
COMBINED BENEFIT
ADMINISTRATORS
COMBINED BENEFIT
ADMINISTRATORS
COMBINED BENEFIT
ADMINISTRATORS
4704 W. Jennifer #104
FRESNO CA 93722
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-262
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ITRON INC
Affiliated With: MARSH ADVANTAGE
AMERICA
Plan Type: Group Health
J D STREETT & COMPANY, INC
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
UTILIZATION REVIEW
CHECK BENEFIT CARD
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
J KNIPPER & COMPANY
Affiliated With: INSURANCE
ADMINISTRATORS OF AMERICA (IAA)
Plan Type: Group Health
J SQUARE
Affiliated With: BENEFIT
ADMINISTRATORS SYSTEMS
Plan Type: Group Health
IAA
IAA
1934 OLNEY AVE STE 200
CHERRY HILL NJ 08003
(856) 470-1200
HEALTHCARE STRATEGIES
INC
8885991515
(856) 470-1200
BENEFIT ADMINISTRATIVE
SYSTEMS
BENEFIT ADMINISTRATIVE
SYSTEMS
17475 JOVANNA DR
HOMEWOOD IL 60430
(708) 799-7400
CHECK BENEFIT CARD
(708) 799-7400
J.M. SMUCKERS COMPANY
Affiliated With: WELLS FARGO THIRD
PARTY ADMINISTRATOR
Plan Type: Group Health
JACK JONES TRUCKING, INC.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
ACORDIA NATIONAL
ACORDIA NATIONAL
CHECK BENEFIT CARD
(888) 685-7774
(888) 685-7774
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
PO Box 5079
WESTLAKE VILLAGE CA 91359
(800) 776-1545
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
(800) 776-1545
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-263
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Jackson Tube Service Inc
Affiliated With: Underwriters Safety &
Claims Inc.
Plan Type: Group Health
CLAIMS SUBMISSION
First Health
PO Box 3017
Scottsdale AZ 85271
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Underwriters Safety & Claims Inc.
UTILIZATION REVIEW
(800) 678-1536
Underwriters Safety & Claims Inc
(800) 678-1536
(800) 678-1536
JACKSON VA MEDICAL CENTER 3110
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
JACKSON VA MEDICAL CENTER
Attn: FEE BASIS 136E
1500 E WOODROW WILSON DR
JACKSON MS 39216
JACKSON VA MEDICAL CENTER
CHECK BENEFIT CARD
JACOB STERN & SONS, INC.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
JAGER DI PAOLA KEMP DESIGN JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
EBPA
EBPA
CHECK BENEFIT CARD
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
JAMES HODGE AUTO GROUP
Affiliated With: EQUITABLE PLAN
SERVICES
Plan Type: Group Health
JARVIS COMPANY
Affiliated With: NORTH AMERICAN
ADMINISTRATORS INC
Plan Type: Group Health
PO Box 3000
SCOTTSDALE AZ 85271-3000
(802) 846-8060
EQUITABLE PLAN SERVICES
EQUITABLE PLAN SERVICES
PO Box 720460
OKLAHOMA CITY OK 73172
(405) 755-2929
CHECK BENEFIT CARD
(405) 755-2929
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-264
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
JARVIS GROUP
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NY
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
CHECK BENEFIT CARD
JASON ASSOCIATES
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT (EBA&M)
JASPER SEATING COMPANY INC
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
PO Box 437017
Louisville KY 40253
(800) 832-8212
JBA CONSULTING % OF SAVINGS
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
UTILIZATION REVIEW
PO Box 5079
WESTLAKE VILLAGE CA 91359
(800) 832-8212
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
JBA CONSULTING ENGINEERS TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
JCB INC
CBCA Administrators Inc
Affiliated With: CBCA Administrators, Inc. 4150 INTERNATIONAL PLAZA STE
900
Plan Type: Group Health
FORT WORTH TX 76109
CBCA Administrators Inc
CHECK BENEFIT CARD
(800) 631-3441
(912) 691-3782
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-265
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
JCM
SIERRA HEALTH & LIFE/HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN OF NEVADA
/ HEALTH PLAN OF NEVADA
2720 N. Tenaya Way, Room 507
Plan Type: Group Health
Las Vegas NV 89128
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 240-8931
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 240-8931
JDC LOGISTICS
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
340 Quadrangle Dr
Bolingbrook IL 60440
(800) 759-1311
Careline UR
(763) 383-4800
SRT ADMINISTRATORS
CHECK BENEFIT CARD
TRUSTMARK LIFE INSURANCE
CO.
(801) 261-5511
(800) 759-1311
JEEHDEEZ 'A ACADEMY, INC.
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
SRT ADMINISTRATORS
JEFFERSON COUNTY
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
SMITH ADMINISTRATORS, INC.
SMITH ADMINISTRATORS, INC.
3761 S 700 E SUITE 202
SALT LAKE CITY UT 84106
(801) 261-5511
JEFFERSON COUNTY BOARD OF
EDUCATION
Affiliated With: PREFERRED CARE
Plan Type: Group Health
JEFFERSON ENERGY COOPERATIVE
Affiliated With: NATIONAL RURAL
ELECTRIC COOPERATIVE
ASSOCIATION
Plan Type: Group Health
PO Box 25160
SCOTTSDALE AZ 85255-0102
(801) 261-5511
PREFERRED CARE, INC.
PREFERRED CARE, INC.
6 Neshaminy Interplex #205
TREVOSE PA 19053
(215) 639-6208
PREFERRED CARE, INC.
(215) 639-6208
COOPERATIVE BENEFIT
ADMINISTRATOR
COOPERATIVE BENEFIT
ADMINISTRATOR
PO Box 6249
LINCOLN NE 68506-0249
(402) 483-9200
CHECK BENEFIT CARD
(402) 483-9200
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-266
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* Jefferson Rehabilitation Center Inc
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
(800) 283-4927
UTILIZATION REVIEW
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
JEFFERSON STATE ROCK
PRODUCTIONS, INC.
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
JERRY'S NUGGET - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
JESUIT HEALTH TRUST/HMSRCHRISTIAN BROTHERS SERVICES
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
* Jetta Operating Company Inc. (TRAVEL)
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
CHECK BENEFIT CARD
(800) 533-5044
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
CHECK BENEFIT CARD
(800) 827-7223
JFP BENEFIT MANAGEMENT
Affiliated With: GLOBALCARE
Plan Type: Group Health
GLOBALCARE
GLOBALCARE
6875 SHILOH RD E
ALPHARETTA GA 30005
(888) 285-4864
AEGIS CARE MANAGEMENT
(800) 868-1660
(888) 285-4864
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-267
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
JFP BENEFIT MANAGEMENT PEPM
Affiliated With: GLOBALCARE
Plan Type: Group Health
CLAIMS SUBMISSION
GLOBALCARE
6875 Shiloh Rd E
ALPHARETTA GA 30005
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GLOBALCARE
UTILIZATION REVIEW
CHECK BENEFIT CARD
(888) 285-4864
(888) 285-4864
JHC ADMINISTRATORS
Affiliated With: JHC ADMINISTRATORS
Plan Type: Group Health
JHC ADMINISTRATORS, INC.
JHC ADMINISTRATORS, INC.
19300 SOUTH HAMILTON AVE STE
120
GARDENA CA 90248
(310) 464-8975
CHECK BENEFIT CARD
(310) 464-8975
* JK GUARDIAN SECURITY SERVICES
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
JMA ARCHITECTURE STUDIO - PEPM
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC CHECK BENEFIT CARD
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
JMA ARCHITECTURE STUDIO TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
JOB OPTIONS
Affiliated With: FCE BENEFIT
ADMINISTRATORS
Plan Type: Group Health
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC UM NOT APPLICABLE
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-268
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
JOB SQUAD INC
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
(800) 283-4927
UTILIZATION REVIEW
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
JOE BROWN COMPANY INC
Affiliated With: WATERSTONE
BENEFIT ADMINISTRATORS
Plan Type: Group Health
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
(405) 440-8888
CHECK BENEFIT CARD
(405) 440-8888
JOHN A MARTIN
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
JOHN A MARTIN TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
JOHN ALDEN LIFE INSURANCE
COMPANY
Affiliated With: ASSURANT HEALTH
Plan Type: Group Health
JOHN ALDEN LIFE INSURANCE
COMPANY
JOHN ALDEN LIFE INSURANCE
COMPANY
PO Box 981602
EL PASO TX 79998
(800) 328-4316
Fortis
(800) 500-0036
(800) 328-4316
JOHN ALDEN LIFE INSURANCE
COMPANY - REMOTE REPRICING
Affiliated With: ASSURANT HEALTH
Plan Type: Group Health
JOHN ALDEN LIFE INSURANCE
COMPANY
JOHN ALDEN LIFE INSURANCE
COMPANY
PO Box 1599
BOISE ID 83701-1599
(800) 328-4316
CHECK BENEFIT CARD
(800) 328-4316
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-269
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
JOHN ALDEN LIFE INSURANCE
COMPANY/HSP ONLY
Affiliated With: FORTIS BENEFITS
INSURANCE COMPANY
Plan Type: Group Health
JOHN ALDEN REWARDS
Affiliated With: FORTIS BENEFITS
INSURANCE COMPANY
Plan Type: Group Health
JOHN BOYLE AND COMPANY INC
Affiliated With: PRIMARY
PHYSICIANCARE INC
Plan Type: Group Health
JOHN BUNNING TRANSFER
COMPANY
CLAIMS SUBMISSION
JOHN ALDEN LIFE INSURANCE
COMPANY
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
JOHN ALDEN LIFE INSURANCE
COMPANY
UTILIZATION REVIEW
CHECK BENEFIT CARD
PO Box 1599
BOISE ID 83701-1599
KEY BENEFIT ADMINISTRATORS
KEY BENEFIT ADMINISTRATORS
8330 ALLISON POINT TRAIL
INDIANAPOLIS IL 46250
(866) 387-0489
FORTIS BENEFITS
INSURANCE COMPANY
(866) 387-3407
(317) 284-7649
PRIMARY PHYSICIAN CARE
PRIMARY PHYSICIAN CARE
PO Box 11088
CHARLOTTE NC 28220
(800) 446-5439
PRIMARY PHYSICIAN CARE
(800) 582-7774
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(800) 446-5439
Affiliated With: REGIONAL CARE INC
Plan Type: Group Health
John Davis Trucking Co Inc - Travel
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
(702) 242-7700
JOHN HAMMONS HOTELS INC
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
CHECK BENEFIT CARD
(800) 533-5044
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-270
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
JOHN MANVILLE
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
JOHN MANVILLE
5916 County Road #49
Willows CA 95988
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
JOHN MANVILLE
(530) 934-6206
UTILIZATION REVIEW
JOHN MANVILLE
(530) 934-6206
(530) 934-6206
JOHN MORRELL ANS COMPANY
Affiliated With: FISERV HEALTH
Plan Type: Group Health
FISERV HEALTH INC
FISERV HEALTH INC
PO Box 8077
WAUSAU WI 54402
(866) 868-0891
FISERV HEALTH CARE
MANAGEMENT
(888) 339-7280
(866) 868-0891
JOHNSON & WALES UNIVERSITY
Affiliated With: KLAIS & COMPANY
Plan Type: Group Health
KLAIS & COMPANY INC
KLAIS & COMPANY INC
1867 W MARKET ST
AKRON OH 44313
(800) 331-1096
CHECK BENEFIT CARD
(800) 331-1096
JOHNSON & WALES UNIVERSITY
PSPM
Affiliated With: KLAIS & COMPANY
Plan Type: Group Health
JOHNSON BIBLE COLLEGE
Affiliated With: STUDENT ASSURANCE
SERVICES
Plan Type: Group Health
JOHNSON BROTHERS CORP
Affiliated With: ASSURECARE
Plan Type: Group Health
KLAIS & COMPANY INC
KLAIS & COMPANY INC
1867 W MARKET ST
AKRON OH 44313
(800) 331-1096
CHECK BENEFIT CARD
(800) 331-1096
STUDENT ASSURANCE SERVICES
STUDENT ASSURANCE SERVICES
333 N. MAIN STREET
STILLWATER MN 55082
6514397098
CHECK BENEFIT CARD
6514397098
ASSURECARE
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
Careline UR
(763) 383-4800
MBA OF WYOMING
MBA OF WYOMING
(800) 422-2026
JOHNSON COUNTY
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
MOUNTAIN STATES REVIEW
PO Box 94
WORLAND WY 82401
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-271
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
JOHNSON COUNTY HOSPITAL
DISTRICT
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
CLAIMS SUBMISSION
MOUNTAIN STATES REVIEW
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MBA OF WYOMING
MBA OF WYOMING
UTILIZATION REVIEW
PO Box 94
WORLAND WY 82401
JOHNSTON EMPLOYEE BENEFIT
ASSOCIATION
Affiliated With: FISERVE HEALTH
KANSAS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
JONES METAL PRODUCTS
Affiliated With: THE CHANDLER
GROUP #13352
Plan Type: Group Health
DIRECT CARE AMERICA
DIRECT CARE AMERICA
CHECK BENEFIT CARD
PO Box 2090 C
STOW OH 44224
(800) 266-5896
JONES VARGAS
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
(800) 266-5896
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
JON-LIN FOODS
Affiliated With: EMPLOYEE BENEFITS
ADMINISTRATION & MANAGEMENT
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M)
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M)
PO Box 5079
WESTLAKE VILLAGE CA 91359
(714) 668-8920
HINES & ASSOCIATES
(800) 528-2498
(714) 668-8920
JORDAN OUTDOOR IMMERSION
GRAPHICS
Affiliated With: PARAGON BENEFITS
INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-272
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
JOSEPH CARRARA & SONS WRAP
JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
JOSEPH GALLO FARMS
Affiliated With: HEALTHCOMP THIRD
PARTY ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
PO Box 2365
SOUTH BURLINGTON VT 05403
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 525-8788
(802) 846-8060
HEALTHCOMP THIRD PARTY
ADMINISTRATORS INC
HEALTHCOMP THIRD PARTY
ADMINISTRATORS INC
PO Box 45018
FRESNO CA 93721
(800) 442-7247
CHECK BENEFIT CARD
(800) 442-7247
JOSEPH MERRITT
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
JOY GLOBAL INC
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
JP FARLEY
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
GISC, INC
GISC, INC
20 INDUSTRIAL PARK DR
PEMBROKE MA 02359
(800) 242-4472
CHECK BENEFIT CARD
7818298595 Ext 136
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
CHECK BENEFIT CARD
(800) 533-5044
GLOBALCARE, INC.
GLOBALCARE, INC.
6875 Shiloh Rd E
ALPHARETTA GA 30005
8008601111
JP Farley
(800) 634-0173
6783411722
JR SIMPLOT
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PRUDENTIAL OVERALL SUPPLY
PRUDENTIAL OVERALL SUPPLY
PO Box 11210
SANTA ANA CA 92711
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
PRUDENTIAL OVERALL
SUPPLY
Info as of 12/13/2007
Page PIRCA-273
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
JR SIMPLOT/UT MEMBERS
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
JSA HEALTHCARE NEVADA LLC
TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
JSI STORE FIXTURES INC
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
CLAIMS SUBMISSION
PRINCIPAL FINANCIAL GROUP
PO Box 39710
COLORADO SPRINGS CO 80949
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PRINCIPAL FINANCIAL GROUP
(888) 421-2926
UTILIZATION REVIEW
PRINCIPAL FINANCIAL GROUP
(800) 553-5044
(888) 421-2926
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(508) 752-2480
CARE MANAGEMENT
SERVICES
(866) 325-1550
(508) 752-2480
JULIET - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
JUPITER MEDIA CORPORATION
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
JUPITERMEDIA
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-274
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
JVS
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
(800) 283-4927
UTILIZATION REVIEW
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
K & D CONSTRUCTION - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
K 12 BUSINESS
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
KAESER COMPRESSORS
Affiliated With: ACS BENEFIT
SERVICES, INC.
Plan Type: Group Health
KAISER
STUDENT INSURANCE DIVISION
STUDENT INSURANCE DIVISION
PO Box 809025
DALLAS TX 75380-9025
(800) 767-0700
CHECK BENEFIT CARD
(800) 767-0700
ACS BENEFIT SERVICES INC
ACS BENEFIT SERVICES INC
PO Box 2000
Winston-Salem SC 27102
(800) 849-5370
CHECK BENEFIT CARD
(800) 849-5370
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Plan Type: Workers' Compensation
KAISER PERM ROCKY MOUNTAIN
Affiliated With: KAISER PERMANENTE
INSURANCE COMPANY ROCKY
MOUNTAIN
Plan Type: Group Health
8003824661
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-275
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
KAISER PERMANENTE NORTH WEST CHECK BENEFIT CARD
Affiliated With: KAISER FOUNDATION
HEALTH PLAN OF THE NORTHWEST
Plan Type: Group Health
Kaisers Contracting Cleaning
Specialities Inc
Affiliated With: Midwest Security
Administrators
Plan Type: Group Health
KALB CONSTRUCTION - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
8008132000
MET Team
MET Team
2700 Midwest Dr.
ONALASKA WI 54650
(800) 783-9281
CHECK BENEFIT CARD
(800) 783-9281
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
KANSAS CITY VAMC 3526
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
KANSAS CITY VAMC
Attn: FEE BASIS 136E
4801 LINWOOD BLVD
KANSAS CITY MO 64128
KANSAS CITY VAMC
CHECK BENEFIT CARD
KATAHDIN PAPER COMPANY LLC
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
KAYCAN LTD
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
(800) 533-5044
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-276
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
KAYSUN CORPORATIOM
Affiliated With: EMPLOYEE BENEFIT
CONSULTANT
Plan Type: Group Health
KBS BUILDING SYSTEMS
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
CLAIMS SUBMISSION
COMPENSABILITY
EMPLOYEE BENEFIT CONSULTANTS EMPLOYEE BENEFIT CONSULTANTS UM NOT APPLICABLE
PO Box 928
(800) 558-7798
FINDLAY OH 45839
(800) 558-7798
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
5087522480
CMS INC
(866) 325-1550
THE EPOCH GROUP
THE EPOCH GROUP
CHECK BENEFIT CARD
10793 WATSON RD
ST. LOUIS MO 63127-1036
(314) 821-3957
5087522480
KCG INC
Affiliated With: THE EPOCH GROUP
#10469
Plan Type: Group Health
KEENE TECHNOLOGY, INC
Affiliated With: EMPLOYEE BENEFIT
CONSULTANTS
Plan Type: Group Health
KELLER SUPPLY COMPANY
Affiliated With: EMPLOYEE BENEFIT
MANAGEMENT SERVICES, INC.
Plan Type: Group Health
(314) 821-3957
EMPLOYEE BENEFIT CONSULTANTS EMPLOYEE BENEFIT CONSULTANTS CHECK BENEFIT CARD
PO Box 928
(800) 558-7798
FINDLAY OH 45839
(800) 558-7798
EBMS
EBMS
PO Box 21367
BILLINGS MT 59104-1367
(800) 777-3575
CHECK BENEFIT CARD
(800) 777-3575
KEMA CONSULTING
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY PO Box 7045
Plan Type: Group Health
WYOMISSING PA 19610
THE LOOMIS COMPANY
CHECK BENEFIT CARD
(877) 634-9814
(877) 634-9814
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-277
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
KENNESAW STATE UNIV AIH0058327 PEARCE ADMINISTRATION
Affiliated With: MAKSIN MANAGEMENT PO Box 2271
CORP #14005
Florence SC 29503
Plan Type: Group Health
(843) 622-6001
KENNESAW STATE UNIV AIH0058337
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
KENNESAW STATE UNIVERSITY
UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
CHECK BENEFIT CARD
(843) 622-6001
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
KENTUCKY CHRISTIAN UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(843) 622-6001
(843) 622-6001
KENTUCKY MACHINE AND
ENGINEERING
Affiliated With: NORTH AMERICA
ADMINISTRATORS, L.P.-TENNESSEE
Plan Type: Group Health
NORTH AMERICA
ADMINISTRATORS, L.P.
NORTH AMERICA
ADMINISTRATORS, L.P.
NORTH AMERICA
ADMINISTRATORS, L.P.
KERN HIGH SCHOOL DISTRICT
Affiliated With: K-12 STUDENT
INSURANCE, A DIVISION OF UICI
Plan Type: Group Health
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
CHECK BENEFIT CARD
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
PO Box 1984
NASHVILLE TN 37202
(800) 237-0903 Ext 6352
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-278
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
KERN VALLEY HEALTHCARE
DISTRICT
Affiliated With: MANAGED CARE
SYSTEMS
Plan Type: Group Health
CLAIMS SUBMISSION
MANAGED CARE SYSTEMS
5080 CALIFORNIA AVE STE 120
BAKERSFIELD CA 93309
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MANAGED CARE SYSTEMS
6617167100
ASSOCIATED ADMINISTRATORS,
INC.
ASSOCIATED
ADMINISTRATORS, INC.
CHECK BENEFIT CARD
6617167100
KETTLE FOODS
Affiliated With: ASSOCIATED
ADMINISTRATORS, INC.
Plan Type: Group Health
ASSOCIATED ADMINISTRATORS,
INC.
KETTLE FOODS
Affiliated With: P5 HEALTH PLAN
SOLUTIONS
Plan Type: Group Health
P5 E HEALTH SERVICES, INC.
P5 E HEALTH SERVICES, INC.
2455 E. Parleys Way #300
Salt Lake City UT 84109
(800) 348-6898
2929 NW 31st St
PORTLAND OR 97210
(800) 348-6898
KEY MANAGEMENT CO OF
MISSOURI, LLC
BENEFIT ADMINISTRATIVE
SYSTEMS
BENEFIT ADMINISTRATIVE
SYSTEMS
Affiliated With: BENEFIT
ADMINISTRATIVE SYSTEMS
Plan Type: Group Health
17475 Jovanna Dr. STE 1B
HOMEWOOD IL 60430
(618) 628-0289
Key Risk Management Services, Inc.
Affiliated With: Key Risk Insurance
Company
Plan Type: Workers' Compensation
KEY RISK MANAGEMENT SERVICES,
INC.
Affiliated With: PENN WESTERN
BENEFITS, INC.
Plan Type: Group Health
UTILIZATION REVIEW
MANAGED CARE SYSTEMS
(661) 716-7140
CHECK BENEFIT CARD
(618) 628-0289
Key Risk Insurance Company
Key Risk Insurance Company
PO Box 49129
Greensboro NC 27419
(800) 366-1511
Key Risk Insurance Company
(800) 366-1511
PENN WESTERN BENEFITS, INC.
CHECK BENEFIT CARD
(800) 366-1511
PENN WESTERN BENEFITS, INC.
C/O CCN
PO Box 5190
TAMPA FL 33675-5190
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-279
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
KEYS INSURANCE SERVICES INC
Affiliated With: SELF INSURED
BENEFIT ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
SELF INSURED BENEFIT
ADMINISTRATORS, INC.
101 STARCREST DR
CLEARWATER FL 33758
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SELF INSURED BENEFIT
ADMINISTRATORS, INC.
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 683-7422
(800) 683-7422
KEYSPAN ENERGY DELIVERY
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATORS
Plan Type: Group Health
EBPA
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
EBPA
CHECK BENEFIT CARD
(800) 578-3272
(800) 578-3272
KEYWELL LLC
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
CHECK BENEFIT CARD
(800) 533-5044
KIFI TV8
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
KIN DAH LICHI 'I OLTA
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
SRT ADMINISTRATORS, INC.
SRT ADMINISTRATORS, INC.
CHECK BENEFIT CARD
KINETICS NOISE CONTROL
Affiliated With: BUSINESS
ADMINISTRATORS AND
CONSULTANTS
Plan Type: Group Health
BAC
BAC
6331 E LIVINGSTON AVE
REYNOLDSBURG OH 43068
(614) 863-8780
BAC
(614) 863-8780
PO Box 25160
SCOTTSDALE AZ 85255-0102
(614) 863-8780
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-280
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
KING, CHAPMAN & BROUSSARD, INC BUSINESS ADMINISTRATORS &
CONSULTANTS INC
Affiliated With: BUSINESS
ADMINISTRATORS & CONSULTANTS PO Box 107
Plan Type: Group Health
REYNOLDSBURG OH 43068
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BUSINESS ADMINISTRATORS &
CONSULTANTS INC
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 521-2684
(614) 863-8780
KINGFISHER REGIONAL HOSPITAL
Affiliated With: C L FRATES &
COMPANY
Plan Type: Group Health
C.L. FRATES AND COMPANY
C.L. FRATES AND COMPANY
PO Box 26967
OKLAHOMA CITY OK 73126-0967
(405) 290-5696
CHECK BENEFIT CARD
(405) 290-5696
KINRO INC
Affiliated With: BOON CHAPMAN
BENEFIT ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
KINROSS GOLD USA INC
Affiliated With: EBMS EMPLOYEE
BENEFIT MANAGEMENT SERVICES
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
KINROSS GOLD USA INC TRAVEL
Affiliated With: EMPLOYEE BENEFIT
MANAGEMENT SERVICES
Plan Type: Group Health
EBMS
KINSETH HOTEL COORPORATION
Affiliated With: SISCO/Cottingham &
Butler
Plan Type: Group Health
8007773575
EBMS
CHECK BENEFIT CARD
BUTLER BENEFIT SERVICES
BUTLER BENEFIT SERVICES
CHECK BENEFIT CARD
215 N MAIN ST STE 800
DAVENPORT IA 52801
(563) 327-2240
PO Box 21367
BILLINGS MT 59104-1367
(563) 327-2240
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-281
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
KIPP & CO PACTRUST
Affiliated With: GLOBALCARE
Plan Type: Group Health
CLAIMS SUBMISSION
GLOBALCARE
6875 Shiloh Rd E
ALPHARETTA GA 30005
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GLOBALCARE
UTILIZATION REVIEW
UM NOT APPLICABLE
(678) 341-1922
(678) 341-1922
KIPP AND COMPANY - WRG DESIGN
Affiliated With: GLOBALCARE
Plan Type: Group Health
GLOBALCARE
GLOBALCARE
6875 Shiloh Rd E
ALPHARETTA GA 30005
(678) 341-1922
UM NOT APPLICABLE
(678) 341-1922
KIRK NATIONAL LEASE
Affiliated With: THE CHANDLER
GROUP #13352
Plan Type: Group Health
KITTRELL GARLOCK & ASSOCIATES
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
DIRECT CARE AMERICA
DIRECT CARE AMERICA
PO Box 2090 C
STOW OH 44224
(800) 266-5896
CHECK BENEFIT CARD
(800) 266-5896
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
KLAIS & COMPANY - PEPM
Affiliated With: KLAIS & COMPANY
Plan Type: Group Health
KLAIS & COMPANY INC
KLAIS & COMPANY INC
1867 W MARKET ST
AKRON OH 44313
(800) 331-1096
CHECK BENEFIT CARD
(800) 331-1096
KLAMATH ALCOHOL & DRUG ABUSE,
INC.
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-282
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
KLAMATH CHILD AND FAMILY
TREATMENT CENTER
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
KLAMATH COUNTY EMPLOYESS
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
KLAMATH COUNTY SCHOOLS
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
KLAMATH FALLS CITY SCHOOLS
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
KLAMATH FAMILY HEAD START
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
KLAMATH FAMILY PRACTICE
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
CLAIMS SUBMISSION
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
QVI RISK SOLUTIONS INC
(541) 312-8512
UTILIZATION REVIEW
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-283
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
KLAMATH HEALTH PARTNERSHIP
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
KLAMATH HOSPICE
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
KLAMATH MEDICAL CLINIC
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
KLAMATH ORTHOPEDIC & SPORTS
MEDICINE CLINIC
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
KLAMATH RADIOLOGY ASSOCIATES,
PC
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
KLAUSSNER FURNITURE
INDUSTRIES, INC
Affiliated With: PRIMARY
PHYSICIANCARE
Plan Type: Group Health
CLAIMS SUBMISSION
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
QVI RISK SOLUTIONS INC
(541) 312-8512
UTILIZATION REVIEW
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
PPC
PPC
PO Box 11088
CHARLOTTE NC 28220
(800) 446-5439
PPC
(704) 523-2758
(800) 446-5439
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-284
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
KNOWLEDGE HEALTHCARE, INC
SIERRA HEALTH & LIFE/HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN OF NEVADA
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
KOHNER PROPERTIES
Affiliated With: THE EPOCH GROUP
Plan Type: Group Health
THE EPOCH GROUP
THE EPOCH GROUP
10795 Watson Rd
St. Louis MO 63129
(314) 821-3957
HEALTHLINK
(314) 821-3957
(314) 821-3957
KONOCTI UNIFIED SCHOOLS
Affiliated With: K-12 STUDENT
INSURANCE, A DIVISION OF UICI
Plan Type: Group Health
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
KORTE ELECTRIC
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
4040 HUNSAKER STE 110
LANSING MI 38823
(800) 968-6616
CARELINE
(763) 383-4800
(800) 968-6616
KOYO CORPORATION
Affiliated With: HEALTHSCOPE
BENEFITS, INC
Plan Type: Group Health
KRAFT FOODS
Affiliated With: HEALTHSCOPE
BENEFITS INC
Plan Type: Group Health
HEALTHSCOPE BENEFITS INC
HEALTHSCOPE BENEFITS INC
27 CORPORATE HILL DR
LITTLE ROCK AR 72205
(866) 885-4944
HEALTHSCOPE BENEFITS INC
(501) 218-7691
(800) 560-4664
HEALTHSCOPE BENEFITS INC
HEALTHSCOPE BENEFITS INC
27 CORPORATE HILL DR
LITTLE ROCK AR 72205
(866) 885-4944
HEALTHSCOPE BENEFITS INC
(501) 218-7691
(800) 560-4664
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-285
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
KRALIS BROTHERS FOODS
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
KUMHO TIRE USA INC
Affiliated With: AFFORDABLE BENEFIT
ADMINISTRATORS, INC. (ABA)
Plan Type: Group Health
CLAIMS SUBMISSION
TALL TREE ADMINISTRATORS
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
TALL TREE ADMINISTRATORS
(801) 274-8100
UTILIZATION REVIEW
CORVEL
(810) 269-8723
(801) 274-8100
AFFORDABLE BENEFIT
ADMINISTRATORS INC
AFFORDABLE BENEFIT
ADMINISTRATORS INC
PO Box 10787
BURBANK CA 91510-0787
(818) 842-0147
AFFORDABLE BENEFIT
ADMINISTRATORS INC
(818) 842-0147
(818) 842-0147
KYOCERA
Affiliated With: CORESOURCE INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CORESOURCE, MN
(866) 280-4120
KYOCERA AMERICA, INC.
Affiliated With: KYOCERA
INTERNATIONAL, INC.
Plan Type: Group Health
HELLER ASSOCIATES
HELLER ASSOCIATES
HELLER ASSOCIATES
KYOCERA SOLAR, INC.
Affiliated With: KYOCERA
INTERNATIONAL, INC.
Plan Type: Group Health
HELLER ASSOCIATES
HELLER ASSOCIATES
HELLER ASSOCIATES
KYOCERA TYCOM
Affiliated With: KYOCERA
INTERNATIONAL, INC.
Plan Type: Group Health
HELLER ASSOCIATES
HELLER ASSOCIATES
HELLER ASSOCIATES
2755 Bristol St STE 250
COSTA MESA CA 92626
2755 Bristol St STE 250
COSTA MESA CA 92626
2755 Bristol St STE 250
COSTA MESA CA 92626
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-286
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The First Health® Network
CALIFORNIA Payor Information Report
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HELLER ASSOCIATES
HELLER ASSOCIATES
SELF INSURED SERVICES
COMPANY (SISCO)
SELF INSURED SERVICES
COMPANY (SISCO)
HEALTHCORP
(800) 457-4726
PO Box 389
DUBUQUE IA 52004-0389
(800) 457-4726
PAYOR NAME
CLAIMS SUBMISSION
KYOCERA WIRELESS CORPORATION HELLER ASSOCIATES
Affiliated With: KYOCERA
2755 Bristol St STE 250
INTERNATIONAL, INC.
COSTA MESA CA 92626
Plan Type: Group Health
K-Z, Inc.
Affiliated With: SISCO/Cottingham &
Butler
Plan Type: Group Health
UTILIZATION REVIEW
(800) 457-4726
L ROBERT KIMBALL AND
THE LOOMIS COMPANY
ASSOCIATES
PO Box 7011
Affiliated With: THE LOOMIS COMPANY WYOMISSING PA 19610-6011
Plan Type: Group Health
(800) 346-1223
THE LOOMIS COMPANY
(800) 346-1223
HINES & ASSOCIATES
(888) 826-5769
LAARS, INC
DIRECT CARE AMERICA
Affiliated With: THE CHANDLER GROUP PO Box 2090 C
Plan Type: Group Health
STOW OH 44224
DIRECT CARE AMERICA
CHECK BENEFIT CARD
(800) 266-5896
(800) 266-5896
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
EBPA
EBPA
CHECK BENEFIT CARD
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
LAB SAFETY SUPPLY
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC
Plan Type: Group Health
MIDWEST SECURITY
ADMINISTRATORS, INC.
LABEL TECH INC JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
PO Box 574
ONALASKA WI 54650
(802) 846-8060
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-287
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The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LABOR CONNECTION INC
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS INC
Plan Type: Group Health
CLAIMS SUBMISSION
TRANSWESTERN INSURANCE
ADMINISTRATORS, INC.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
THE LOOMIS COMPANY
CHECK BENEFIT CARD
UTILIZATION REVIEW
PO Box 45019
Fresno CA 93718
8002218942
LABOR READY
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY 850 N PARK RD
Plan Type: Group Health
WYOMISSING PA 19610
(866) 473-6615
(866) 473-6615
LACK STORES INC
Affiliated With: BUSINESS
ADMINISTRATORS CONSULTANTS
Plan Type: Group Health
BUSINESS ADMINISTRATORS &
CONSULTANTS INC
BUSINESS ADMINISTRATORS &
CONSULTANTS INC
PO Box 107
REYNOLDSBURG OH 43068
(800) 521-2654
CHECK BENEFIT CARD
(800) 521-2654
LACONIA SAVINGS BANK
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
EBPA
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
EBPA
CHECK BENEFIT CARD
(800) 578-3272
(800) 578-3272
LADY CUBITT COMPASSIONATE
ASSOCIATION
Affiliated With: LIBERTY MUTUAL
Plan Type: Group Health
LIBERTY MUTUAL
LIBERTY MUTUAL
LIBERTY MUTUAL
LAFRANCE BROTHERS, INC. ET AL
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
BENEFIRST LLC
BENEFIRST LLC
1020 PLAIN ST
MARSHFIELD MA 02050
7818374402
AMERICAN HEALTH HOLDINGS
(800) 641-3224
100 Main St., Box 1525
DOVER NH 03320
7818374402
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-288
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LAKE COUNTY
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
LAKE COUNTY CLERK OF COURTS
Affiliated With: WEB TPA
Plan Type: Group Health
CLAIMS SUBMISSION
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
QVI RISK SOLUTIONS INC
(541) 312-8512
UTILIZATION REVIEW
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
WEB TPA
WEB TPA
1000 Riverside Ave. #500
JACKSONVILLE FL 32204
(800) 697-2235
CHECK BENEFIT CARD
(800) 697-2235
LAKE COUNTY GOVERNMENT
Affiliated With: PROFESIONAL CLAIMS
MANAGEMENT
Plan Type: Group Health
PROFESSIONAL CLAIMS MGMT
PROFESSIONAL CLAIMS MGMT
16455 Frontage Rd
Burr Ridge IL 60527
(800) 590-6500
(800) 590-6500
LAKE COUNTY PLASTERS AND
CEMENT MASONS WELFARE
LAKE COUNTY PLASTERS
AND CEMENT MASONS
WELFARE
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
LAKE COUNTY PLASTERS AND
CEMENT MASONS WELFARE FUND
Affiliated With: LAKE COUNTY
PLASTERS & CEMENT MASONS
WELFARE FUND
Plan Type: Group Health
LAKE COUNTY PLASTERS AND
CEMENT MASONS WELFARE
LAKE DISTRICT HOSPITAL
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
LAKE ELSINORE UNIFIED SCHOOLS
Affiliated With: K-12 STUDENT
INSURANCE, A DIVISION OF UICI
Plan Type: Group Health
CHECK BENEFIT CARD
28 N. First St
GENEVA IL 60134
(541) 312-8512
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-289
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LAKE FOREST COLLEGE
Affiliated With: PIONEER
MANAGEMENT SERVICES
Plan Type: Group Health
LAKE LAS VEGAS RESORT
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
PIONEER MANAGEMENT SYSTEMS
PO Box 9040
WEST SPRINGFIELD MA 01090
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PIONEER MANAGEMENT SYSTEMS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(413) 539-9900
(413) 539-9900
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
LAKELAND VILLAGE
Affiliated With: CNIC HEALTH
SOLUTIONS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
LAKESHORE FOODS CORPORATION
Affiliated With: PROFESSIONAL
BENEFIT ADMINISTRATORS, INC. /
ILLINO
Plan Type: Group Health
PROFESSIONAL BENEFIT
ADMINISTRATORS, INC. C/O CCN
Professional Benefit Administrators, Inc. CHECK BENEFIT CARD
LAKESIDE INDUSTRIES, INC
Affiliated With: EMPLOYEE BENEFIT
MANAGAMENT SERVICES #15318
Plan Type: Group Health
EBMS
EBMS
PO Box 21367
BILLINGS MT 59104-1367
(800) 777-3575
LAKESIDE TRAVEL
Affiliated With: FISERV HEALTH KANSAS
Plan Type: Group Health
CHECK BENEFIT CARD
900 Jorie Blvd Ste 250
Oakbrook IL 60523
EBMS CARELINK
4062453575
(800) 777-3575
FISERV HEALTH KANSAS
FISERV HEALTH KANSAS
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
TRUSTMARK LIFE INSURANCE
CO.
(800) 725-6566
(800) 235-7160
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-290
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LAMAR COUNTY
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
GROUP & PENSION
ADMINISTRATORS INC
12770 MERIT DR STE 200
DALLAS TX 75251
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GROUP & PENSION
ADMINISTRATORS INC
UTILIZATION REVIEW
HEALTH WATCH
(972) 238-7900
(972) 238-7900
(972) 238-7900
LAMAR UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
LAND AIR EXPRESS INC
Affiliated With: MERITAIN HEALTH
Plan Type: Group Health
TRUE CHOICE USA
TRUE CHOICE USA
PO Box 700307
DALLAS TX 75370
(800) 785-2446
CHECK BENEFIT CARD
(800) 785-2446
MERITAIN HEALTH
MERITAIN HEALTH
PO Box 1090
EVANSVILLE IN 47706
(800) 455-1938
UM NOT APPLICABLE
(800) 455-1938
LAND AIR EXPRESS OF N E
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
LANDAMRK COMMUNITIES
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
LANDER MEDICAL CLINIC
Affiliated With: MANAGED BENEFITS
ADMINISTRATORS & INS
CONSULTANTS
Plan Type: Group Health
MANAGED BENEFITS
ADMINISTRATOR & INSURANCE
CONSULTANTS
MANAGED BENEFITS
ADMINISTRATOR & INSURANCE
CONSULTANTS
PO Box 98
WORLAND WY 82401
(307) 347-6151
MOUNTAIN STATES REVIEW
(307) 347-7979
(307) 347-6151
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-291
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LANDMARK COLLEGE WRAP JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
LANDMARK SERVICES, INC
Affiliated With: FCE BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
EBPA
PO Box 2365
SOUTH BURLINGTON VT 05403
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EBPA
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 525-8788
(802) 846-8060
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC UM NOT APPLICABLE
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
LANDSCAPE DEVELOPMENT INC
Affiliated With: PHYSICIANS
DEVELOPMENT INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
LANG GRAPHICS, LTD.
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC
Plan Type: Group Health
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
LAS VEGAS ATHLETIC CLUB
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 742-7345
2700 Midwest Dr.
ONALASKA WI 54650
(702) 242-7700
LAS VEGAS POLICE PROTECTIVE
ASSOCIATION CIVILIAN EMPLOYEES
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-292
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LAUNDRY AND DRY CLEANING
WORKERS HEALTH AND WELFARE
TRUST
Affiliated With: LAUNDRY AND DRY
CLEANING WORKERS HEALTH AND
WELFAR
Plan Type: Group Health
Laundry, Dry Cleaning Workers & Allied
Industries Health Fund
Affiliated With: Amalgamated Life
Insurance Co
Plan Type: Group Health
CLAIMS SUBMISSION
BENEFIT PROGRAM
ADMINISTRATOR
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BENEFIT PROGRAM
ADMINISTRATOR
UTILIZATION REVIEW
CHECK BENEFIT CARD
13191 CROSSROADS PARK NORTH
STE 205
CITY OF INDUSTRY CA 91746-3434
Amalgamated Life Insurance Co.
Amalgamated Life Insurance Co.
730 Broadway
New York NY 10003
ECS Payor ID 13550
(212) 539-5104
ALICARE, Inc
(800) 332-5426
(212) 539-5104
LAUREL HEALTH CARE COMPANY
Affiliated With: PROFESSIONAL
BENEFIT ADMINISTRATORS
Plan Type: Group Health
PROFESSIONAL BENEFIT
ADMINISTRATORS
PROFESSIONAL BENEFIT
ADMINISTRATORS
PO Box 4687
OAKBROOK IL 60522-4687
(800) 435-5694
CHECK BENEFIT CARD
(800) 435-5694
LB WHITE COMPANY
Affiliated With: MMSI
Plan Type: Group Health
MMSI
MMSI
4001 41ST STREET NW
ROCHESTER MN 55901
(800) 965-6674
MMSI
(800) 965-6674
(800) 965-6674
LEADER DISTRIBUTION SYSTEMS INC GISC, INC
Affiliated With: GROUP INSURANCE
20 WINTER ST
SERVICE CENTER
PEMBROKE MA 02359
Plan Type: Group Health
(800) 242-4472
GISC, INC
LEAR CORPORATION
Affiliated With: ASSURECARE OF
ILLINOIS
Plan Type: Group Health
ASSURECARE
ASSURECARE
4050 HUNSACKER DR STE 110
EAST LANSING MI 48823
(800) 968-6616
(800) 242-4472
GISC TOTALCARE
(800) 242-4472
ASSURECARE
(800) 968-6616
(800) 968-6616
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-293
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LEARFIELD COMMUNICATIONS, INC
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
MUTUAL ASSURANCE
ADMINISTRATORS
3121 QUAIL SPRINGS PKWY
OKLAHOMA CITY OK 73134
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MUTUAL ASSURANCE
ADMINISTRATORS
UTILIZATION REVIEW
(800) 825-3540
MUTUAL ASSURANCE
ADVANTAGE
(800) 825-3540
(800) 825-3540
LEASE CRUTCHER LEWIS
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS
INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
LEAVITT GROUP
Affiliated With: P5 HEALTH PLAN
SOLUTIONS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
LEAVITT GROUP AGENCY
ASSOCIATION
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
HEALTH NET FEDERAL SERVICES
HEALTH NET FEDERAL SERVICES
CHECK BENEFIT CARD
5504 HILL HEAVEN CT
FRISCO TX 75035
(214) 387-3232
Affiliated With: P5 HEALTH SOLUTIONS
Plan Type: Group Health
LEBANON VAMC 3126
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
LEDCOR HOLDINGS INC
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
(214) 387-3232
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-294
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
LEDCOR HOLDINGS INC - TRAVEL
SIERRA HEALTH & LIFE/HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN OF NEVADA
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
LEE AND RUSSELL LAW FIRM TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
LEGACY BANK
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
LEGACY INVESTMENTS
Affiliated With: PRODUCERS
EXCHANGE BENEFIT SERVICES INC
Plan Type: Group Health
PRODUCERS EXCHANGE BENEFIT
SERVICES INC.
PRODUCERS EXCHANGE BENEFIT
SERVICES INC.
4004 BELT LINE RD STE 160
ADDISON TX 75001
(800) 443-2595
CHECK BENEFIT CARD
(800) 443-2595
LEICA GEOSYSTEMS
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NEW YORK
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
LENNYS FURNITURE, INC
Affiliated With: SELF INSURED
BENEFIT ADMINISTRATORS, LLC
Plan Type: Group Health
SELF INSURED BENEFIT
ADMINISTRATORS, INC.
SELF INSURED BENEFIT
ADMINISTRATORS, INC.
UM NOT APPLICABLE
101 STARCREST DR
CLEARWATER FL 33758
(727) 532-0400
(727) 532-0400
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-295
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LESCO RESTORATIONS INC
Affiliated With: CORPORATE
BENEFITS SERVICE INC
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
8002779476
Letica Corporation
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
LEW A CUMMINGS PRINTING INC
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
LEWIS AND CLARK UNIVERSITY
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS
Plan Type: Group Health
PERSONAL INSURANCE
ADMINISTRATORS
PERSONAL INSURANCE
ADMINISTRATORS
CHECK BENEFIT CARD
30401 Agoura Rd #250
Agoura Hills CA 91376
(800) 468-4343
(800) 468-4343
LEWIS M CARTER MANUFACTURING
COMPANY
Affiliated With: KHS, A KMG AMERICA
COMPANY
Plan Type: Group Health
LEWIS M CARTER MANUFACTURING
COMPANY PEPM
Affiliated With: KHS, A KMG AMERICA
COMPANY
Plan Type: Group Health
KHS, A KMG AMERICA COMPANY
KHS, A KMG AMERICA COMPANY
PO Box 1000
LANCASTER SC 29721
(803) 283-5378
KHS, A KMG AMERICA
COMPANY
(803) 283-2737
(803) 283-5378
KHS, A KMG AMERICA COMPANY
KHS, A KMG AMERICA COMPANY
PO Box 1000
LANCASTER SC 29721
(803) 283-5378
KHS, A KMG AMERICA
COMPANY
(803) 283-2737
(803) 283-5378
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-296
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LEWIS SEEDS
Affiliated With: NORTH AMERICA
ADMNISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
NORTH AMERICA
ADMINISTRATORS, L.P.
PO Box 1984
NASHVILLE TN 37202
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NORTH AMERICA
ADMINISTRATORS, L.P.
UTILIZATION REVIEW
MED-CERT
(800) 356-7126
(615) 255-6654
(615) 255-6654
LEXINGTON PRECISION
CORPORATION
Affiliated With: THE CHANDLER
GROUP #13352
Plan Type: Group Health
DIRECT CARE AMERICA
DIRECT CARE AMERICA
PO Box 2090 C
STOW OH 44224
(800) 266-5896
CHECK BENEFIT CARD
(800) 266-5896
LEXINGTON VA MEDICAL CENTER
3147
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
LEXINGTON VA MEDICAL CENTER
Attn: 4-FEE
1101 VETERANS DR
LEXINGTON KY 40502
LEXINGTON VA MEDICAL CENTER
CHECK BENEFIT CARD
LIBERTY GOLD
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Liberty Mutual
Affiliated With: Fair Isaac
Plan Type: Auto
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Liberty Mutual Insurance
Company/Liberty Northwest Companies
Affiliated With: Liberty Mutual Insurance
Company/Liberty
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
8772615511
Participates in California Custom
Network (Please refer to patient's
employer to confirm your participation in
this Network)
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-297
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LICKING KNOX GOODWILL
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
(800) 283-4927
UTILIZATION REVIEW
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
LIDSEEN OF NORTH CAROLINA
Affiliated With: FISERV HEALTH KANSAS
Plan Type: Group Health
LIFEGUARD TRANSPORTATION
SERVICES INC
Affiliated With: HILLCREST BENEFIT
ADMINISTRATORS
Plan Type: Group Health
LIFETIME FITNESS
Affiliated With: AMERICA'S TPA
Plan Type: Group Health
FISERV HEALTH KANSAS
FISERV HEALTH KANSAS
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
TRUSTMARK LIFE INSURANCE
CO.
(800) 725-6566
(800) 235-7160
HILLCREST BENEFIT
ADMINISTRATORS INC
HILLCREST BENEFIT
ADMINISTRATORS INC
PO Box 1516
MOUNT DORA FL 32756
(800) 743-9264
STRATEGIC HEALTH
DEVELOPMENT
(800) 874-2378
America's TPA
America's TPA
CHECK BENEFIT CARD
PO Box 398220
Bloomington MN 55439
(952) 896-4888
(800) 743-9264
(952) 896-4888
LIFETIME FITNESS TRAVEL
Affiliated With: AMERICA'S TPA
Plan Type: Group Health
America's TPA
America's TPA
PO Box 398220
Bloomington MN 55439
(952) 896-4888
CHECK BENEFIT CARD
(952) 896-4888
LIFEWISE HEALTH PLAN OF OREGON
Affiliated With: LIFEWISE HEALTH
PLAN OF OREGON
Plan Type: Group Health
Term Effective: 9/6/2007
LIFEWISE HEALTH PLAN OF
OREGON
LIFEWISE HEALTH PLAN OF
OREGON
815 S W BOND
BEND OR 97702
(800) 722-3372
LIFEWISE HEALTH PLAN OF
OREGON
(800) 722-3372
(800) 722-3372
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-298
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
THE LOOMIS COMPANY
LIFT-ALL COMPANY
Affiliated With: THE LOOMIS COMPANY PO Box 14086
Plan Type: Group Health
READING PA 19612-4086
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
THE LOOMIS COMPANY
UTILIZATION REVIEW
(800) 875-2364
CHN SOLUTIONS
(800) 293-9795
EBA&M
EBA&M
UM NOT APPLICABLE
PO Box 5079
WESTLAKE VILLAGE CA 91359
(800) 776-1545
(800) 875-2364
LIMONEIRA COMPANY
Affiliated With: EMPLOYEE BENEFITS
ADMINISTRATION & MGMT (EBA&M)
Plan Type: Group Health
(800) 776-1545
LINCOLN UNIVERSITY
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
CHECK BENEFIT CARD
Lincolnway Affiliate Schools
Affiliated With: Lincolnway Affiliate
Schools
Plan Type: Group Health
Professional Benefit Administrators, Inc. Professional Benefit Administrators, Inc. First Health
(800) 522-8812
900 Jorie Blvd Ste 250
(630) 655-3755
Oakbrook IL 60523
CHECK BENEFIT CARD
CHECK BENEFIT CARD
For written inquiries regarding claims &
payment, contact:
ASCO
800 Roosevelt Rd Bldg E #200
Glen Ellyn IL 60137
(630) 655-3755
(800) 323-8092 Outside IL
LINDEN A SHOWALTER CPA
Affiliated With: MENNONITE MUTUAL
AID
Plan Type: Group Health
LINDENMEYER MUNROE
Affiliated With: GROUP INSURANCE
SERVICE CENTER INC
Plan Type: Group Health
MMA
MMA
PO Box 483
GOSHEN IN 46527
(800) 348-7468
CHECK BENEFIT CARD
(800) 348-7468
GROUP INSURANCE SERVICE
CENTER INC
GROUP INSURANCE SERVICE
CENTER INC
PO Box 9120
MARSHFIELD MA 02050
(800) 242-4472
CHECK BENEFIT CARD
(800) 242-4472
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-299
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LINFIELD COLLEGE - DOMESTIC
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
CLAIMS SUBMISSION
PERSONAL INSURANCE
ADMINISTRATORS
30401 Agoura Rd #250
Agoura Hills CA 91376
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PERSONAL INSURANCE
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 468-4343
(800) 468-4343
LINFIELD COLLEGE INTERNATIONAL
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
PERSONAL INSURANCE
ADMINISTRATORS
PERSONAL INSURANCE
ADMINISTRATORS
30401 Agoura Rd #250
Agoura Hills CA 91376
(800) 468-4343
CHECK BENEFIT CARD
(800) 468-4343
LINK SNACKS INC
Affiliated With: PREFERREDONE
ADMINISTRATIVE SERVICES
Plan Type: Group Health
PREFERREDONE ADMINISTRATIVE
SERVICES
PO Box 59212
MINNEAPOLIS MN 55459
PREFERREDONE ADMINISTRATIVE PREFERREDONE
ADMINISTRATIVE SERVICES
SERVICES
(800)
997-1750
(800) 997-1750
(800) 997-1750
LINTON-STOCKTON SCHOOL CORP
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
(800) 832-8212
LIPE ROLLWAY CORPORATION PRE
65 RETIREES
Affiliated With: THE EPOCH GROUP L
C
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
LIQUIDHUB INC
Affiliated With: BENEFIT CONCEPTS
INC
Plan Type: Group Health
BENEFIT CONCEPTS, INC.
BENEFIT CONCEPTS, INC.
CHECK BENEFIT CARD
PO Box 61553
KING OF PRUSSIA PA 19406
(610) 337-2600
(610) 337-2600
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-300
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
LITTLE SINGER COMMUNITY SCHOOL SRT ADMINISTRATORS, INC.
Affiliated With: SRT
PO Box 25160
ADMINISTRATORS, INC.
SCOTTSDALE AZ 85255-0102
Plan Type: Group Health
LIUNA
Affiliated With: ULLICO
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SRT ADMINISTRATORS, INC.
UTILIZATION REVIEW
CHECK BENEFIT CARD
LIUNA Staf Health and Welfare Plan
LIUNA Staf Health and Welfare Plan
905 16th St NW
Washington DC 20006
(800) 548-6242
Ullicare
(800) 848-9200
DIRECT CARE AMERICA
DIRECT CARE AMERICA
CHECK BENEFIT CARD
PO Box 2090 C
STOW OH 44224
(800) 266-5896
(800) 548-6242
LJ SMITH
Affiliated With: THE CHANDLER
GROUP 13352
Plan Type: Group Health
LOCAL 348 PLAN D RD JETRO (RDC)
Affiliated With: SUPERIEN HEALTH
NETWORK #18373
Plan Type: Group Health
(800) 266-5896
SUPERIEN HEALTH NETWORK
Attn: Supervisor of the Claims Dept
PO Box 2388 C
STOW OH 44224
SUPERIEN HEALTH NETWORK
CHECK BENEFIT CARD
(800) 266-5896
(800) 266-5896
LOCAL 348 PLAN J JETRO INNETWORK (JETINILA)
Affiliated With: SUPERIEN HEALTH
NETWORK #18373
Plan Type: Group Health
SUPERIEN HEALTH NETWORK
Attn: Supervisor of the Claims Dept
PO Box 2388 C
STOW OH 44224
SUPERIEN HEALTH NETWORK
CHECK BENEFIT CARD
(800) 266-5896
(800) 266-5896
LOCAL 348 STAFF PLAN
Affiliated With: SUPERIEN HEALTH
NETWORK #18373
Plan Type: Group Health
SUPERIEN HEALTH NETWORK
Attn: Supervisor of the Claims Dept
SUPERIEN HEALTH NETWORK
CHECK BENEFIT CARD
(800) 266-5896
PO Box 2388 C
STOW OH 44224
(800) 266-5896
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-301
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Local 75 California
Affiliated With: Amalgamated Life
Insurance Co.
Plan Type: Group Health
CLAIMS SUBMISSION
Amalgamated Life Insurance Co.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
PO Box 10728
Scottsdale AZ 85271
(800) 356-0850
LOCKHEED MISSILES & SPACE CO
LOCKHEED MISSILES & SPACE CO
LOCKHEED MISSILES & SPACE CO
Plan Type: Workers' Compensation
PO Box 23010
Tucson AZ 85734
(510) 790-4600
LOCKHEED MISSILES &
SPACE CO
(510) 790-4600
(510) 790-4600
LODGING HOST HOTEL
CORPORATION
Affiliated With: CORPORATE BENEFIT
SERVICE OF AMERICA
Plan Type: Group Health
LOGAN MEDICAL CENTER
Affiliated With: C L FRATES &
COMPANY
Plan Type: Group Health
CBSA
CBSA
400 Highway 169 South, Ste 800
Minneapolis MN 55426-1141
(952) 593-6438
GUIDED2HEALTH
(952) 593-6447
C.L. FRATES AND COMPANY
C.L. FRATES AND COMPANY
CHECK BENEFIT CARD
PO Box 26967
OKLAHOMA CITY OK 73126-0967
(405) 290-5696
(952) 593-6438
(405) 290-5696
Logans Roadhouse
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
LOGISTICS HEALTH INC
Affiliated With: MMSI
Plan Type: Group Health
MMSI
MMSI
4001 41ST STREET NW
ROCHESTER MN 55901
(800) 965-6674
MMSI
(800) 965-6674
(800) 965-6674
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-302
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
LOMA LINDA VA MEDICAL CENTER
LOMA LINDA VA MEDICAL CENTER
3190
Attn: FEE BASIS - 11C
Affiliated With: HEALTH NET FEDERAL 11201 BENTON ST
SERVICES
LOMA LINDA CA 92359
Plan Type: Group Health
LONE PINE UNIFIED SCHOOLS
Affiliated With: K-12 STUDENT
INSURANCE, A DIVISION OF UICI
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
LOMA LINDA VA MEDICAL CENTER
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
UTILIZATION REVIEW
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
LONG BEACH VAMC 3191
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
LONG BEACH VAMC
Attn: FEE BASIS 04F
5901 E 7TH ST
LONG BEACH CA 90822
LONG BEACH VAMC
CHECK BENEFIT CARD
LONG TERM CARE WORKERS
HEALTH TRUST FUND
PHYSICIANS CARE INSURANCE
SERVICES, INC.
PHYSICIANS CARE INSURANCE
SERVICES, INC.
Affiliated With: PHYSICIANS CARE
INSURANCE SERVICES
Plan Type: Group Health
PO Box 15165
SANTA ANA CA 92735
(714) 540-5882
PHYSICIAN CARE OF
CALIFORNIA
(714) 540-5882
NHBC
NHBC
CHECK BENEFIT CARD
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
LONGVIEW FIBRE
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
(714) 540-5882
(888) 621-7900
LOOMIS COMPANY
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY PO Box 7045
Plan Type: Group Health
Wyomissing PA 19610
THE LOOMIS COMPANY
CHECK BENEFIT CARD
(877) 634-9814
(877) 634-9814
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-303
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LOPEZ FOODS, INC.
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MUTUAL ASSURANCE
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 825-3540
(800) 825-3540
LOS ALAMITOS UNIFIED SCHOOL
DISTRICT
Affiliated With: LOS ALAMITOS
UNIFIED SCHOOL DISTRICT
Plan Type: Group Health
RIVERSIDE COUNTY FOUNDATION
FOR MEDICAL CARE
LOS ANGELES CARDIOLOGY
ASSOCIATES
Affiliated With: AFFORDABLE BENEFIT
ADMINISTRATORS, INC. (ABA)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
LOS ANGELES COUNTY
FIREFIGHTERS LOCAL 1014
Affiliated With: LOS ANGELES
COUNTY FIREFIGHTERS LOCAL 1014
Plan Type: Group Health
CHECK BENEFIT CARD
LOS ANGELES HOTEL-RESTAURANT
EMPLOYER UNION WLF FUND
Affiliated With: LOS ANGELES HOTELRESTAURANT EMPLOYER UNION
WELF
Plan Type: Group Health
LOS ANGELES HOTEL
RESTAURANT EMPLOYER UNION
WELFARE FUND
LOS RIOS COMMUNITY COLLEGE
DISTRICT
Affiliated With: A G ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
RIVERSIDE COUNTY FOUNDATION
FOR MEDICAL CARE
RIVERSIDE COUNTY
FOUNDATION FOR MEDICAL
CARE
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
CHECK BENEFIT CARD
CHECK BENEFIT CARD
3993 Jurupa
RIVERSIDE CA 92506
PO Box 3000
SCOTTSDALE AZ 85271-3000
8006601014
LOS ANGELES HOTEL
RESTAURANT EMPLOYER UNION
WELFARE FUND
LOS ANGELES HOTEL
RESTAURANT EMPLOYER
UNION WELFARE FUND
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PO Box 57924
LOS ANGELES CA 90057
6109330300
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-304
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
MACORI ADMINISTRATION
LOUISIANA STATE UNIVERSITY PENNINGTON
19609 WIED
Affiliated With: MAKSIN MANAGEMENT SPRING TX 77388
CORP
(800) 285-8133
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MACORI ADMINISTRATION
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 285-8133
LOUISIANA STATE UNIVERSITY
HEALTH SCIENCES CENTER
Affiliated With: STUDENT ASSURANCE
SERVICES INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
LOUISVILLE VAMC 3150
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
LOUISVILLE VAMC
Attn: FEE BASIS (136F)
800 ZORN AVE
LOUISVILLE KY 40206
LOUISVILLE VAMC
CHECK BENEFIT CARD
LOVARC
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
LOVEJOY TOOL COMPANY WRAP
JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
LOVES TRAVEL INC
Affiliated With: FMH BENEFIT
SERVICES INC
Plan Type: Group Health
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
CHECK BENEFIT CARD
(802) 846-8060
FMH BENEFIT SERVICES INC
FMH BENEFIT SERVICES INC
PO Box 25946
OVERLAND PARK KS 66225-5946
(800) 990-9058
CHECK BENEFIT CARD
(800) 990-9058
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-305
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LOVITT & TOUCHE
Affiliated With: MOUNTAIN STATES
ADMINISTRATIVE SERVICES INC
Plan Type: Group Health
CLAIMS SUBMISSION
Mountain States Administrative
Services
7202 E ROSEWOOD STE 200
TUCSON AZ 85710
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Mountain States Administrative
Services
UTILIZATION REVIEW
Hines and Associates
(847) 214-2780
(520) 722-7133
(520) 722-7133
LOWELL BROTHERS AND BAILEY
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
LSA ASSOCIATES, INC.
Affiliated With: BENEFIT AND RISK
MANAGEMENT SERVICES
Plan Type: Group Health
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
LSB INDUSTRIES
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
CHECK BENEFIT CARD
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
(800) 825-3540
LUCAS TREE EXPERTS PEPM
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
LUKACHUKAI COMMUNITY SCHOOL
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
SRT ADMINISTRATORS, INC.
SRT ADMINISTRATORS, INC.
CHECK BENEFIT CARD
PO Box 25160
SCOTTSDALE AZ 85255-0102
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-306
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
LUMBER PRODUCTS
Affiliated With: EBMS EMPLOYEE
BENEFIT MANAGEMENT SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
UTILIZATION REVIEW
Lumbermans Underwriting Alliance
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
Lutheran Church Synod
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
International Medical Group, Inc.
International Medical Group, Inc.
CHECK BENEFIT CARD
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
LYLE HUGHART WELFARE PLAN
Affiliated With: HEALTHCARE
SOLUTIONS GROUP INC
Plan Type: Group Health
(317) 655-4500 Outside US
(800) 628-4664 Inside US
HEALTHCARE SOLUTIONS GROUP,
INC.
HEALTHCARE SOLUTIONS GROUP,
INC.
PO Box 1309
MUSKOGEE OK 74402
(800) 749-1422
CHECK BENEFIT CARD
(800) 749-1422
M & J WILKOW, LTD.
Affiliated With: BENEFIT
ADMINISTRATIVE SYSTEMS, LTD.
Plan Type: Group Health
BENEFIT ADMINISTRATIVE
SYSTEMS, LTD.
BENEFIT ADMINISTRATIVE
SYSTEMS LTD
17475 Jovanna Dr. STE 1B
HOMEWOOD IL 60430
7087997400
BENEFIT ADMINISTRATIVE
SYSTEMS LTD
7087997400
M D PPRODUCTS INC
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-307
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* M7 Aerospace TRAVEL
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
GROUP & PENSION
ADMINISTRATORS
12770 MERIT DR STE 200
DALLAS TX 75251
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GROUP & PENSION
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 827-7223
(800) 827-7223
MAC Risk Managament, Inc.
Affiliated With: MAC Risk Managament
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Mac Risk MANAGEMENT, INC.
MAC Risk Management, Inc.
MAC Risk Management, Inc.
(800) 288-8415
MAC Risk Management, Inc.
(800) 288-8415
Plan Type: Workers' Compensation
45 Dan Road
Canton MA 02021
DIRECT CARE AMERICA
DIRECT CARE AMERICA
CHECK BENEFIT CARD
PO Box 2090 C
STOW OH 44224
(800) 266-5896
MAC Risk Management, Inc.
(800) 288-8415
MAC Risk Management, Inc.
(800) 288-8415
(800) 288-8415
MACCAFERRI INC
Affiliated With: THE CHANDLER
GROUP #13352
Plan Type: Group Health
MACON STATE COLLEGE AIH0058347
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
MACON STATE COLLEGE OF GA
UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
(800) 266-5896
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-308
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MACRO PLASTICS INC
Affiliated With: BROKERAGE
CONCEPTS INC/BENEFIT CONCEPTS
INC.
Plan Type: Group Health
CLAIMS SUBMISSION
PERFORMAX / BROKERAGE
CONCEPTS, INC.
PO Box 61505
KING OF PRUSSIA PA 19406
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PERFORMAX / BROKERAGE
CONCEPTS, INC.
UTILIZATION REVIEW
(888) 554-7629
PERFORMAX / AMERICAN
HEALTH HOLDING
(800) 337-0506
(888) 554-7629
MACSTEEL SERVICE CENTERS USA
Affiliated With: INNOVATIVE
ADMINISTRATIVE SERVICES
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Madison National Life Insurance
Company Inc
Affiliated With: Insurers Administrative
Corporation
Plan Type: Group Health
Benefits/Eligibility
Benefits/Eligibility
PO Box 828
Park Ridge IL 60068-0828
(800) 843-3106
CHECK BENEFIT CARD
(800) 522-2161
Insurers Administrative Corporation
(IAC)
Insurers Administrative Corporation
(IAC)
Med-Valu
(800) 522-2161
PO Box 828
Park Ridge IL 60068-0828
(800) 843-3106
MADISON NATIONAL LIFE
INSURANCE COMPANY INC
Affiliated With: INSURERS
ADMINISTRATIVE CORPORATION
#11337
Plan Type: Group Health
(800) 843-3106
(800) 843-3106
MADISON PRECISION PRODUCTS INC PREFERRED HEALTH PLANS INC.
Affiliated With: PREFERRED HEALTH
10160 LINN STATION RD
PLANS, INC.
LOUISVILLE KY 40223
Plan Type: Group Health
(800) 832-8212
PREFERRED HEALTH PLANS INC.
MADISON VAMC 3164
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
MADISON VAMC
MADISON VAMC
Attn: FEE 136
2500 OVERLOOK TERRACE
MADISON WI 53705
CHECK BENEFIT CARD
(800) 832-8212
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-309
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
MADSEN KNEPPERS & ASSOCIATES, PREFERRED BENEFIT
INC.
ADMINISTRATORS INC
Affiliated With: PREFERRED BENEFIT
PO Box 916188
ADMINISTRATORS INC.
LONGWOOD FL 32791-6188
Plan Type: Group Health
(407) 786-2777
MAGSTAR TECHNOLOGIES
Affiliated With: BENEFITS
INCORPORATED
Plan Type: Group Health
MAINE DISTRIBUTORS - %
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PREFERRED BENEFIT
ADMINISTRATORS INC
UTILIZATION REVIEW
MedWatch
(800) 432-8421
(407) 786-2777
BENEFITS INCORPORATED
BENEFITS INCORPORATED
2277 W. Hwy 36 #316
ROSEVILLE MN 55113-3887
(651) 636-8288
BENEFITS INCORPORATED
(651) 636-8288
(651) 636-8288
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(508) 752-2480
CARE MANAGEMENT
SERVICES
(866) 325-1550
(508) 752-2480
MACHIGONNE BENEFIT
ADMINISTRATORS
CHECK BENEFIT CARD
HEALTH PLAN INC
HEALTH PLAN INC
100 FRONT ST STE 600
WORCESTER MA 01608
(800) 532-7575
CARE MANAGEMENT
SERVICES
(866) 325-1550
MAINE MUNICIPAL EMPLOYEES
HEALTH TRUST
Affiliated With: MACHIGONNE BENEFIT
ADMINISTRATORS
Plan Type: Group Health
MACHIGONNE BENEFIT
ADMINISTRATORS
MAINE RUBBER INTERNATIONAL
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
PO BOX 3859
PORTLAND ME 04104-3859
(508) 752-2480
MAKSIN - WRAP
Affiliated With: MAKSIN MANAGEMENT
CORPORATION
Plan Type: Group Health
MACORI ADMINISTRATION
MACORI ADMINISTRATION
19609 WIED
SPRING TX 77388
(281) 651-8787
CHECK BENEFIT CARD
(281) 651-8787
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-310
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MAMMOTH HOSPITAL
Affiliated With: SUPERIOR
ADMINISTRATORS, INC.
Plan Type: Group Health
MAMMOTH MOUNTAIN SKI AREA
Affiliated With: CLAIMS AND BENEFIT
MANAGEMENT INC
Plan Type: Group Health
CLAIMS SUBMISSION
SUPERIOR ADMINISTRATORS, INC.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SUPERIOR ADMINISTRATORS, INC.
UTILIZATION REVIEW
(714) 429-1700
CHECK BENEFIT CARD
(702) 733-3145
CLAIMS AND BENEFIT
MANAGEMENT INC
CLAIMS AND BENEFIT
MANAGEMENT INC
CHINCORP
(702) 433-3145
6251 SCHAEFER AVE STE M
CHINO CA 91710
(909) 902-1890
3720 SOUTH SUSAN ST STE 200
SANTA ANA CA 92704
(714) 429-1700
(909) 902-1890
MAMMOTH MOUNTAIN SKI RESORT
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
MAMMOTH UNIFIED SCHOOLS
Affiliated With: K-12 STUDENT
INSURANCE, A DIVISION OF UICI
Plan Type: Group Health
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
PO Box 80
Stockton CA 95201
(559) 228-4198
DELTA TEAM CARE
(800) 356-2395
(559) 228-4198
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
Manageability, Inc
Affiliated With: FDI Group DBA
Manageability, Inc
Plan Type: Workers' Compensation
ManageAbility Inc
ManageAbility Inc
ManageAbility Inc
MANAGED CARE SYSTEMS LP
Affiliated With: MANAGED CARE
SYSTEMS LP
Plan Type: Group Health
MANAGED CARE SYSTEMS
MANAGED CARE SYSTEMS
CHECK BENEFIT CARD
4550 California Ave Ste 500
Bakersfield CA 93309
6617167100
39500 High Pointe Blvd
Novi MI 48375
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-311
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MANAGED HEALTH FUNDING
Affiliated With: MHF INSURANCE
ADMINISTRATORS
Plan Type: Group Health
MANAGEMENT INFORMATION
DISCIPLINES
Affiliated With: BUSINESS
ADMINISTRATORS AND
CONSULTANTS
Plan Type: Group Health
MANCHESTER VA MEDICAL CENTER
3117
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
BAC
BAC
6331 E LIVINGSTON AVE
REYNOLDSBURG OH 43068
(614) 863-8780
UTILIZATION REVIEW
CHECK BENEFIT CARD
BAC
(614) 863-8780
(614) 863-8780
MANCHESTER VA MEDICAL CENTER
Attn: FEE BASIS 136F
718 SMYTH RD
MANCHESTER NH 03104
MANCHESTER VA MEDICAL CENTER CHECK BENEFIT CARD
MANOR VAIL LODGE
Affiliated With: CNIC HEALTH
SOLUTIONS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MANPOWER
MANPOWER
MANPOWER
(214) 220-1500
MANPOWER
(214) 220-1500
Plan Type: Workers' Compensation
600 North Pearl Street, 17th Floor
Dallas TX 75201
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
(214) 220-1500
MANSFIELD PAPER COMPANY WRAP
JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
CHECK BENEFIT CARD
(802) 846-8060
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-312
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MANUFACTURING TECHNOLOGY,
INC.
Affiliated With: UNITED BENEFITS
DIVISION
Plan Type: Group Health
MARAVILLA
Affiliated With: INNOVATIVE
ADMINISTRATIVE SERVICES
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BROWN & BROWN, INC.
CHECK BENEFIT CARD
INNOVATIVE ADMINISTRATIVE
SERVICES
INNOVATIVE ADMINISTRATIVE
SERVICES
HEALTH ASSIST
(866) 214-1106
540 WALD AVE
IRVINE CA 92618
8002723433
CLAIMS SUBMISSION
BROWN & BROWN, INC.
UTILIZATION REVIEW
PO Box 2480
DAYTONA BEACH FL 32115-2480
8002723433
MARC-JAC POULTRY
Affiliated With: ADMINISTRATIVE
SOLUTIONS INC
Plan Type: Group Health
Marcone Appliance Parts
Affiliated With: MERITAIN HEALTH
Plan Type: Group Health
ADMINISTRATIVE SOLUTIONS INC
ADMINISTRATIVE SOLUTIONS INC
PO Box 2490
ALPHARETTA GA 30023
(678) 339-0211
INNOVATIVE CARE
MANAGEMENT
(800) 398-7353
(678) 339-0211
MERITAIN HEALTH
Attn: Claims Dept
PO Box 853921
Richardson TX 75085-3921
(800) 828-6922
HEALTHLINK
(800) 624-2356
MERITAIN HEALTH
(800) 828-6922
MARIAN MANOR
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MARICOPA COUNTY COMMUNITY
COLLEGE AKA MCCCD
Affiliated With: ZENITH
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-313
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MARICOPA VOL
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MARIE CALLENDER PIE SHOPS INC
Affiliated With: PHYSICIANS CARE
INSURANCE SERVICES INC
Plan Type: Group Health
PHYSICIANS CARE INSURANCE
SERVICES, INC.
PHYSICIANS CARE INSURANCE
SERVICES, INC.
1570 BROOKHOLLOW STE 208
SANTA ANA CA 92705
(714) 540-5882
PHYSICIANS CARE
INSURANCE SERVICES, INC.
(714) 540-5882
PAYOR NAME
MARICOPA INT
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
UTILIZATION REVIEW
(714) 540-5882
MARION IL VAMC 3523
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
MARION IL VAMC
Attn: FISCAL SERVICE 04C
2401 WEST MAIN
MARION IL 62959
MARION IL VAMC
CHECK BENEFIT CARD
MARION IN VA MEDICAL CENTER 3157
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
MARION IN VA MEDICAL CENTER
Attn: FEE BASIS 136C3
1700 E 38TH ST
MARION IN 46953
MARION IN VA MEDICAL CENTER
CHECK BENEFIT CARD
MARKET LOGISTICS INC
Affiliated With: FISERV HEALTH KANSAS
Plan Type: Group Health
FISERV HEALTH KANSAS
FISERV HEALTH KANSAS
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
TRUSTMARK LIFE INSURANCE
CO.
(800) 725-6566
(800) 235-7160
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-314
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MARKET TRANSPORT LTD
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
MARLITE
Affiliated With: SUPERIEN HEALTH
NETWORK 18373
Plan Type: Group Health
CLAIMS SUBMISSION
TRUSTEED PLANS SERVICE GROUP
PO Box 1894
TACOMA WA 98401-1894
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
AMERICAN
HEALTH HOLDING
TRUSTEED PLANS SERVICE GROUP
(888)
877-7994
(800) 426-9786
(800) 426-9786
SUPERIEN HEALTH NETWORK
Attn: Supervisor of the Claims Dept
PO Box 2388 C
STOW OH 44224
SUPERIEN HEALTH NETWORK
CHECK BENEFIT CARD
(800) 266-5896
(800) 266-5896
MARQUETTE TRANSPORTATION
COMPANY, INC.
Affiliated With: NORTH AMERICA
ADMINISTRATORS
Plan Type: Group Health
MARQUIS COMPANIES
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
MARSHALL RETAIL GROUP LLC
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
NORTH AMERICA
ADMINISTRATORS, L.P.
NORTH AMERICA
ADMINISTRATORS, L.P.
PO Box 1984
NASHVILLE TN 37202
(615) 255-6654
MED-CERT
(800) 356-7126
(615) 255-6654
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
MARSHALL RETAIL GROUP LLC TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-315
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MARTIN & ASSOCIATES, INC.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
Martin Boyer
Affiliated With: Cambridge
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
UTILIZATION REVIEW
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
PO Box 3000
SCOTTSDALE AZ 85271-3000
Cambridge
Cambridge
175 W Jackson Ste 1000
Chicago IL 60604
(312) 821-8800
Cambridge
(312) 821-8800
(312) 821-8800
MARTIN BOYER
MARTIN BOYER
MARTIN BOYER
Plan Type: Workers' Compensation
175 W Jackson Ste 1000
Chicago IL 60604
(312) 381-8800
MARTIN BOYER
(312) 381-8800
(312) 381-8800
MARTIN HARRIS CONSTRUCTION
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
MARTINS POINT HEALTHCARE JMS
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATORS INC (EBPA)
Plan Type: Group Health
EMPLOYEE BENEFIT PLAN
ADMINISTRATION
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
EMPLOYEE BENEFIT PLAN
ADMINISTRATION
MARTINSBURG VA MEDICAL CENTER
3133
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
MARTINSBURG VA MEDICAL
CENTER
Attn: FEE SVCS GB113
510 BUTLER AVE
MARTINSBURG WV 25401
MARTINSBURG VA MEDICAL
CENTER
CHECK BENEFIT CARD
(800) 525-8788
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-316
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MARYMOUNT COLLEGE
Affiliated With: PIONEER
MANAGEMENT SERVICES
Plan Type: Group Health
MARYMOUNT UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
Term Effective: 8/31/2007
MARYVILLE UNIVERSITY
Affiliated With: STUDENT ASSURANCE
SERVICES INC
Plan Type: Group Health
CLAIMS SUBMISSION
PIONEER MANAGEMENT SYSTEMS
PO Box 9040
WEST SPRINGFIELD MA 01090
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PIONEER MANAGEMENT SYSTEMS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(413) 539-9900
(413) 539-9900
TRUE CHOICE
CI
PO Box 700307
DALLAS TX 75370
(817) 479-2115
CI
(817) 479-2115
(800) 785-2446
STUDENT ASSURANCE SERVICES
INC
STUDENT ASSURANCE SERVICES
INC
333 N. MAIN STREET
STILLWATER MN 55082
(800) 328-2739
CHECK BENEFIT CARD
(800) 328-2739
MASAMI FOODS, INC.
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
MASCO CONTRACTOR SERVICES
CENTRAL, INC.
Affiliated With: BENESIGHT, INC.
Plan Type: Group Health
FISERV HEALTH INC
FISERV HEALTH INC
FISERV HEALTH INC
MASONRY INDUSTRY TRUST
Affiliated With: UNITED CLAIMS
SOLUTIONS
Plan Type: Group Health
UNITED CLAIM SOLUTIONS
UNITED CLAIM SOLUTIONS
UM NOT APPLICABLE
10835 N 25TH AVE STE 105
PHOENIX AZ 85029
(602) 393-4553
PO Box 360
PUEBLO CO 81002
(602) 393-4553
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-317
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MASSACHUSETTS COMMUNITY
COLLEGES
Affiliated With: CONSOLIDATED
HEALTH PLANS, INC.
Plan Type: Group Health
MASTER CRAFT FABRICS
Affiliated With: BENESIGHT INC
Plan Type: Group Health
CLAIMS SUBMISSION
CONSOLIDATED HEALTH PLANS INC
195 STAFFORD ST
SPRINGFIELD MA 01104
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
CONSOLIDATED HEALTH PLANS INC
(800) 633-7867
(800) 633-7867
BENESIGHT INC
BENESIGHT INC
PO Box 370
PUEBLO CO 81002
(877) 718-6920
BENESIGHT MEDICAL
MANAGEMENT
(877) 718-6920
(877) 718-6920
MASTERGRAPHICS, INC
Affiliated With: EMPLOYEE BENEFIT
CONSULTANTS
Plan Type: Group Health
Masters, Mates & Pilots
Affiliated With: Master Mates & Pilots
Health and Benefit Plan
Plan Type: Group Health
EMPLOYEE BENEFIT CONSULTANTS EMPLOYEE BENEFIT CONSULTANTS AMERICAN HEALTH HOLDING
(614) 818-3222
215 STANFORD PARKWAY
(800) 558-7798
FINDLAY OH 45840
(800) 558-7798
Masters, Mates and Pilots Health &
Benefit Plan
Masters, Mates and Pilots Health &
Benefit Plan
5700 Hammonds Ferry Rd
Linthicum Heights MD 21090-1996
(410) 850-8500
First Health
(800) 213-1185
(410) 850-8500
MATERIAL SERVICES
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
340 Quadrangle Dr
Bolingbrook IL 60440
(800) 759-1311
Careline UR
(763) 383-4800
(800) 759-1311
MATHES MANAGEMENT
ENTERPRISES, INC.
Affiliated With: PREFERRED BENEFIT
ADMINISTRATORS, INC.
Plan Type: Group Health
PREFERRED BENEFIT
ADMINISTRATORS INC
PREFERRED BENEFIT
ADMINISTRATORS INC
CHECK BENEFIT CARD
PO Box 916188
LONGWOOD FL 32791-6188
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-318
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MATHEWS BROTHERS
Affiliated With: PATIENT ADVOCATE
LLC
Plan Type: Group Health
MATHIS BROTHERS FURNITURE
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PATIENT ADVOCATES LLC
CHECK BENEFIT CARD
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
CLAIMS SUBMISSION
PATIENT ADVOCATES LLC
UTILIZATION REVIEW
PO Box 1959
Gray ME 04039
(800) 533-5044
Matrix Absence Management Inc
Affiliated With: Matrix Absence
Management Inc
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
First Health
(800) 931-3439
MATRIX BANCORP, INC.
Affiliated With: AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
Plan Type: Group Health
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
MATSON NAVIGATION
MATSON NAVIGATION
MATSON NAVIGATION
(415) 957-4659
MATSON NAVIGATION
(415) 957-4659
Plan Type: Workers' Compensation
333 Market Street, 3rd Floor
San Francisco CA 94105
Matson Navigation Company
Matson Navigation Company
PO Box 10787
BURBANK CA 91510
(415) 957-4659
Matson Navigation Company
Affiliated With: Matson Navigation
Company
Plan Type: Workers' Compensation
Matson Navigation Company
555 12th St
Oakland CA 94607
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-319
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
May Department Stores Co - Central
Affiliated With: May Department Stores
Co.
Plan Type: Workers' Compensation
May Department Stores Co - Eastern
Affiliated With: May Department Stores
Co.
Plan Type: Workers' Compensation
May Department Stores Co - Western
Affiliated With: May Department Stores
Co.
Plan Type: Workers' Compensation
MAYO FOUNDATION
Affiliated With: MAYO MANAGEMENT
SERVICES INC
Plan Type: Group Health
CLAIMS SUBMISSION
May Department Stores
7004 Security Blvd, Ste 304
Baltimore MD 21244
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
May Department Stores
(410) 298-1866
UTILIZATION REVIEW
May Department Stores
(410) 298-1866
(410) 298-1866
May Department Stores
May Department Stores
7004 Security Blvd, Ste 304
Baltimore MD 21244
(410) 298-1866
May Department Stores
(410) 298-1866
(410) 298-1866
May Department Stores
May Department Stores
7004 Security Blvd, Ste 304
Baltimore MD 21244
(410) 298-1866
May Department Stores
(410) 298-1866
(410) 298-1866
MMSI
MMSI
MMSI
(866) 222-3914
4001 41ST STREET NW
ROCHESTER MN 55901
(866) 222-3914
MAYO FOUNDATION SCOTTSDALE
Affiliated With: MAYO MANAGEMENT
SERVICES INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MAYS HOUSECALL HOME HEALTH
Affiliated With: MARSH
ADVANTAGE/MERCER
ADMINISTRATION #10442
Plan Type: Group Health
MERCER ADMINISTRATION
MERCER ADMINISTRATION
CHECK BENEFIT CARD
ONE W. THIRD ST #900
TULSA OK 74103
(918) 732-4935
(918) 732-4935
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-320
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MCA SIGNS COMPANY INC
Affiliated With: THE CHANDLER
GROUP #13352
Plan Type: Group Health
MCALESTER REGIONAL HEALTH
CENTER
Affiliated With: WATERSTONE
BENEFIT ADMINISTRATORS
#962501227
Plan Type: Group Health
MCARE HMO
Affiliated With: THE CHANDLER
GROUP 1352
Plan Type: Group Health
MCARE HMO - GLOBALCARE WRAP
Affiliated With: GLOBALCARE
Plan Type: Group Health
CLAIMS SUBMISSION
DIRECT CARE AMERICA
PO Box 2090 C
STOW OH 44224
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
DIRECT CARE AMERICA
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 266-5896
(800) 266-5896
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
(888) 440-0971
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
(800) 460-0238
DIRECT CARE AMERICA
DIRECT CARE AMERICA
CHECK BENEFIT CARD
PO Box 2090 C
STOW OH 44224
(800) 266-5896
(888) 440-0971
(800) 266-5896
GLOBALCARE
GLOBALCARE
6875 SHILOH RD E
ALPHARETTA GA 30005
(678) 341-1811
CHECK BENEFIT CARD
(678) 341-1811
MCBRIDE CLINIC INC
Affiliated With: THE KEMPTON GROUP
INC
Plan Type: Group Health
MCBRIDE ELECTRIC
Affiliated With: WILLIS OF KANSAS,
INC.
Plan Type: Group Health
THE KEMPTON GROUP
THE KEMPTON GROUP
PO Box 54889
OKLAHOMA CITY OK 73154
(405) 521-1711
CHECK BENEFIT CARD
(405) 521-1711
WILLIS OF KANSAS, INC.
WILLIS OF KANSAS, INC.
WILLIS OF KANSAS, INC.
PO Box 2697
WICHITA KS 67201
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-321
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MCCALL PATTERN COMPANY
Affiliated With: FISERVE HEALTH
KANSAS
Plan Type: Group Health
* MCCORMICK TRUCKING
Affiliated With: FCE BENEFIT
ADMINISTRATORS #10388
Plan Type: Group Health
* MCCOY'S CORPORATION
Affiliated With: BENEFIT PLANNERS
Plan Type: Group Health
CLAIMS SUBMISSION
FISERV HEALTH INC
PO Box 520
Pueblo CO 81002-0520
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
FISERV HEALTH INC
(800) 235-7160
UTILIZATION REVIEW
TRUSTMARK INSURANCE CO
(800) 725-6566
(800) 235-7160
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC CHECK BENEFIT CARD
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
Benefit Planners
Benefit Planners
PO Box 690450
SAN ANTONIO TX 78269
(800) 292-5386
CHECK BENEFIT CARD
(800) 292-5386
MCCRACKEN COUNTY JAIL INMATES
Affiliated With: EMPLOYEE BENEFIT
CONSULTANTS
Plan Type: Group Health
Term Effective: 8/31/2007
EBC
EBC
PO Box 1639
APPLETON WI 54912
(800) 342-1407
CHECK BENEFIT CARD
(800) 342-1407
MCDANIEL FIRE SYSTEMS
Affiliated With: PROFESSIONAL
BENEFIT ADMINISTRATORS, ILLINOIS
Plan Type: Group Health
PROFESSIONAL BENEFIT
ADMINISTRATORS, INC. C/O CCN
McGean
CHECK BENEFIT CARD
Professional Benefit Administrators, Inc. CHECK BENEFIT CARD
900 Jorie Blvd Ste 250
Oakbrook IL 60523
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Plan Type: Group Health
Exclude Northern CA Network Facilities.
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-322
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MCGUIRE BEARINGS, INC.
Affiliated With: LOOMIS BENEFITS
WEST
Plan Type: Group Health
CLAIMS SUBMISSION
THE LOOMIS COMPANY
PO Box 13906
READING PA 19612
GLOBALCARE, INC.
MCO Advantage - EDI
Affiliated With: MCO Advantage / PBM
Corporation
Plan Type: Workers' Compensation
MCO Advantage - Paper
Affiliated With: MCO Advantage / PBM
Corporation
Plan Type: Workers' Compensation
MD BUILDING PRODUCTS
Affiliated With: MD BUILDING
PRODUCTS
Plan Type: Group Health
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 367-3721
(800) 367-3721
MCLAREN HEALTH PLANS
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
* MD ABROAD
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
THE LOOMIS COMPANY
GLOBALCARE, INC.
GLOBALCARE, INC.
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
STAR HEALTHCARE NETWORK
STAR HEALTHCARE NETWORK
CHECK BENEFIT CARD
850 Seventh Ave STE 803
New York NY 10019
(212) 581-8228
6875 Shiloh Rd E
ALPHARETTA GA 30005
(212) 581-8228
WINTERBROOK/CCN
WINTERBROOK/CCN
PO Box 568800
OKLAHOMA CITY OK 73156-8800
(405) 843-9551 Ext 106
CHECK BENEFIT CARD
(405) 843-9551 Ext 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.
Info as of 12/13/2007
Page PIRCA-323
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
MENNONITE MUTUAL AID & ASSOC
& MMA INSURANCE
MEBP - EASTERN MENNONITE
UNIVERSITY
Affiliated With: MENNONITE MUTUAL
PO Box 483
AID ASSOC AND MMA INSURANCE CO GOSHEN IN 46527
Plan Type: Group Health
(574) 533-9515
* MEDAIRE
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
MENNONITE
MUTUAL AID C/O
MENNONITE MUTUAL AID & ASSOC
CCN
& MMA INSURANCE
(800) 348-7468
(574) 533-9515
STAR HEALTHCARE NETWORK
STAR HEALTHCARE NETWORK
850 Seventh Ave STE 803
New York NY 10019
(212) 581-8228
CHECK BENEFIT CARD
(212) 581-8228
MEDBEN
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
GLOBALCARE, INC.
MEDCARE INTERNATIONAL, INC.
Affiliated With: MEDCARE
INTERNATIONAL, INC.
Plan Type: Group Health
MEDCARE INTERNATIONAL, INC.
MEDCATH INC
Affiliated With: HEALTHSCOPE
BENEFITS INC
Plan Type: Group Health
CHECK BENEFIT CARD
MEDCOST BENEFIT SERVICES
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
NHBC
NHBC
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
GLOBALCARE, INC.
GLOBALCARE, INC.
MEDCARE INTERNATIONAL, INC.
MEDCARE INTERNATIONAL,
INC.
CHECK BENEFIT CARD
CHECK BENEFIT CARD
6875 Shiloh Rd E
ALPHARETTA GA 30005
7301 N.W. 4th St. #109
DAVIE FL 33317
8009723025
CHECK BENEFIT CARD
(888) 621-7900
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-324
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MEDICAL CARE DEVELOPMENT
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
EBPA
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EBPA
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 578-3272
(800) 578-3272
MEDICAL CARE DEVELOPMENT JMS
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATORS
Plan Type: Group Health
EBPA
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
EBPA
CHECK BENEFIT CARD
(800) 578-3272
(800) 578-3272
MEDICAL CARE DEVELOPMENT
WRAP % JMS
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATORS
Plan Type: Group Health
EBPA
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
EBPA
CHECK BENEFIT CARD
(800) 578-3272
(800) 578-3272
MEDICAL CLAIMS MANAGEMENT
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
MEDICAL COLLEGE OF GA
UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
NHBC
NHBC
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
CHECK BENEFIT CARD
(888) 621-7900
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
419 S. COIT ST
FLORENCE SC 29501
(800) 222-6491
PEARCE ADMINISTRATION
MEDICAL COLLEGE OF GEORGIA
AIH0058367
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-325
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Medical Consultants Network
Plan Type: Workers' Compensation
Participates in California Select Network
MEDICAL DATA SYSTEMS INC
Affiliated With: BENESIGHT INC
Plan Type: Group Health
CLAIMS SUBMISSION
Medical Consultants Network
3 Huntington Quad
Melville NY 11747
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Medical Consultants Network
(631) 454-8399
UTILIZATION REVIEW
Medical Consultants Network
(631) 454-8399
(631) 454-8399
BENESIGHT INC
BENESIGHT INC
PO Box 360
Pueblo CO 81002-0360
(800) 476-5832
BENESIGHT MEDICAL
MANAGEMENT
(800) 476-5832
(800) 476-5832
MEDICAL MUTUAL OF OHIO - CCN
RESIDENT
Affiliated With: MEDICAL MUTUAL OF
OHIO
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MEDICAL MUTUAL OF OHIO - CCN
TRAVEL
Affiliated With: MEDICAL MUTUAL OF
OHIO
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MEDICAL RESOURCES
CBCA Administrators Inc
MANAGEMENT, INC.
PO Box 9000
Affiliated With: CBCA Administrators, Inc. LONDON KY 40742
Plan Type: Group Health
CBCA Administrators Inc
CBCA Administrators Inc
MEDICAL UNIVERSITY OF SOUTH
CAROLINA
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
PO Box 2437
Florence SC 29503-2437
(843) 622-6001
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
(843) 622-6001
Plan Type: Group Health
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-326
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MEDICOR AUTO
Affiliated With: MEDICOR
Plan Type: Auto
CLAIMS SUBMISSION
MEDICOR
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MEDICOR
UM NOT APPLICABLE
UTILIZATION REVIEW
1745 N Brown Rd Ste 400
Lawrenceville GA 30043
Medicor Managed Care
Affiliated With: Medicor
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
MediCor-DOAS_Medata
Affiliated With: Medicor Managed Care
LLC
Plan Type: Workers' Compensation
MEDICOR
MEDICOR
UM NOT APPLICABLE
MEDIPAC INTERNATIONAL INC
Affiliated With: MEDIPAC
INTERNATIONAL
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MEDSAVE, INC
Affiliated With: MEDSAVE, INC
Plan Type: Group Health
MEDSAVE
MEDSAVE
CHECK BENEFIT CARD
390 Rabro Rd
Hauppauge NY 11788
(516) 622-1700
1745 N Brown Rd Ste 400
Lawrenceville GA 30043
(516) 622-1700
* MEGA ASSISTANCE
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
STAR HEALTHCARE NETWORK
STAR HEALTHCARE NETWORK
850 Seventh Ave STE 803
New York NY 10019
(212) 581-8228
CHECK BENEFIT CARD
(212) 581-8228
MEGA CORPORATION
HCH ADMINISTRATORS
Plan Type: Group Health
PO Box 1986
PEORIA IL 61656
HCH ADMINISTRATORS
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
HCH ADMINISTRATORS
Info as of 12/13/2007
Page PIRCA-327
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MEGA LIFE & HEALTH INSURANCE
COMPANY
Affiliated With: MEGA LIFE & HEALTH
INSURANCE COMPANY
Plan Type: Group Health
CLAIMS SUBMISSION
MEGA LIFE & HEALTH INSURANCE
COMPANY
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MEGA LIFE & HEALTH INSURANCE
COMPANY
MEGA LIFE & HEALTH
INSURANCE COMPANY
UTILIZATION REVIEW
PO Box 982009
NORTH RICHLAND HILLS TX 76182
MEGA LIFE AND HEALTH INC CO
CDHP INDIVIDUAL
Affiliated With: MEGA LIFE &
INSURANCE COMPANY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MEGA LIFE AND HEALTH INSURANCE
COMPANY - CDHP
HEALTHMARKETS
HEALTHMARKETS
CHECK BENEFIT CARD
PO Box 982009
NORTH RICHLAND HILLS TX 76182
(866) 855-5542
Affiliated With: MEGA LIFE & HEALTH
INSURANCE COMPANY - CDHP
Plan Type: Group Health
(866) 855-5542
MELALEUCA INC
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MELITTA NORTH AMERICA
Affiliated With: SELF INSURED
BENEFIT ADMINISTRATORS, INC.
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MELO INTERNATIONAL
CHECK BENEFIT CARD
Affiliated With: BENEFIT SERVICES INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-328
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Memco Barge Line Inc
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
MEMORIAL HOSPITAL THE JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
UTILIZATION REVIEW
CONTACT EMPLOYER
CHECK BENEFIT CARD
(802) 846-8060
MEMORIAL HOSPITALS ASSOCIATION HEALTHCOMP TPA
Affiliated With: HEALTHCOMP THIRD
PO Box 45018
PARTY ADMINISTRATORS
Fresno CA 93718
Plan Type: Group Health
(800) 442-7247
HEALTHCOMP TPA
MEMPHIS VA MEDICAL CENTER 3148
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
MEMPHIS VA MEDICAL CENTER
Attn: FEE BASIS (136G)
1030 JEFFERSON AVE
MEMPHIS TN 38104
MEMPHIS VA MEDICAL CENTER
CHECK BENEFIT CARD
MENDOCINO COUNTY
Affiliated With: MENDOCINO COUNTY
Plan Type: Group Health
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
MENNONITE CHURCH USA
Affiliated With: MENNONITE MUTUAL
AID ASSOC AND MMA INS CO MMA
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 442-7247
PO Box 1199
STOCKTON CA 95201
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-329
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MENNONITE MUTUAL AID ASSOC
AND MMA INS
Affiliated With: MENNONITE MUTUAL
AID ASSOC. AND MMA INS. CO./MMA
Plan Type: Group Health
MENTOR GRAPHICS CORP
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
CLAIMS SUBMISSION
MENNONITE MUTUAL AID C/O CCN
PO Box 5190
TAMPA FL 33675-5190
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
CHECK BENEFIT CARD
(800) 533-5044
PREFERRED BENEFIT
ADMINISTRATORS INC
CHECK BENEFIT CARD
INSURANCE PROGRAMMERS INC.
INSURANCE PROGRAMMERS
INC.
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
PREFERRED BENEFIT
ADMINISTRATORS INC
MERCEDES-BENZ CREDIT
CORPORATION
INSURANCE PROGRAMMERS INC.
MERCER TRANSPORTATION
Affiliated With: MERCER
ADMINISTRATION
Plan Type: Group Health
(574) 533-9515 Ext 389
(574) 533-9515 Ext 389
MERCEDES HOMES, INC.
Affiliated With: PREFERRED BENEFIT
ADMINISTRATORS, INC.
Plan Type: Group Health
Affiliated With: INSURANCE
PROGRAMMERS, INC.
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
MENNONITE
MUTUAL AID &
MENNONITE MUTUAL AID & ASSOC
ASSOC & MMA INSURANCE
& MMA INSURANCE
PO Box 916188
LONGWOOD FL 32791-6188
60 MAIN
WALLINGFORD CT 06492
(502) 992-4535
PEARCE ADMINISTRATION
MERCER UNIVERSITY - DOMESTIC
AMH9033306
PO Box 2439
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(800) 722-1668
Plan Type: Group Health
(888) 722-1668
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-330
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Mercury Insurance Company
Affiliated With: Mercury Insurance
Plan Type: Auto
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MERIAL LIMITED
Affiliated With: WAUSAU BENEFITS
INC
Plan Type: Group Health
WAUSAU BENEFITS, INC.
Attn: LeAnn Fichtner
PO Box 8046
WAUSAU WI 54401-8046
WAUSAU BENEFITS, INC.
CHECK BENEFIT CARD
PAYOR NAME
MERCURY INSURANCE
Affiliated With: MITCHELL MEDICAL
Plan Type: Auto
UTILIZATION REVIEW
Mercury: Administered by Mitchell Medical
Exclude Physical Therapists,
Chiropractors & Behavioral Health
providers (OCN ONLY)
(715) 841-7802
(715) 841-7802
MERIT AUTO
Affiliated With: MCMC LLC
Plan Type: Auto
MCMC LLC
MCMC LLC
701 Technology Dr Ste 100
Canonsburg PA 15317
(888) 350-1150 Ext 228
MCMC LLC
(888) 350-1150 Ext 228
MERRIMACK BUILDING SUPPLY
Affiliated With: ATLANTIC
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MERRIMACK COLLEGE
Affiliated With: PIONEER
MANAGEMENT SYSTEMS
Plan Type: Group Health
PIONEER MANAGEMENT SYSTEMS
INC
PIONEER MANAGEMENT SYSTEMS
INC
PIONEER MANAGEMENT
SYSTEMS INC
330 WHITNEY AVE
HOLYOKE MA 01041
8004234586
8004234586
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-331
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MESABA AVIATION, INC.
Affiliated With: HEALTHCOMP
ADMINISTRATORS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
MIDWEST SECURITY
ADMINISTRATORS, INC.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
UTILIZATION REVIEW
2700 Midwest Dr.
ONALASKA WI 54650
MESILLA VALLEY TRANSPORTATION
Affiliated With: BOON CHAPMAN
BENEFIT ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Met America Mortgage Bankers Inc.
Affiliated With: MERITAIN HEALTH
Plan Type: Group Health
MERITAIN HEALTH
MERITAIN HEALTH
300 CORPORATE PKWY
AMHERST NY 14226
(800) 828-6922
MERITAIN HEALTH
(800) 828-6922
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
New York State Insurance Fund
CONTACT EMPLOYER
CONTACT EMPLOYER
(800) 828-6922
MetLife
Affiliated With: Mitchell Medical
Plan Type: Auto
Metlife: Administered by Mitchell Medical
Exclude Physical Therapists,
Chiropractors & Behavioral Health
providers (OCN ONLY)
MetLife Insurance (Auto)
Affiliated With: Mitchell Medical
Plan Type: Auto
Metlife: Administered by Mitchell Medical
* Metro Group 90
Affiliated With: New York State
Insurance Fund
Plan Type: Workers' Compensation
199 Church St
New York NY 10007
(212) 312-7306
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-332
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
METROPOLITAN LIBRARY SYSTEM
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MUTUAL ASSURANCE
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 825-3540
(800) 825-3540
Metropolitan Life
Affiliated With: Mitchell Medical div. of
Thompson Publishing Corp
Plan Type: Auto
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
METROPOLITAN STATE COLLEGE OF
DENVER
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Metropolitan Transit Authority
Affiliated With: Metropolitan Transit
Authority
Plan Type: Workers' Compensation
Metro
Metro
Metro
METSCH HOURLY
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
Careline UR
(763) 383-4800
(800) 422-2026
METSCH SALARY
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
Careline UR
(763) 383-4800
(800) 422-2026
MEYER TRUCKING INC.
ADVANCED BENEFIT SOLUTIONS
Affiliated With: MEYER TRUCKING INC. LLC
PO Box 71490
Plan Type: Group Health
PHOENIX AZ 85050
ADVANCED BENEFIT SOLUTIONS
LLC
(888) 419-1094
ARIZONA FOUNDATION FOR
MEDICAL CARE
(800) 852-8001
(888) 419-1094
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-333
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MFIA
Affiliated With: GALLAGHER BENEFIT
ADMINISTRATORS INC
Plan Type: Group Health
CLAIMS SUBMISSION
GALLAGHER BENEFIT
ADMINISTRATORS INC
750 WARRENVILLE RD STE 200
LISLE IL 60532
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GALLAGHER BENEFIT
ADMINISTRATORS INC
UTILIZATION REVIEW
(630) 493-3511
GALLAGHER BENEFIT
ADMINISTRATORS INC
(630) 493-3845
(630) 493-3511
MIAMI VAMC 3140
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
MIAMI VAMC
Attn: FEE BASIS - 136B
1201 NW 16TH ST
MIAMI FL 33125
MIAMI VAMC
CHECK BENEFIT CARD
MICA
Affiliated With: GROUP
ADMINISTRATORS, LTD
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MICROCHIP
Affiliated With: MOUNTAIN STATES
ADMINISTRATIVE SERVICES
Plan Type: Group Health
Mountain States Administrative
Services
Mountain States Administrative
Services
Hines and Associates
(847) 214-2780
7202 E ROSEWOOD STE 200
TUCSON AZ 85710
(520) 722-7133
(520) 722-7133
MICROGROUP INC
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(508) 752-2480
CMS
(866) 325-1550
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
(508) 752-2480
MID AMERICAN ENERGY HOLDINGS
COMPANY
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
(800) 533-5044
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-334
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MID CONTINENT UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
CLAIMS SUBMISSION
MAKSIN MANAGEMENT CORP
2500 McClellan Ave
Pennsauken NJ 08109
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MAKSIN MANAGEMENT CORP
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 220-1123
(800) 220-1123
MIDDLE GEORGIA COLLEGE
PEARCE ADMINISTRATION
AIH0058377
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
MIDDLE GEORGIA COLLEGE
UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
CHECK BENEFIT CARD
(843) 622-6001
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
MIDDLEBURY COLLEGE
Affiliated With: KLAIS AND COMPANY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MIDDLEBURY COLLEGE
Affiliated With: KLAIS & COMPANY
Plan Type: Group Health
KLAIS & COMPANY INC
KLAIS & COMPANY INC
CHECK BENEFIT CARD
1867 W MARKET ST
AKRON OH 44313
(330) 867-8443
(330) 867-8443
MIDDLEBURY COLLEGE - JMS
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATION
Plan Type: Group Health
EBPA
Attn: Denise Oberg
EBPA
CHECK BENEFIT CARD
(800) 578-3272
PO Box 2000
Exeter NH 03833
(800) 578-3272
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-335
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Midlands Injury Management
Affiliated With: Midlands Injury
Management
Plan Type: Workers' Compensation
MIDWEST PRODUCTS CO. INC
Affiliated With: BENEFIT
ADMINISTRATORS SYSTEMS
Plan Type: Group Health
CLAIMS SUBMISSION
Deborah Storey
PO Box 238804
Oklahoma City OK 73116
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Deborah Storey
(405) 767-1760
UTILIZATION REVIEW
Deborah Storey
(405) 767-1760
(405) 767-1760
BENEFIT ADMINISTRATIVE
SYSTEMS
BENEFIT ADMINISTRATIVE
SYSTEMS
7 JOVANNA DR STE 1B
HOMEWOOD IL 60430
(800) 523-0582
CHECK BENEFIT CARD
(800) 523-0582
MIDWEST SECURITY INSURANCE
COMPANIES PPO
Affiliated With: MIDWEST SECURITY
LIFE INSURANCE COMPANY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MIDWEST TROPHY MANUFACTURING MUTUAL ASSURANCE
CO, INC.
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
CHECK BENEFIT CARD
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
(800) 825-3540
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
MIDWESTERN TEAMSTERS HEALTH
& WELFARE FUND
Affiliated With: MIDWESTERN
TEAMSTERS HEALTH & WELFARE
FUND
Plan Type: Group Health
TEDRO & ASSOCIATES C/O CCN
MIECO, INC.
Affiliated With: AFFORDABLE BENEFIT
ADMINISTRATORS, INC. (ABA)
Plan Type: Group Health
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
TEDRO & ASSOCIATES C/O CCN
CHECK BENEFIT CARD
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
PO Box 5190
TAMPA FL 33675-5190
PO Box 10787
BURBANK CA 91510
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-336
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MIKE BROOKS, INC
Affiliated With: SISCO/Cottingham &
Butler
Plan Type: Group Health
MILES KIMBALL COMPANY
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
SISCO
PO Box 389
DUBUQUE IA 52004-0389
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SISCO
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 547-4726
(800) 547-4726
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
MILES MCCLELLAN CONSTRUCTION
CO
Affiliated With: BUSINESS
ADMINISTRATORS & CONSULTANTS
Plan Type: Group Health
MILITARY DELI AND BAKERY
Affiliated With: HEALTH AND
WELFARE BENEFIT SYSTEMS INC
Plan Type: Group Health
BAC
BAC
PO Box 107
REYNOLDSBURG OH 43068
(800) 521-2654
BAC
(614) 863-8780
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
MANAGED CARE STRATEGIES
(800) 283-4927
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
(614) 863-8780
(800) 283-4927
Millennium Risk Managers
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
MILLER AND COMPANY
Affiliated With: BENEFIT SYSTEMS &
SERVICES
Plan Type: Group Health
BENEFIT SYSTEMS & SERVICES,
INC.
BENEFIT SYSTEMS & SERVICES,
INC.
CHECK BENEFIT CARD
760 Pasquinelli Dr. STE 320
WESTMONT IL 60559
(630) 203-5124
(630) 203-5124
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-337
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
MILLS PENINSULA HEALTH SYSTEMS BRMS
Affiliated With: BENEFIT & RISK
PO Box 2650
MANAGEMENT SERVICES
RANCHO CORDOVA CA 98401
Plan Type: Group Health
(888) 326-2555
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BRMS
UTILIZATION REVIEW
(888) 326-2555
BRMS
(800) 368-0767
MILWAUKEE VAMC (CLEMENT J
ZABLOCKI VAMC)
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
MILWAUKEE VA MEDICAL CENTER
Attn: FEE BASIS MIS-136E
5000 W NATIONAL AVE
MILWAUKEE WI 53295
MILWAUKEE VA MEDICAL CENTER
CHECK BENEFIT CARD
MINERAL TECHNOLOGIES INC
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
MINI SYSTEMS INC
Affiliated With: AMERICA'S CHOICE
HEALTHPLANS, LLC
Plan Type: Group Health
(800) 533-5044
AMERICA'S CHOICE HEALTHPLANS,
LLC
13111 Northwest Fwy, Ste 510
Houston TX 77040
AMERICA'S CHOICE HEALTHPLANS, AMERICAN HEALTH
HOLDINGS INC
LLC
(888)
578-1812
(877) 224-3627
(877) 224-3627
MINI-SYSTEMS, INC
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
MINNEAPOLIS VA MEDICAL CENTER
3703
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
GISC TOTALCARE
GISC TOTALCARE
20 WINTER ST
PEMBROKE MA 02359
(800) 242-4472
GISC TOTALCARE
(800) 242-4472
(800) 242-4472
MINNEAPOLIS VA MEDICAL CENTER
Attn: FEE BASIS 17A2
ONE VETERANS DR
MINNEAPOLIS MN 55417
MINNEAPOLIS VA MEDICAL CENTER CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-338
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MIRAMAR BOBCAT, INC ET.AL.
Affiliated With: THE EPOCH GROUP
#10469
Plan Type: Group Health
CLAIMS SUBMISSION
THE EPOCH GROUP
PO Box 12170
OVERLAND PARK KS 66282
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
THE EPOCH GROUP
(800) 255-6065
UTILIZATION REVIEW
SHPS
(888) 645-1380
(800) 255-6065
MISSION AVIATION FELLOWSHIP
Affiliated With: CORESOURCE
Plan Type: Group Health
CORESOURCE
MISSION AVIATION FELLOWSHIP
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
MISSION LINEN SUPPLY
Affiliated With: WAUSAU BENEFITS
INC
Plan Type: Group Health
WAUSAU BENEFITS, INC.
Attn: LeAnn Fichtner
PO Box 8046
WAUSAU WI 54401-8046
CORESOURCE
CORESOURCE
(800) 480-6658
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
WAUSAU BENEFITS, INC.
CHECK BENEFIT CARD
PO Box 2920
CLINTON OH 52733-2920
PO Box 3000
SCOTTSDALE AZ 85271-3000
(715) 841-7802
(715) 841-7802
Mission Plus
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
MISSION TO THE WORLD (PCA) INC
Affiliated With: ALTERNATIVE
INSURANCE RESOURCES, INC.
Plan Type: Group Health
International Medical Group, Inc.
International Medical Group, Inc.
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
CHECK BENEFIT CARD
(317) 655-4500 Outside US
(800) 628-4664 Inside US
INSURANCE CLAIMS SERVICES INC
INSURANCE CLAIMS SERVICES INC CHECK BENEFIT CARD
PO Box 660787
BIRMINGHAM AL 35266
(800) 931-3439
(800) 931-3439
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-339
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MISSOURI CONSORTIUM NORTHWEST STATE UNIVERSITY
Affiliated With: STUDENT ASSURANCE
SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
STUDENT ASSURANCE SERVICES
333 N. MAIN STREET
STILLWATER MN 55082
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
STUDENT ASSURANCE SERVICES
UTILIZATION REVIEW
CHECK BENEFIT CARD
6514397098
6514397098
MISSOURI CONSORTIUM SOUTHEAST STATE UNIVERSITY
Affiliated With: STUDENT ASSURANCE
SERVICES INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MISSOURI CONSORTIUM SOUTHERN STATE UNIVERSITY
STUDENT ASSURANCE SERVICES
STUDENT ASSURANCE SERVICES
CHECK BENEFIT CARD
333 N. MAIN STREET
STILLWATER MN 55082
6514397098
Affiliated With: STUDENT ASSURANCE
SERVICES
Plan Type: Group Health
MISSOURI CONSORTIUM - TRUMAN
STATE UNIVERSITY
Affiliated With: STUDENT ASSURANCE
SERVICES
Plan Type: Group Health
MISYS INTERNATIONAL BANKING
SYSTEMS MKI FRUSTUM
Affiliated With: PERFORMAX NAA
Plan Type: Group Health
6514397098
STUDENT ASSURANCE SERVICES
STUDENT ASSURANCE SERVICES
333 N. MAIN STREET
STILLWATER MN 55082
6514397098
CHECK BENEFIT CARD
6514397098
NORTH AMERICAN
ADMINISTRATORS-PERFORMAX
NORTH AMERICAN
ADMINISTRATORS-PERFORMAX
PO Box 1065
AMHERST NY 14226
(877) 777-6076
CHECK BENEFIT CARD
(877) 777-6076
MITSUBISHI CEMENT CORPORATION
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
PO Box 5079
WESTLAKE VILLAGE CA 91359
(800) 249-8440
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
(800) 249-8440
Info as of 12/13/2007
Page PIRCA-340
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MMI PLANS
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
MMO Indemnity Travel
Affiliated With: Medical Mutual of Ohio
Plan Type: Group Health
CLAIMS SUBMISSION
TRUSTEED PLANS SERVICE GROUP
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
TRUSTEED PLANS SERVICE GROUP
PO Box 1894
TACOMA WA 98406-1705
Medical Mutual of Ohio
Attn: Barb Hufgard
2060 E 9th St
Cleveland OH 44115
Medical Mutual of Ohio
CHECK BENEFIT CARD
(216) 736-2522
(216) 736-2522
MODERN FACILITIES
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
MODERN LUXURY
Affiliated With: CNIC HEALTH
SOLUTIONS
Plan Type: Group Health
MODERN WOODMEN OF AMERICA
Affiliated With: CORESOURCE, MN
Plan Type: Group Health
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC UM NOT APPLICABLE
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
CNIC HEALTH SOLUTIONS
CNIC HEALTH SOLUTIONS
PO Box 3559
ENGLEWOOD CO 80155-3559
(800) 426-7453
CNIC HEALTH SOLUTIONS
(800) 426-7453
CORESOURCE MN
CORESOURCE MN
THE LOOMIS COMPANY
(800) 875-2364
HINES & ASSOCIATES
(888) 826-5769
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 426-7453
CORESOURCE MN
7830 BROADWAY
TUCSON AZ 85710
MODSPACE
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY 850 N PARK RD
Plan Type: Group Health
WYOMISSING PA 19610
(800) 875-2364
MOHON INTERNATIONAL INC
Affiliated With: CAPITOL
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-341
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MONROE COUNTY SCHOOL BOARD
Affiliated With: FLORIDA HEALTH
ADMINISTRATORS DBA FHA - TPA
Plan Type: Group Health
MONROE PLUMBERS & PIPEFITTERS
Affiliated With: THE CHANDLER
GROUP #13352
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
CLAIMS SUBMISSION
COMPENSABILITY
FLORIDA HEALTH ADMINISTRATORS FLORIDA HEALTH ADMINISTRATORS CORVEL CORPORATION
(954) 340-8990
PO Box 327810
(954) 366-0111
Fort Lauderdale FL 33332
(954) 366-0111
DIRECT CARE AMERICA
DIRECT CARE AMERICA
PO Box 2090 C
STOW OH 44224
(800) 266-5896
CHECK BENEFIT CARD
(800) 266-5896
MONTANA HEALTH CARE SYSTEM
3534
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
MONTANA HEALTH CARE SYSTEM
Attn: FEE BASIS
WILLIAM ST off HWY 12 WEST
FORT HARRISON MT 59636
MONTANA HEALTH CARE SYSTEM
CHECK BENEFIT CARD
MONTEBELLO PACAKAGING INC
Affiliated With: PREFERRED HEALTH
PLAN INC 962550088
Plan Type: Group Health
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
PACIFIC HEALTH ALLIANCE
PACIFIC HEALTH ALLIANCE
SERVICE ADVOCATES
(801) 261-5511
(502) 992-4535
MONTEREY BAY PUBLIC
EMPLOYEES TRUST
Affiliated With: PACIFIC HEALTH
ALLIANCE
Plan Type: Group Health
PACIFIC HEALTH ALLIANCE
MONTEX DRILLING
Affiliated With: SMITH
ADMINISTRATORS INC
Plan Type: Group Health
SMITH ADMINISTRATORS, INC.
SMITH ADMINISTRATORS, INC.
3800 SANDSHELL DR STE 260
FT. WORTH TX 76134
(817) 335-2582
PO Box 9248
FRESNO CA 93791
(817) 335-2582
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-342
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MONTGOMERY ESCALATOR
ELEVATOR INC
Affiliated With: INTEGRITY HEALTH
SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
UTILIZATION REVIEW
MONTGOMERY VAMC 3543
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
MONTGOMERY VAMC
Attn: FEE BASIS SECTION
215 PERRY HILL RD
MONTGOMERY AL 36109
MONTGOMERY VAMC
CHECK BENEFIT CARD
MOOSEHEAD MANUFACTURING
COMPANY
Affiliated With: PATIENT ADVOCATE
LLC
Plan Type: Group Health
PATIENT ADVOCATES LLC
PATIENT ADVOCATES LLC
CHECK BENEFIT CARD
PO Box 1959
Gray ME 04039
(207) 657-7733
MORIDGE MANUFACTURING, INC
Affiliated With: BENEFIT
MANAGEMENT INC
Plan Type: Group Health
MORRIS COLLEGE
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
MORRIS INDUSTRIAL
Affiliated With: CAROLINA BENEFIT
ADMINISTRATORS
Plan Type: Group Health
(207) 657-7733
BENEFIT MANAGEMENT INC.
BENEFIT MANAGEMENT INC.
PO Box 1090
GREAT BEND KS 67530
(800) 290-1368
CHECK BENEFIT CARD
(800) 290-1368
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2437
Florence SC 29503-2437
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-343
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MORRIS TRANSFER, INC.
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
CLAIMS SUBMISSION
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
QVI RISK SOLUTIONS INC
(541) 312-8512
UTILIZATION REVIEW
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(541) 312-8512
MORTON WELDING COMPANY INC
OSF HealthPlans, Inc.
Affiliated With: OSF HEALTHPLANS INC PO Box 5128
Plan Type: Group Health
PEORIA IL 61601-5128
(800) 673-5222
OSF HealthPlans, Inc.
(800) 673-5222
MOSLEY HOLDINGS
BENEFIT SUPPORT
Affiliated With: HEALTHDATAINSIGHTS 305 GREEN ST
DBA MVPPO
GAINSVILLE GA 30501
Plan Type: Group Health
(800) 777-4782
BENEFIT SUPPORT
CHECK BENEFIT CARD
MOSSBERG SANITATION
Affiliated With: BENEFIT
MANAGEMENT INC
Plan Type: Group Health
BENEFIT MANAGEMENT INC.
BENEFIT MANAGEMENT INC.
MedWatch
(800) 432-8421
Motel Hotel Associates, Inc
Affiliated With: CORESOURCE INC
Plan Type: Group Health
CORESOURCE
CORESOURCE
PO Box 2920
CLINTON OH 52733-2920
(800) 624-7143
CORESOURCE
(800) 480-6658
CHECK BENEFIT CARD
CHECK BENEFIT CARD
OSF HealthPlans, Inc.
(309) 677-8356
(800) 777-4782
(800) 624-7143
MOUNT HERMON ASSOCIATION INC
Affiliated With: HEALTHCOMP
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
2094992450
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-344
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MOUNT HOLYOKE COLLEGE
Affiliated With: PIONEER
MANAGEMENT SYSTEMS
Plan Type: Group Health
MOUNT IDA COLLEGE
Affiliated With: KLAIS & COMPANY
Plan Type: Group Health
CLAIMS SUBMISSION
PIONEER MANAGEMENT SYSTEMS
123 INTERSTATE DR
W SPRINGFIELD MA 01090
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PIONEER MANAGEMENT SYSTEMS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(877) 868-9060
(877) 868-9060
KLAIS & COMPANY INC
KLAIS & COMPANY INC
1867 W MARKET ST
AKRON OH 44313
(330) 867-8443
CHECK BENEFIT CARD
(330) 867-8443
MOUNTAIN HOME VA MEDICAL
CENTER 3146
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
MOUNTAIN HOME VA MEDICAL
CENTER
Attn: 04F
MOUNTAIN HOME VAMC
MOUNTAIN HOME TN 37684
MOUNTAIN HOME VA MEDICAL
CENTER
CHECK BENEFIT CARD
MOUNTAIN VIEW HOSPITAL
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
TALL TREE ADMINISTRATORS
TALL TREE ADMINISTRATORS
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
(801) 274-8100
CORVEL
(801) 269-8723
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MOUNTVILLE MILLS INC
Affiliated With: JSL ADMINISTRATORS
INC
Plan Type: Group Health
* MPD INC
Affiliated With: WELLS FARGO THIRD
PARTY ADMINISTRATOR
Plan Type: Group Health
(801) 274-8100
CHECK BENEFIT CARD
8882954864
ACORDIA NATIONAL
ACORDIA NATIONAL
CHECK BENEFIT CARD
(888) 685-7774
(888) 685-7774
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-345
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
THE LOOMIS COMPANY
MPR ASSOCIATES INC
Affiliated With: THE LOOMIS COMPANY PO Box 7011
Plan Type: Group Health
WYOMISSING PA 19610-6011
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
THE LOOMIS COMPANY
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 346-1223
(800) 346-1223
MRCC EMPLOYEE BENEFITS
FUND/RETIREES
Affiliated With: MRCC EMPLOYEE
BENEFITS FUND
Plan Type: Group Health
MRCC EMPLOYEE BENEFITS
FUND/TRAVEL
Affiliated With: MRCC EMPLOYEE
BENEFITS FUND
Plan Type: Group Health
MT. VERNON COMMUNITY SCHOOL
CORPORATION
Affiliated With: WEYCO, INC.
Plan Type: Group Health
BENESYS INC
BENESYS INC
700 TOWER DR
TROY MI 48098
(248) 813-9800
HINES & ASSOCIATES
(847) 214-2780
(248) 813-9800
BENESYS INC
BENESYS INC
700 TOWER DR
TROY MI 48098
(248) 813-9800
HINES & ASSOCIATES
(847) 214-2780
WEYCO INC
WEYCO INC
(248) 813-9800
WEYCO INC
PO Box 30132
LANSING MI 48909
MTA (Metropolitan Transportation
Authority)
Plan Type: Workers' Compensation
MTA (Metropolitan Transportation
Authority)
MTA (Metropolitan Transportation
Authority)
One Gateway Plaza M/S 99-10-2
Los Angeles CA 90012-2952
(213) 922-4297
MTA (Metropolitan Transportation
Authority)
(213) 922-4297
Participates in California Select Network
(213) 922-4297
MTS - INTRANSIT, INC
Affiliated With: TRUSTEED PLANS
SERVICE GROUP
Plan Type: Group Health
TRUSTEED PLANS SERVICE
CORPORATION
TRUSTEED PLANS SERVICE
CORPORATION
AMERICAN HEALTH HOLDING
(888) 877-7994
PO Box 1894
TACOMA WA 98406-1705
(253) 564-5850
(253) 564-5850
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-346
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The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MUELLER INDUSTRIES INC
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
CLAIMS SUBMISSION
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PRINCIPAL FINANCIAL GROUP
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 533-5044
(800) 533-5044
MULLER MARTINI CORPORATION
CHECK BENEFIT CARD
Affiliated With: HEALTHDATAINSIGHTS
/ DBA MVPPO
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MULVANNY G2 ARCHITECTURE
Affiliated With: TRUSTEED PALNS
SERVICE CORPORATION
Plan Type: Group Health
TRUSTEED PLANS SERVICE
CORPORATION
TRUSTEED PLANS SERVICE
CORPORATION
AMERICAN HEALTH HOLDING
(888) 877-7994
PO Box 1984
NASHVILLE TN 37202
(253) 564-5850
(253) 564-5850
MURFREESBORO VA MEDICAL
CENTER 3151
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
MURFREESBORO VA MEDICAL
CENTER
Attn: FEE BASIS (136)
3400 LEBANON PIKE
MURFREESBORO TN 37129
MURFREESBORO VA MEDICAL
CENTER
CHECK BENEFIT CARD
MURRAY BROS CADDY SHACK
Affiliated With: FISERV HEALTH KANSAS
Plan Type: Group Health
FISERV HEALTH KANSAS
FISERV HEALTH KANSAS
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
AVIDYN HEALTH
(866) 802-1328
MUSKOGEE VAMC
CHECK BENEFIT CARD
MUSKOGEE VAMC 3105
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
(800) 235-7160
MUSKOGEE VAMC
Attn: 161A
1011 HONOR HEIGHTS DR
MUSKOGEE OK 74401
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-347
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The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MUSTANG MACHINERY COMPANY
LTD
Affiliated With: EQUITABLE PLAN
SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
EQUITABLE PLAN SERVICES
PO Box 720460
OKLAHOMA CITY OK 73172
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EQUITABLE PLAN SERVICES
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 749-2631
(800) 749-2631
MUTUAL FIRE ASSOC THE
PROVIDENCE MUTUAL FIRE
Affiliated With: GALLAGHER BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MUTUAL FIRE INSURANCE OF NEW
ENGLAND
GALLAGHER BENEFIT
ADMINISTRATORS INC
GALLAGHER BENEFIT
ADMINISTRATORS INC
Affiliated With: GALLAGHER BENEFIT
ADMINISTRATORS INC
Plan Type: Group Health
750 WARRENVILLE RD STE 200
LISLE IL 60532
(630) 493-3516
GALLAGHER BENEFIT
ADMINISTRATORS INC
(630) 493-3845
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PREFERRED CARE, INC.
PREFERRED CARE, INC.
CHECK BENEFIT CARD
1300 VIRGINIA DR STE 315
FT. WASHINGTON PA 19034
(215) 639-6208
* MUTUAL OF OMAHA
Affiliated With: MUTUAL OF OMAHA
Plan Type: Group Health
MUTUAL OF OMAHA - SPECIAL RISK
STUDENT ATHLETIC PROGRAM
Affiliated With: PREFERRED CARE INC
Plan Type: Group Health
(630) 493-3516
(215) 639-6208
MVM INC.
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY PO Box 7011
Plan Type: Group Health
WYOMISSING PA 19610-6011
THE LOOMIS COMPANY
(800) 498-6250
HINES & ASSOCIATES
(888) 826-5769
(800) 498-6250
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-348
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
MYERS LUMBER
Affiliated With: NORTH AMERICA
ADMINISTRATORS, L.P.-TENNESSEE
Plan Type: Group Health
N LITTLE ROCK VA MEDICAL CENTER
3109
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
NORTH AMERICA
ADMINISTRATORS, L.P.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NORTH AMERICA
ADMINISTRATORS, L.P.
UTILIZATION REVIEW
CHECK BENEFIT CARD
PO Box 1984
NASHVILLE TN 37202
HEALTH NET FEDERAL SERVICES
Attn: FEE BASIS (136G)
2200 FORT ROOTS DR
N LITTLE ROCK AR 72114
HEALTH NET FEDERAL SERVICES
CHECK BENEFIT CARD
(214) 387-3232
(214) 387-3232
N. KOHL GROCER
Affiliated With: ROBERT C. BOUCK,
INC.
Plan Type: Group Health
ROBERT C. BOUCK, INC.
ROBERT C. BOUCK, INC.
ROBERT C. BOUCK, INC.
NACHI ROBOTIC
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
CHECK BENEFIT CARD
4050 HUNSACKER DR STE 110
EAST LANSING MI 48823
(800) 968-6616
126 N. 30th #205
QUINCY IL 62301
(800) 968-6616
NA'NEELZHIIN JI OLTA TORREON
DAY SCHOOL
Affiliated With: SUMMIT
Plan Type: Group Health
NASH DE CAMP
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS INC
Plan Type: Group Health
SUMMIT
SUMMIT
PO Box 25160
SCOTTSDALE AZ 85255-0102
(888) 690-2020
UM NOT APPLICABLE
(888) 690-2020
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8002218942
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-349
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
CONTACT EMPLOYER
NATIONAL BUSINESS FURNITURE INC CLAIM MANAGEMENT SERVICES
Affiliated With: NATIONAL BUSINESS
PO Box 2790
FURNITURE INC
WEST BEND WI 53095-7970
Plan Type: Group Health
CLAIM MANAGEMENT SERVICES
CHECK BENEFIT CARD
NATIONAL COLLEGE OF
NATUROPATHIC MEDICINE
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS
Plan Type: Group Health
PERSONAL INSURANCE
ADMINISTRATORS, (PIA)
PERSONAL INSURANCE
ADMINISTRATORS, (PIA)
CHECK BENEFIT CARD
30401 Agoura Rd #250
Agoura Hills CA 91376
(800) 468-4343
PAYOR NAME
* Nassau
Affiliated With: New York State
Insurance Fund
Plan Type: Workers' Compensation
NATIONAL DISTRIBUTORS
Affiliated With: PATIENT ADVOCATES
LLC
Plan Type: Group Health
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
UTILIZATION REVIEW
(800) 468-4343
PATIENT ADVOCATES LLC
PATIENT ADVOCATES LLC
PO Box 1959
Gray ME 04039
(207) 657-7733
PATIENT ADVOCATES LLC
(207) 657-7733
(207) 657-7733
NATIONAL FOUNDATION LIFE
INSURANCE CO.
Affiliated With: NATIONAL
FOUNDATION LIFE INSURANCE CO.
Plan Type: Group Health
NATIONAL FOUNDATION LIFE
INSURANCE CO C/O CCN
National Grange Mutual Insurance
Company
Affiliated With: Genex Services, Inc.
Plan Type: Auto
CONTACT EMPLOYER
Attn:
NATIONAL FOUNDATION LIFE
INSURANCE CO C/O CCN
CHECK BENEFIT CARD
CONTACT EMPLOYER
CONTACT EMPLOYER
PO Box 5190
TAMPA FL 33675-5190
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-350
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
National Grange Mutual Insurance
Company
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
NATIONAL HEALTH BENEFIT
CORPORATION PEMP (NHBC)
Affiliated With: NATIONAL HEALTH
BENEFIT CORPORATION (NHBC)
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
CONTACT EMPLOYER
NHBC
NHBC
CHECK BENEFIT CARD
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 321-7900
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
UTILIZATION REVIEW
(888) 321-7900
DBA: SPENCER AND ASSOCIATES
NATIONAL HEALTH BENEFITS
CORPORATION % SAVINGS (NHBC)
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
NHBC
NATIONAL HEALTH BENEFITS
CORPORATION (NHBC)
NATIONAL HEALTH BENEFITS
CORPORATION (NHBC)
NATIONAL HEALTH INSURANCE
Affiliated With: PREMIER ACCESS
Plan Type: Group Health
PREMIER ACCESS
PREMIER ACCESS
CHECK BENEFIT CARD
PO Box 150375
Arlington TX 76015
(888) 463-4137
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 463-4137
NATIONAL HEALTHCARE
RESOURCES
Plan Type: Workers' Compensation
NATIONAL HEALTHCARE
RESOURCES
NATIONAL HEALTHCARE
RESOURCES
720 Cool Springs Blvd., #300
Franklin TN 37067
(800) 243-2336
NATIONAL HEALTHCARE
RESOURCES
(800) 243-2336
(800) 243-2336
NATIONAL INSURANCE BOARD
Affiliated With: SANUS HEALTH
Plan Type: Group Health
SANUS HEALTH CORPORATION
SANUS HEALTH CORPORATION
12501 KENDALL DR STE 2
MIAMI FL 33186
(305) 572-9756
SANUS HEALTH
CORPORATION
(305) 572-9756
(305) 572-9756
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-351
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
NATIONAL OUTDOOR LEADERSHIP
SCHOOLS
Affiliated With: MANAGED BENEFITS
ADMINISTRATOR AND INSURANCE
CONSU
Plan Type: Group Health
NATIONAL PEN CORPORATION
Affiliated With: CENBEN USA INC
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
CENBEN USA
Attn: Melissa Joseph
4079 Executive Pkwy
Westerville OH 43081
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CENBEN USA
CHECK BENEFIT CARD
UTILIZATION REVIEW
(614) 797-5204
(614) 797-5204
NATIONAL SPORTS SERVICES
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH & LIFE /
HEALTH PLAN
(702) 242-7345
ECOM PPO ADVISORS, INC
CHECK BENEFIT CARD
(702) 242-7700
NATIONAL TELECOMMUNICATION
COOPERATIVE ASSOCIATION
Affiliated With: ECOM PPO ADVISORS
INC
Plan Type: Group Health
ECOM PPO ADVISORS, INC
Attn: ACCOUNTING
8350 N. CENTRAL EXPWY, STE 600
DALLAS TX 75206
(800) 342-0719
(800) 342-0719
National Title Travel
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
NATIONAL WOOD PRODUCTS
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
First Health
8774534201
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-352
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
NATIONWIDE HEALTH PLAN
Affiliated With: GLOBAL EMERGENCY
MEDICAL SERVICES, INC. (GEMS)
Plan Type: Group Health
NATIONWIDE HEALTH PLANS CALIFORNIA FARM BUREAU
Affiliated With: NATIONWIDE HEALTH
PLANS
Plan Type: Group Health
Term Effective: 9/30/2007
NATIONWIDE HEALTH PLANS CALIFORNIA SMALL GROUP
PRODUCT
Affiliated With: NATIONWIDE
Plan Type: Group Health
NATIONWIDE HEALTH PLANS - OHIO
FARM BUREAU PRIM
Affiliated With: NATIONWIDE HEALTH
PLANS
Plan Type: Group Health
NATIONWIDE HEALTH PLANS - OHIO
FARM BUREAU WRAP
Affiliated With: NATIONWIDE HEALTH
PLANS
Plan Type: Group Health
NATIONWIDE HEALTH PLANS - OHIO
WRAP
Affiliated With: NATIONWIDE HEALTH
PLANS - OHIO WRAP
Plan Type: Group Health
CLAIMS SUBMISSION
GLOBAL EMERGENCY MEDICAL
SERVICES (GEMS) C/O CCN
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GLOBAL EMERGENCY MEDICAL
SERVICES (GEMS) C/O CCN
UTILIZATION REVIEW
GLOBALCARE
PO Box 5190
TAMPA FL 33675-5190
NATIONWIDE HEALTH CLAIMS
NATIONWIDE HEALTH CLAIMS
PO Box 182690
COLUMBUS OH 43218
(800) 299-6080
NATIONWIDE BETTER HEALTH
(866) 835-5328
(800) 299-6080
NATIONWIDE HEALTH PLANS
NATIONWIDE HEALTH PLANS
PO Box 8026
DUBLIN OH 43017
(800) 331-4222
NATIONWIDE HEALTH PLANS
(800) 331-4222
(800) 331-4222
NATIONWIDE HEALTH CLAIMS
NATIONWIDE HEALTH CLAIMS
PO Box 182690
COLUMBUS OH 43218
(800) 299-6080
HEALTH & MEDICAL
SOLUTIONS
(866) 835-5328
(800) 299-6080
NATIONWIDE HEALTH CLAIMS
NATIONWIDE HEALTH CLAIMS
PO Box 182690
COLUMBUS OH 43218
(800) 299-6080
NATIONWIDE BETTER HEALTH
(866) 835-5328
(800) 299-6080
NATIONWIDE HEALTH PLANS
NATIONWIDE HEALTH PLANS
PO Box 182690
COLUMBUS OH 43218
(800) 331-4222
NATIONWIDE HEALTH PLANS
(800) 331-4222
(800) 331-4222
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-353
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
NATIONWIDE HEALTH PLANS OHIO
PRIMES LIVES
Affiliated With: NATIONWIDE HEALTH
PLANS OHIO PRIMES LIVES
Plan Type: Group Health
CLAIMS SUBMISSION
NATIONWIDE HEALTH PLANS
PO Box 182690
COLUMBUS OH 43218
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NATIONWIDE HEALTH PLANS
UTILIZATION REVIEW
(800) 331-4222
NATIONWIDE HEALTH PLANS
(800) 331-4222
CHECK BENEFIT CARD
(800) 331-4222
NATURAL GAS PROCESSING
Affiliated With: MANAGED BENEFITS
ADMINISTRATOR AND INSURANCE
CONSU
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
NATURES REALM
Affiliated With: PACIFIC LIFE &
ANNUITY
Plan Type: Group Health
PACIFIC LIFE & ANNUITY COMPANY
PACIFIC LIFE & ANNUITY COMPANY CHECK BENEFIT CARD
PO Box 295
Onalaska WI 54650
(800) 542-6642
NAVAGENTE GROUP INC
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
(800) 542-6642
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
NAVAJO MOUNTAIN COMMUNITY
SCHOOL
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
SRT ADMINISTRATORS, INC.
NAVAJO PREPARATORY SCHOOL
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
SRT ADMINISTRATORS, INC.
SRT ADMINISTRATORS, INC.
SRT ADMINISTRATORS, INC.
SRT ADMINISTRATORS, INC.
CHECK BENEFIT CARD
14646 N. Kierland Blvd. #200
SCOTTSDALE AZ 85254
PO Box 25160
SCOTTSDALE AZ 85255-0102
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-354
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
NAZLINI COMMUNITY SCHOOL
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
NBM CORPORATION DBA THE BANK
NA
Affiliated With: WATERSTONE
BENEFITS ADMINISTRATORS
Plan Type: Group Health
NE CONSERVATORY MUSIC
Affiliated With: PIONEER
MANAGEMENT SERVICES
Plan Type: Group Health
Nebraska Western Iowa HCS - Grand
Island 4006
CLAIMS SUBMISSION
SRT ADMINISTRATORS, INC.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SRT ADMINISTRATORS, INC.
UTILIZATION REVIEW
CHECK BENEFIT CARD
PO Box 25160
SCOTTSDALE AZ 85255-0102
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
(888) 440-0971
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
(800) 460-0238
PIONEER MANAGEMENT SYSTEMS
PIONEER MANAGEMENT SYSTEMS
CHECK BENEFIT CARD
PO Box 9040
WEST SPRINGFIELD MA 01090
(413) 539-9900
(888) 440-0971
(413) 539-9900
CLAIMS MANAGER
Attn: Fee Basis 136F
2201 N Broadwell Ave
Grand Island NE 68803
HEALTH NET FEDERAL SERVICES
Nebraska Western Iowa HCS - Lincoln
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
NEBRASKA WESTERN IOWA HCS LINCOLN
Attn: FEE BASIS BLDG 1
600 S 70TH ST
LINCOLN NE 68510
NEBRASKA WESTERN IOWA HCS LINCOLN
NEI WPCC
Affiliated With: AMERICA'S CHOICE
HEALTHPLANS LLC
Plan Type: Group Health
AMERICA'S CHOICE HEALTHPLANS,
LLC
AMERICA'S CHOICE HEALTHPLANS, AMERICAN HEALTH
HOLDINGS INC
LLC
(888)
578-1812
(877) 224-3627
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
13111 Northwest Fwy, Ste 510
Houston TX 77040
UM NOT APPLICABLE
(916) 985-1259
CHECK BENEFIT CARD
(877) 224-3627
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-355
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
NEIL HUFFMAN INC
Affiliated With: UNITED CLAIMS
SOLUTIONS
Plan Type: Group Health
CLAIMS SUBMISSION
UNITED CLAIM SOLUTIONS
10835 N 25TH AVE STE 105
PHOENIX AZ 85029
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
UNITED CLAIM SOLUTIONS
UTILIZATION REVIEW
UM NOT APPLICABLE
(602) 393-4553
(602) 393-4553
NELSON AND SONS INC
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
NELSON NUTRACEUTICAL
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
TALL TREE ADMINISTRATORS
TALL TREE ADMINISTRATORS
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
(801) 274-8100
CORVEL
(801) 269-8723
WAUSAU BENEFITS, INC.
CHECK BENEFIT CARD
NESTLE, USA
Affiliated With: WAUSAU BENEFITS,
INC.
Plan Type: Group Health
(801) 274-8100
WAUSAU BENEFITS, INC.
Attn: LeAnn Fichtner
PO Box 8046
WAUSAU WI 54401-8046
(715) 841-7802
(715) 841-7802
NETAFIM IRRIGATION, INC.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
NETCARE LIFE & HEALTH
CHECK BENEFIT CARD
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PO Box 3000
SCOTTSDALE AZ 85271-3000
Plan Type: Group Health
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-356
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
NEUMAN ENTERPRISES
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
NEVADA CANCER CENTER TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
MBA OF WYOMING
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MBA OF WYOMING
UTILIZATION REVIEW
MBA OF WYOMING
PO Box 98
WORLAND WY 82401
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
NEVADA TITLE INSURANCE
COMPANY
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
NEW COM INC PEPM
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
NEW COM INC.
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
NEW ENGLAND COLLEGE SPORTS
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-357
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
NEW ENGLAND CULINARY INSTITUTE CONSOLIDATED HEALTH PLANS INC
Affiliated With: CONSOLIDATED
195 STAFFORD ST
HEALTH PLANS, INC.
SPRINGFIELD MA 01104
Plan Type: Group Health
(800) 633-7867
NEW ENGLAND HOMES
Affiliated With: PATIENT ADVOCATES
LLC
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
CONSOLIDATED HEALTH PLANS INC
(800) 633-7867
PATIENT ADVOCATES LLC
PATIENT ADVOCATES LLC
PO Box 1959
Gray ME 04039
(800) 290-8559
PATIENT ADVOCATES LLC
(800) 290-8559
EBPA
EBPA
CHECK BENEFIT CARD
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
(800) 290-8559
NEW ENGLAND PRECISION JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
(802) 846-8060
NEW ERA LIFE INSURANCE
Affiliated With: ECOM PPO ADVISORS
INC
Plan Type: Group Health
ECOM PPO ADVISORS, INC
Attn: ACCOUNTING
8350 N. CENTRAL EXPWY, STE 600
DALLAS TX 75206
ECOM PPO ADVISORS, INC
CHECK BENEFIT CARD
(800) 552-7879
(800) 552-7879
New Freedom Care
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
NEW HAMPSHIRE HEALTH PLAN
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATION
Plan Type: Group Health
International Medical Group, Inc.
International Medical Group, Inc.
2960 N Meridian St
Indianapolis IN 46208
(800) 628-4664 or (317) 6554500
International Medical Group, Inc.
(800) 628-4664 or (317) 6554500
EMPLOYEE BENEFIT PLAN
ADMINISTRATION
EMPLOYEE BENEFIT PLAN
ADMINISTRATION
APS HEALTHCARE
(262) 787-2200
37 INDUSTRIAL DR
EXETER NH 03833
(888) 877-6447
(800) 628-4664 or (317) 6554500
(888) 877-6447
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-358
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
NEW MEXICO INSTITUTE OF MINING
AND TECHNOLOGY
Plan Type: Group Health
CLAIMS SUBMISSION
HCH ADMINISTRATORS
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HCH ADMINISTRATORS
UTILIZATION REVIEW
HCH ADMINISTRATORS
PO Box 1986
PEORIA IL 61656
NEW ORLEANS VA MEDICAL CENTER
3106
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
NEW ORLEANS VA MEDICAL
CENTER
Attn: FEE BASIS 136F
400 VETERANS AVE
BILOXI MS 39531
NEW ORLEANS VA MEDICAL
CENTER
CHECK BENEFIT CARD
NEW PARK RESOURCES INC
Affiliated With: GILSBAR INC
Plan Type: Group Health
GILSBAR, INC.
GILSBAR, INC.
CHECK BENEFIT CARD
PO Box 2947
COVINGTON LA 70434-2947
(800) 445-7227
(800) 445-7227
NEW TRIBES MISSION
Affiliated With: NEW TRIBES MISSION
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
NEW TRIBES MISSION FLORIDA
Affiliated With: NEW TRIBES MISSION
Plan Type: Group Health
SELF INSURED PLANS LLC
SELF INSURED PLANS LLC
1016 COLLIER CENTER STE 200
NAPLES FL 34103
(239) 403-7884
MedWatch
(800) 432-8421
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
(239) 403-7884
* New York City Division
Affiliated With: New York State
Insurance Fund
Plan Type: Workers' Compensation
New York Special Funds Conservation
Affiliated With: New York Special Funds
Conservation
Plan Type: Workers' Compensation
New York State Insurance Fund
199 Church St
New York NY 10007
(212) 312-7306
CONTACT EMPLOYER
Attn:
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-359
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
NEW YORK VA MEDICAL CENTER
3522
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTH NET FEDERAL SERVICES
5504 HILL HEAVEN CT
FRISCO TX 75035
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTH NET FEDERAL SERVICES
UTILIZATION REVIEW
CHECK BENEFIT CARD
(214) 387-3232
(214) 387-3232
NEWBURY COLLEGE SPORTS
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
NEWBURY COMICS INC
Affiliated With: AMERICA'S CHOICE
HEALTHPLANS LLC
Plan Type: Group Health
AMERICA'S CHOICE HEALTHPLANS,
LLC
AMERICA'S CHOICE HEALTHPLANS, AMERICAN HEALTH
HOLDINGS INC
LLC
(888) 578-1812
(877) 224-3627
13111 Northwest Fwy, Ste 510
Houston TX 77040
CHECK BENEFIT CARD
(877) 224-3627
Newkirk's Ace Hardware
Affiliated With: Rapid City Regional
Hospital DBA Western Health
Plan Type: Group Health
NEWMAN MEMORIAL HOSPITAL
Affiliated With: C L FRATES &
COMPANY
Plan Type: Group Health
NEWSPAPER FIRST INC
Affiliated With: PERFORMAX CBSA
Plan Type: Group Health
Western Health
Western Health
529 Kansas City St Ste 200
Rapid City SD 57701
(605) 719-4600 or (888) 3411766
Western Health
(605) 719-4640 or (800) 2290892
C.L. FRATES AND COMPANY
C.L. FRATES AND COMPANY
CHECK BENEFIT CARD
PO Box 26967
OKLAHOMA CITY OK 73126-0967
(405) 290-5696
(605) 719-4600 or (888) 3411766
(405) 290-5696
CBSA
CBSA
PO Box 27725
MINNEAPOLIS MN 55427
(800) 925-2272
PERFORMAX /
GUIDED2HEALTH
(866) 405-2021
(304) 353-8743
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-360
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
NF SG VA MEDICAL CENTER 3143
NF SG VA MEDICAL CENTER
Affiliated With: HEALTH NET FEDERAL Attn: BUSINESS OFFICE 04
SERVICES
619 S MARION
Plan Type: Group Health
LAKE CITY FL 32025
Nippon Life Insurance Company of
America
Affiliated With: Insurers Administrative
Corporation #962500302
Plan Type: Group Health
NOAHS COLLECTORS GALLERY
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NF SG VA MEDICAL CENTER
Benefits/Eligibility
Benefits/Eligibility
PO Box 828
Park Ridge IL 60068-0828
(800) 843-3106
UTILIZATION REVIEW
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 522-2161
(800) 843-3106
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
NOBLE HEALTH SYSTEMS INC WRAP
JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
NOBLE HEALTH SYSTEMS INC WRAP
VST
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
NOOKSACK RIVER CASINO
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
EBPA
EBPA
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
CHECK BENEFIT CARD
(802) 846-8060
COMPREHENSIVE BENEFITS
ADMINISTRATORS INC
COMPREHENSIVE BENEFITS
ADMINISTRATORS INC
PO Box 2365
SOUTH BURLINGTON VT 05407-2365
(800) 587-3272
COMPREHENSIVE BENEFITS
ADMINISTRATORS INC
(800) 587-3272
(800) 587-3272
SRT ADMINISTRATORS, INC. C/O
CCN
SRT ADMINISTRATORS, INC. C/O
CCN
CHECK BENEFIT CARD
PO Box 3000
SCOTTSDALE AZ 85271-3000
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-361
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
NOR-CAL BEVERAGE COMPANY
Affiliated With: COMBINED BENEFIT
ADMINIS./VALUE ADDED BENEFITS
Plan Type: Group Health
NORDENIA USA, INC
Affiliated With: HEALTHSCOPE
BENEFITS, INC.
Plan Type: Group Health
NORDSTROM
Affiliated With: NORDSTROM
Plan Type: Workers' Compensation
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
COMBINED BENEFIT
ADMINISTRATORS
COMBINED BENEFIT
ADMINISTRATORS
HEALTHSCOPE BENEFITS INC
HEALTHSCOPE BENEFITS INC
CHECK BENEFIT CARD
PO Box 619055
DALLAS TX 75261
(877) 266-2054
CLAIMS SUBMISSION
COMBINED BENEFIT
ADMINISTRATORS
UTILIZATION REVIEW
4704 W. Jennifer #104
FRESNO CA 93722
(877) 266-2054
NORDSTROM
NORDSTROM
3501 West Sunflower Avenue
Santa Ana CA 92704-6944
(714) 513-4879
NORDSTROM
(714) 513-4879
(714) 513-4879
Participates in California Custom
Network (Please refer to patient's
employer to confirm your participation in
this Network)
NORRIS SUCKER RODS
Affiliated With: WATERSTONE
BENEFITS ADMINISTRATORS, INC.
Plan Type: Group Health
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
(405) 440-8888
CHECK BENEFIT CARD
(405) 440-8888
NORTEL GOVERNMENT SOLUTIONS
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY PO Box 7011
Plan Type: Group Health
WYOMISSING PA 19610-6011
(866) 239-7191
HINES & ASSOCIATES
(888) 826-5769
CHECK BENEFIT CARD
CHECK BENEFIT CARD
THE LOOMIS COMPANY
(866) 239-7191
NORTH AMERICAN ADMINISTRATORS CHECK BENEFIT CARD
Affiliated With: MERITAIN HEALTH
Plan Type: Group Health
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-362
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
NORTH AMERICAN PREFERRED
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NY
Plan Type: Group Health
CLAIMS SUBMISSION
NORTH AMERICAN
ADMINISTRATORS-NY
PO Box 9501
AMHERST NY 14226
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NORTH AMERICAN
ADMINISTRATORS-NY
UTILIZATION REVIEW
(800) 828-6922
NORTH AMERICAN
ADMINISTRATORS-NY
(800) 828-6922
UM NOT APPLICABLE
(800) 828-6922
NORTH AMERICAN RISK SERVICES
(NARS)
Affiliated With: CompIQ #13910
Plan Type: Workers' Compensation
CompIQ Corporation
CompIQ Corporation
35 Tesla Way #100
Irvine CA 92618
(800) 293-3131
NORTH AMERICAN RISK SERVICES
(NARS) AUTO
Affiliated With: CompIQ #13910
Plan Type: Auto
CompIQ Corporation
CompIQ Corporation
35 Tesla Way #100
Irvine CA 92618
(800) 293-3131
NORTH CARE CENTER
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS 20183
Plan Type: Group Health
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
MUTUAL ASSURANCE
ADMINISTRATORS
(800) 825-3540
NORTH CAROLINA AT&T STATE
PEARCE ADMINISTRATION
UNIVERSITY
PO Box 2408
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503-2408
CORP #14005
(888) 722-1668
Plan Type: Group Health
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(405) 607-2587
NORTH CAROLINA SCHOOL OF THE
ARTS
Affiliated With: MAKSIN MANAGEMENT
CORPORATION
Plan Type: Group Health
(888) 722-1668
CHECK BENEFIT CARD
(888) 722-1668
(800) 722-1668
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-363
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
NORTH CAROLINA STATE
PEARCE ADMINISTRATION
UNIVERSITY
Attn: WHIT WALTERS
Affiliated With: MAKSIN MANAGEMENT 419 S. COIT ST
CORPORATION
FLORENCE SC 29501
Plan Type: Group Health
(800) 722-1668
NORTH CAROLINA WESLEYAN
COLLEGE
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
(800) 251-9665
NORTH CHICAGO VA MEDICAL
CENTER 3165
NORTH CHICAGO VA MEDICAL
CENTER
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
Attn: FEE 136B
3001 GREE BAY RD
NORTH CHICAGO IL 60064
NORTH COUNTY HEALTH SYSTEMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATOR, INC.
Plan Type: Group Health
NORTH COUNTY HEALTH SYSTEMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS, INC.
Plan Type: Group Health
TRUE CHOICE
PO Box 700307
DALLAS TX 75370
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
CHECK BENEFIT CARD
(888) 722-1668
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
UM NOT APPLICABLE
(800) 251-9665
NORTH CHICAGO VA MEDICAL
CENTER
CHECK BENEFIT CARD
EBPA
EBPA
CHECK BENEFIT CARD
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
(802) 846-8060
EBPA
EBPA
PO Box 2365
SOUTH BURLINGTON VT 05407-2365
(802) 846-8060
CHECK BENEFIT CARD
(802) 846-8060
NORTH GEORGIA COLLEGE & STATE PEARCE ADMINISTRATION
UNIV AIH0058397
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-364
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
NORTH GEORGIA COLLEGE & STATE PEARCE ADMINISTRATION
UNIVERSITY UNDERGRAD
Attn: WHIT WALTERS
MANDATORY
419 S. COIT ST
Affiliated With: MAKSIN MANAGEMENT
FLORENCE SC 29501
CORP
Plan Type: Group Health
(800) 222-6491
NORTH GREENVILLE UNIVERSITY DOMESTIC
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 222-6491
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(843) 622-6001
(843) 622-6001
NORTH HARRIS MONTGOMERY CCD
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
TRUE CHOICE
TRUE CHOICE
PO Box 700307
DALLAS TX 75370
(800) 251-9665
UM NOT APPLICABLE
(800) 251-9665
NORTH ORANGE COMMUNITY
COLLEGE DISTRICT CYPRESS
COLLEGE DISTRICT/CYPRESS
COLLEGE
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
Term Effective: 8/31/2007
AMERIBEN SOLUTIONS
NORTHAMPTON VA MEDICAL
CENTER 3112
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
NORTHAMPTON VAMC
Attn: FEE BASIS 001 FEE
421 N MAIN ST
LEEDS MA 01053
AMERIBEN SOLUTIONS
CHECK BENEFIT CARD
HEALTH NET FEDERAL SERVICES
CHECK BENEFIT CARD
PO Box 6977
BOISE ID 83707
(214) 387-3232
(214) 387-3232
NORTHEAST KINGDOM HUMAN
SERVICES
Affiliated With: COMPREHENSIVE
BENEFITS ADMINISTRATOR
Plan Type: Group Health
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
PO Box 2365
SOUTH BURLINGTON VT 05407
(800) 525-8788
CHECK BENEFIT CARD
(800) 525-8788
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-365
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
NORTHEASTERN VERMONT
REGIONAL HOSPITAL WRAP JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
CLAIMS SUBMISSION
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
PO Box 2365
SOUTH BURLINGTON VT 05403
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 525-8788
(802) 846-8060
BENESYS
NORTHERN CA SHEET METAL
WORKERS DBA "LOCAL 162" HEALTH PO Box 1138
CARE PLAN
SAN RAMON CA 94583
Affiliated With: SHEET METAL
(248)
822-4200
WORKERS LOCAL 104 HEALTH CARE
PLAN
Plan Type: Group Health
BENESYS
(248) 822-4200
HEALTH CARE EVALUATION
(209) 951-6711
NORTHERN CALIFORNIA HCS 3184
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
NORTHERN CALIFORNIA HCS
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
NORTHERN CALIFORNIA HCS
Attn: FEE SERVICE (04F)
201 WALNUT AVE
VALLEJO CA 94592
NORTHERN MAINE MEDICAL CENTER CHECK BENEFIT CARD
Affiliated With: ULTRABENEFITS
Plan Type: Group Health
NORTHPORT VA MEDICAL CENTER
3120
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
NORTHPORT VA MEDICAL CENTER
Attn: FEE BASIS 136A
79 MIDDLEVILLE RD
NORTHPORT NY 11768
NORTHPORT VA MEDICAL CENTER CHECK BENEFIT CARD
Northstar Providers LLC
Affiliated With: COMP IQ
Plan Type: Auto
NORTHSTAR PROVIDERS, LLC
NORTHSTAR PROVIDERS, LLC
8080 NW 155TH ST
MIAMI LAKES FL 33016
(786) 507-1600
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
UM NOT APPLICABLE
Info as of 12/13/2007
Page PIRCA-366
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Northstar Providers LLC
Affiliated With: COMP IQ
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
NORTHSTAR PROVIDERS, LLC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NORTHSTAR PROVIDERS, LLC
UTILIZATION REVIEW
UM NOT APPLICABLE
8080 NW 155TH ST
MIAMI LAKES FL 33016
(786) 507-1600
NORTHWEST BEC CORPORATION
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
CRITIQUE
CRITIQUE
CHECK BENEFIT CARD
NORTHWEST INDIANA PAINTERS
Affiliated With: PAINTERS LOCAL 460
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
NORTHWEST LIQUID FERTILIZER INC
Affiliated With: FISERV HEALTH KANSAS
Plan Type: Group Health
FISERV HEALTH KANSAS
FISERV HEALTH KANSAS
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
AVIDYN HEALTH
(866) 802-1328
PO Box 651109
S SALT LAKE UT 84165-1109
(800) 235-7160
NORTHWEST METAL PRODUCTS CO
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS
INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
NORTHWEST TEXTBOOK
Affiliated With: LOOMIS BENEFITS
WEST
Plan Type: Group Health
THE LOOMIS COMPANY
THE LOOMIS COMPANY
CHECK BENEFIT CARD
PO Box 7045
WYOMISSING PA 19610
(877) 634-9814
(877) 634-9814
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-367
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
NORTHWESTERN MUTUAL LIFE
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
* Norwich University
Affiliated With: PIONEER
MANAGEMENT SYSTEMS
Plan Type: Group Health
NOTRE DAME DE NAMUR
Affiliated With: AMERIBEN SOLUTIONS
#15255
Plan Type: Group Health
NOVA HEALTHCARE
ADMINISTRATORS
Affiliated With: NOVA HEALTHCARE
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PRINCIPAL FINANCIAL GROUP
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 533-5044
(800) 533-5044
PIONEER MANAGEMENT SYSTEMS
PIONEER MANAGEMENT SYSTEMS
123 INTERSTATE DR
W SPRINGFIELD MA 01089
(413) 534-8658
UM NOT APPLICABLE
(413) 534-8658
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 786-7930
AMERIBEN
(800) 388-3193
(800) 786-7930
NOVA HEALTHCARE
ADMINISTRATORS INC
NOVA HEALTHCARE
ADMINISTRATORS INC
250 ESSJAY RD
BUFFALO NY 14221
(800) 999-5703
CHECK BENEFIT CARD
(716) 250-7302
NOXIOUS VEGETATION CONTROL,
INC.
Affiliated With: ENTERPRISE GROUP
PLANNING, INC.
Plan Type: Group Health
ENTERPRISE GROUP PLANNING,
INC.
NRECA - HOPPO
Affiliated With: NRECA NATIONAL
RURAL ELECTRIC COOPERATIVE
Plan Type: Group Health
COOPERATIVE BENEFIT
ADMINISTRATOR
ENTERPRISE GROUP PLANNING,
INC.
CHECK BENEFIT CARD
COOPERATIVE BENEFIT
ADMINISTRATOR
CHECK BENEFIT CARD
5910 Harper Rd.
CLEVELAND OH 44139-1835
PO Box 6249
LINCOLN NE 68506-0249
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-368
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
NRECA - OUT OF AREA NATIONAL
NETWORK (TRAVEL @ %)
Affiliated With: NRECA - National Rural
Electric Cooperative
Plan Type: Group Health
NSB RETAIL SYSTEM
Affiliated With: THE CHANDLER
GROUP #13352
Plan Type: Group Health
NUNN MILLING
Affiliated With: NORTH AMERICAN
Plan Type: Group Health
CLAIMS SUBMISSION
CBA - COOPERATIVE BENEFITS
CORPORATION
PO Box 6249
LINCOLN NE 68506-0249
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CBA - COOPERATIVE BENEFITS
CORPORATION
UTILIZATION REVIEW
CHECK BENEFIT CARD
(402) 483-9265
(402) 483-9265
DIRECT CARE AMERICA
DIRECT CARE AMERICA
PO Box 2090 C
STOW OH 44224
(800) 266-5896
CHECK BENEFIT CARD
(800) 266-5896
MERITAIN HEALTH
MERITAIN HEALTH
PO Box 1090
GREAT BEND KS 67530
(812) 429-2747
CHECK BENEFIT CARD
(812) 429-2747
NW DOOR
CHECK BENEFIT CARD
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
NYK LOGISTICS (AMERICAS) NUWDC
DIVISION
Affiliated With: MID SOUTH
ADMINISTRATIVE GROUP
Plan Type: Group Health
MSAG
MSAG
1180 Vickery Lane
Cordova TN 38016
(800) 486-4068
MSAG
(800) 486-4068
CHECK BENEFIT CARD
CHECK BENEFIT CARD
O C TANNER
Affiliated With: EBMS EMPLOYEE
BENEFIT MANAGEMENT SERVICES
Plan Type: Group Health
(800) 486-4068
CHECK BENEFIT CARD
8007159414
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-369
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
O.P.E.I.U. LOCALS 30 & 537 HEALTH
& WELFARE FUND
Affiliated With: O.P.E.I.U. LOCALS 30 &
537 HEALTH & WELFARE FUND
Plan Type: Group Health
OAK HOTELS GROUP
Affiliated With: ENTRUST INC
Plan Type: Group Health
CLAIMS SUBMISSION
BENEFIT PROGRAM
ADMINISTRATOR
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BENEFIT PROGRAM
ADMINISTRATOR
UTILIZATION REVIEW
CHECK BENEFIT CARD
13191 CROSSROADS PARK NORTH
STE 205
CITY OF INDUSTRY CA 91746-3434
ENTRUST INC
ENTRUST INC
14701 ST MARY'S LN STE 150
HOUSTON TX 77079
(281) 368-7878
UM NOT APPLICABLE
(281) 368-7878
OAKTREE CAPITAL MANAGEMENT
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
O'BRIEN STEEL
Affiliated With: OSF HEALTHPLANS,
INC.
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
CHECK BENEFIT CARD
(800) 533-5044
OSF HealthPlans, Inc.
OSF HealthPlans, Inc.
PO Box 5128
PEORIA IL 61601-5128
(309) 677-8356
CHECK BENEFIT CARD
(309) 677-8356
OCEAN PROPERTIES LTD
Affiliated With: SELF INSURED PLANS
LLC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SELF INSURED PLANS LLC
OCEANSIDE AUTO COUNTRY
Affiliated With: HEALTHCOMP TPA
Plan Type: Group Health
HealthComp
HealthComp
PO Box 45018
Fresno CA 93718
(800) 442-7247
HealthComp
(800) 755-7247
(800) 442-7247
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-370
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* OCS-EAJ RICHMOND
Affiliated With: STAR HEALTHCARE
NETWORK 19313
Plan Type: Group Health
Octagon Risk Services, Inc
Affiliated With: CompManagement, Inc.
(CMI)
Plan Type: Workers' Compensation
ODLE MCGUIRE AND SHOOK
Affiliated With: PROFESSIONAL
BENEFIT ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
STAR HEALTHCARE NETWORK
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
STAR HEALTHCARE NETWORK
UTILIZATION REVIEW
UM NOT APPLICABLE
850 Seventh Ave STE 803
New York NY 10019
CONTACT EMPLOYER
Attn:
Octagon Risk Services, Inc - Rancho
Cordova
(866) 672-9296
Octagon Risk Services, Inc Rancho Cordova
(866) 672-9296
(866) 672-9296
PROFESSIONAL BENEFIT
ADMINISTRATORS
PROFESSIONAL BENEFIT
ADMINISTRATORS
900 Jorie Blvd Ste 250
Oakbrook IL 60523
(800) 435-5694
CHECK BENEFIT CARD
(800) 435-5694
OHIO ASSOCIATED ENTERPRISES
DIRECT CARE AMERICA
Affiliated With: THE CHANDLER GROUP PO Box 2090 C
Plan Type: Group Health
STOW OH 44224
DIRECT CARE AMERICA
CHECK BENEFIT CARD
(800) 266-5896
(800) 266-5896
Ohio Casualty
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
Ohio Casualty Group AUTO
Affiliated With: GENEX Services, Inc.
Plan Type: Auto
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
OHIO STATE UNIVERSITY BENEFITS
Affiliated With: GLOBAL EMERGENCY
MEDICAL SERVICES, INC. (GEMS)
Plan Type: Group Health
GLOBAL EMERGENCY MEDICAL
SERVICES (GEMS)
GLOBAL EMERGENCY MEDICAL
SERVICES (GEMS)
GLOBAL EMERGENCY
MEDICAL SERVICES (GEMS)
2001 Westside Pkwy. #120
ALPHARETTA GA 30004
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-371
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
OKLAHOMA BANKERS ASSOCIATION FISERV HEALTH KANSAS
Affiliated With: FISERV HEALTH
PO Box 520
KANSAS - 11297
Pueblo CO 81002-0520
Plan Type: Group Health
(800) 235-7160
OKLAHOMA BAPTIST UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
OKLAHOMA BLOOD INSTITUTE
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
FISERV HEALTH KANSAS
UTILIZATION REVIEW
(800) 235-7160
AVIDYN HEALTH
(866) 802-1328
TRUE CHOICE
TRUE CHOICE
UM NOT APPLICABLE
PO Box 700307
DALLAS TX 75370
(800) 251-9665
(800) 251-9665
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
OKLAHOMA CARDIOVASCULAR
ASSOCIATES
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
OKLAHOMA CHRISTIAN UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
OKLAHOMA CITY UNIVERSITY
DOMESTIC
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
TRUE CHOICE USA
TRUE CHOICE USA
PO Box 700307
DALLAS TX 75370
(800) 785-2446
CHECK BENEFIT CARD
(800) 785-2446
TRUE CHOICE
CI
PO Box 700307
DALLAS TX 75370
(817) 479-2115
CI
(817) 479-2115
(800) 785-2446
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-372
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
OKLAHOMA CITY VAMC 3107
OKLAHOMA CITY VAMC
Affiliated With: HEALTH NET FEDERAL Attn: FEE SERVICES (136A-2)
SERVICES
921 NE 13TH
Plan Type: Group Health
OKLAHOMA CITY OK 73104
OKLAHOMA CITY ZOO
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
OKLAHOMA CITY VAMC
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
UTILIZATION REVIEW
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 825-3540
OKLAHOMA CONFERENCE OF
UNITED METHODIST CHURCHES
Affiliated With: THE KEMPTON GROUP
INC
Plan Type: Group Health
THE KEMPTON GROUP
THE KEMPTON GROUP
PO Box 54889
OKLAHOMA CITY OK 73154
(405) 521-1711
(405) 521-1711
OKLAHOMA COUNTY
COMMISSIONERS RETIREES
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
OKLAHOMA ELECTRIC COOPERATIVE THE KEMPTON GROUP
Affiliated With: THE KEMPTON GROUP PO Box 54889
INC
OKLAHOMA CITY OK 73154
Plan Type: Group Health
(405) 521-1711
OKLAHOMA FOUNDATION FOR
CARDIOVASCULAR RESEARCH
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
THE KEMPTON GROUP
CHECK BENEFIT CARD
(405) 521-1711
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-373
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
OKLAHOMA HEALTH INSURANCE
HIGH RISK
Affiliated With: THE EPOCH GROUP
#10469
Plan Type: Group Health
OKLAHOMA HEART HOSPITAL LLC
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS #20183
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
UTILIZATION REVIEW
CHECK BENEFIT CARD
MUTUAL ASSURANCE
ADVANTAGE
(800) 825-3540
(405) 607-2624
AMERICA'S CHOICE HEALTHPLANS, MANAGED CARE CONCEPTS
LLC
(409) 886-2723
OKLAHOMA LEATHER PRODUCTS INC
Affiliated With: AMERICAS CHOICE
HEALTH PLAN
Plan Type: Group Health
AMERICA'S CHOICE HEALTHPLANS,
LLC
OKLAHOMA LUMBERMANS
ASSOCIATION
C.L. FRATES AND COMPANY
C.L. FRATES AND COMPANY
PO Box 26967
OKLAHOMA CITY OK 73126-0967
(405) 290-5696
Affiliated With: C L FRATES &
COMPANY
Plan Type: Group Health
OKLAHOMA MED RESEARCH
FOUNDATION
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
OKLAHOMA MUNICIPAL ASSURANCE
GROUP
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
PO Box 922043
HOUSTON TX 77292
CHECK BENEFIT CARD
(405) 290-5696
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-374
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
OKLAHOMA PRESS
ASSOCIATION/MEMBERS
EMPLOYEES BENEFIT TRUST
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
OKLAHOMA STATE UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
OKLAHOMA UNIVERSITY
INTERNATIONAL STUDENTS
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
OLYMPIA TILE (USA), INC.
Affiliated With: FLORIDA BENEFIT
ADMINISTRATORS
Plan Type: Group Health
* ON CALL INTERNATIONAL
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
ON CALL INTERNATIONAL
Affiliated With: ON CALL
INTERNATIONAL
Plan Type: Group Health
CLAIMS SUBMISSION
MUTUAL ASSURANCE
ADMINISTRATORS
3121 QUAIL SPRINGS PKWY
OKLAHOMA CITY OK 73134
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MUTUAL ASSURANCE
ADMINISTRATORS
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 825-3540
(800) 825-3540
TRUE CHOICE USA
TRUE CHOICE USA
PO Box 700307
DALLAS TX 75370
(800) 785-2446
CHECK BENEFIT CARD
(800) 785-2446
TRUE CHOICE
CI
PO Box 700307
DALLAS TX 75370
(817) 479-2115
CI
(817) 479-2115
(800) 785-2446
FLORIDA BENEFIT
ADMINISTRATORS, INC.
FLORIDA BENEFIT
ADMINISTRATORS, INC.
CHECK BENEFIT CARD
STAR HEALTHCARE NETWORK
STAR HEALTHCARE NETWORK
CHECK BENEFIT CARD
850 Seventh Ave STE 803
New York NY 10019
(212) 581-8228
13080 Belcher Rd. S. #A
LARGO FL 33773-1642
(212) 581-8228
ON CALL INTERNATIONAL
ON CALL INTERNATIONAL
ON CALL INTERNATIONAL
8c Industrial Way
SALEM NH 03079
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-375
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
THE LOOMIS COMPANY
ON SITE E-DISCOVERY
Affiliated With: THE LOOMIS COMPANY PO Box 14086
Plan Type: Group Health
READING PA 19612-4086
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
THE LOOMIS COMPANY
UTILIZATION REVIEW
(800) 875-2364
HINES & ASSOCIATES
(888) 826-5769
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
OPERATING ENGINEERS LOCAL 139
HEALTH BENEFIT FUND
Affiliated With: OPERATING
ENGINEERS LOCAL 139 HEALTH
BENEFIT FUND
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
OPEX CORPORATION
Affiliated With: INSURANCE
ADMINISTRATORS OF AMERICA (IAA)
Plan Type: Group Health
INSURANCE ADMINISTRATORS OF
AMERICA INC
INSURANCE ADMINISTRATORS OF
AMERICA INC
HEALTHCARE STRATEGIES
INC
8885991515
OPHTHALMIC MANAGEMENT
COMPANY
Affiliated With: SELECT BENEFIT
ADMINISTRATORS, INC.
Plan Type: Group Health
SELECT BENEFIT
ADMINISTRATORS, INC. C/O CCN
SELECT BENEFIT
ADMINISTRATORS, INC.
SELECT BENEFIT
ADMINISTRATORS, INC.
OPPORTUNITIES ENTERPRISES
Affiliated With: UNITED CLAIMS
SOLUTIONS
Plan Type: Group Health
PROFESSIONAL BUSINESS
SERVICES
PROFESSIONAL BUSINESS
SERVICES
CHECK BENEFIT CARD
2959 LUCERNE DR
GRAND RAPIDS MI 48546
(800) 732-3412
(800) 875-2364
One Beacon
Affiliated With: Mitchell Medical
Plan Type: Auto
One Beacon: Administered by Mitchell
Medical
Exclude Physical Therapists,
Chiropractors & Behavioral Health
providers (OCN ONLY)
1934 OLNEY AVE STE 200
CHERRY HILL NJ 08003
PO Box 3000
SCOTTSDALE AZ 85271-3000
(800) 732-3412
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-376
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
OPPORTUNITY RESOURCES
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
(800) 283-4927
UTILIZATION REVIEW
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(619) 574-1685
(800) 283-4927
* OPTIMUS CORPORATION
Affiliated With: FISERV BENEFIT
PLANNERS
Plan Type: Group Health
ORAL ROBERTS UNIVERSITY
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
Benefit Planners
Benefit Planners
PO Box 690450
SAN ANTONIO TX 78269
(866) 868-8230
FISERV HEALTH INC
(866) 868-8230
STUDENT RESOURCES
STUDENT RESOURCES
CHECK BENEFIT CARD
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 237-0903 Ext 6352
(866) 868-8230
(800) 237-0903 Ext 6352
GUARANTEE TRUST LIFE
INSURANCE CO
GUARANTEE TRUST LIFE
INSURANCE CO
TRUSTEED PLANS SERVICE
CORPORATION
TRUSTEED PLANS SERVICE
CORPORATION
AMERICAN HEALTH HOLDING
(888) 877-7994
PO Box 1894
TACOMA WA 98401-1894
(800) 426-9786
ORAL ROBERTS UNIVERSITY
GUARANTEE TRUST LIFE
INSURANCE CO. C/O CCN
Plan Type: Group Health
PO Box 3000
SCOTTSDALE AZ 85271
ORCHARD RITE LTD
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
(800) 426-9786
OREGON COLLEGE OF ARTS AND
CRAFTS
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS
Plan Type: Group Health
PERSONAL INSURANCE
ADMINISTRATORS
PERSONAL INSURANCE
ADMINISTRATORS
30401 Agoura Rd #250
Agoura Hills CA 91376
(800) 468-4343
CHECK BENEFIT CARD
(800) 468-4343
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-377
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
OREGON GLASS COMPANY
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS,
INC
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
220 120TH Ave NE Bldg D
Bellevue WA 98005
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
UTILIZATION REVIEW
(800) 700-7153
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
(800) 869-7093
(800) 700-7153
OREGON GRADUATE INSTITUTE
SCHOOL OF SCIENCE AND ENG
Affiliated With: FIRST UNDERWRITERS
INC
Plan Type: Group Health
ADMINISTRATIVE CONCEPTS, INC.
Attn: Customer Service Dept
997 Old Eagle School Rd. #215
WAYNE PA 19087-1706
ADMINISTRATIVE CONCEPTS, INC.
CHECK BENEFIT CARD
OREGON INSTITUTE OF
TECHNOLOGY
USI ADMINISTRATORS
USI ADMINISTRATORS
USI ADMINISTRATORS
AMERIBEN SOLUTIONS
OREGON INSTITUTE OF
TECHNOLOGY INTERNATIONAL &
PO Box 7186
DOMESTIC
BOISE ID 83707
Affiliated With: AMERIBEN SOLUTIONS
(800)
786-7930
Plan Type: Group Health
AMERIBEN SOLUTIONS
(800) 786-7930
AMERIBEN SOLUTIONS
(800) 786-7930
ORION MARIN GROUP
Affiliated With: BUSINESS
ADMINISTRATORS AND
CONSULTANTS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ORLAND SCHOOL #135
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
340 Quadrangle Dr
Bolingbrook IL 60440
(800) 759-1311
Careline UR
(763) 383-4800
PO Box 3357
Affiliated With: FIRST UNDERWRITERS FORT WORTH TX 76113
INC
Plan Type: Group Health
(800) 759-1311
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-378
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ORTHOPAEDIC CENTER OF THE
ROCKIES
Affiliated With: AFFORDABLE BENEFIT
ADMINISTRATORS, INC. (ABA)
Plan Type: Group Health
CLAIMS SUBMISSION
AFFORDABLE BENEFIT
ADMINISTRATORS INC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AFFORDABLE BENEFIT
ADMINISTRATORS INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
PO Box 10787
BURBANK CA 91510-0787
OSF-H S I PARTNERSHIP
OSF HealthPlans, Inc.
Affiliated With: OSF HEALTHPLANS INC PO Box 5128
Plan Type: Group Health
PEORIA IL 61601-5128
OSF HealthPlans, Inc.
CHECK BENEFIT CARD
(877) 677-8222
(877) 677-8222
OSFHP
Affiliated With: OSF HEALTHPLANS,
INC.
Plan Type: Group Health
OSLER INSTITUTE
Affiliated With: MERITAIN HEALTH
Plan Type: Group Health
OSF HealthPlans, Inc.
OSF HealthPlans, Inc.
PO Box 1229
Peoria IL 61601-5128
(800) 673-5222
OSF HealthPlans, Inc.
(800) 284-2273
MERITAIN HEALTH
MERITAIN HEALTH
UM NOT APPLICABLE
9245 N Meridian St Ste 100
Indianapolis IN 46260
(800) 842-3216
(800) 673-5222
(800) 842-3216
OSMA HEALTH NETWORK
Affiliated With: C L FRATES &
COMPANY
Plan Type: Group Health
OTT SCHWEITZER DISTRIBUTORS
INC
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC
Plan Type: Group Health
C.L. FRATES AND COMPANY
C.L. FRATES AND COMPANY
PO Box 26967
OKLAHOMA CITY OK 73126-0967
(405) 290-5696
CHECK BENEFIT CARD
(405) 290-5696
MIDWEST SECURITY
ADMINISTRATORS INC
MIDWEST SECURITY
ADMINISTRATORS INC
MIDWEST SECURITY
ADMINISTRATORS INC
PO Box 574
ONALASKA WI 54650
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-379
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
OUR LADY OF THE LAKE UNIVERSITY TRUE CHOICE
Affiliated With: ACADEMIC RISK
PO Box 700307
MANAGEMENT
DALLAS TX 75370
Plan Type: Group Health
(800) 251-9665
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
TRUE CHOICE
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 251-9665
OVERLAND WEST INC
Affiliated With: P5 HEALTH PLAN
SOLUTIONS
Plan Type: Group Health
CHECK BENEFIT CARD
Owens Illinois
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
OWENSBORO MEDICAL HEALTH
SYSTEM
Affiliated With: MERITAIN HEALTH
Plan Type: Group Health
MERITAIN HEALTH
MERITAIN HEALTH
CHECK BENEFIT CARD
111 SE THIRD ST STE 404
EVANSVILLE IN 47708
(800) 455-1938
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8014742555
(800) 455-1938
SELECT BENEFIT
ADMINISTRATORS, INC.
SELECT BENEFIT
ADMINISTRATORS, INC.
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
OXLEY PETROLEUM
Affiliated With: SELECT BENEFIT
ADMINISTRATORS, INC.
Plan Type: Group Health
SELECT BENEFIT
ADMINISTRATORS, INC. C/O CCN
PACE - TEC, INC.
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
PO Box 3000
SCOTTSDALE AZ 85271-3000
(800) 283-4927
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-380
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PACIFIC CATARACT AND LASER
INSTITUTE
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
8004269786
PACIFIC COAST FEATHER
NORTHWEST FRAMING
Affiliated With: HEALTHCOMP
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
PACIFIC COAST STEEL TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8004427247
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
PACIFIC ECHO, INC.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
PACIFIC GAS & ELECTRIC COMPANY
Plan Type: Workers' Compensation
Participates in California Select Network
Pacific Gas and Electric
Affiliated With: Pacific Gas and Electric
Plan Type: Workers' Compensation
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
Pacific Gas & Electric Company
Pacific Gas & Electric Company
77 Beale St., 28th Floor
San Francisco CA 94105
(415) 973-3350
Pacific Gas & Electric Company
(415) 973-3350
PO Box 3000
SCOTTSDALE AZ 85271-3000
(415) 973-3350
Pacific Gas & Electric Company
Pacific Gas & Electric Company
77 Beale St., 28th Floor
San Francisco CA 94105
(415) 973-3350
Pacific Gas & Electric Company
(415) 973-3350
(415) 973-3350
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-381
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PACIFIC LUTHERAN UNIVERSITY
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
6102939229
PACIFIC MARITIME ASSOCIATION
Affiliated With: PACIFIC MARITIME
ASSOCIATION
Plan Type: Group Health
CHECK BENEFIT CARD
PACIFIC NORTHWEST COLLEGE OF
ART
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS
Plan Type: Group Health
PERSONAL INSURANCE
ADMINISTRATORS
PERSONAL INSURANCE
ADMINISTRATORS
30401 Agoura Rd #250
Agoura Hills CA 91376
(800) 468-4343
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8009922322
CHECK BENEFIT CARD
(800) 468-4343
PACIFIC SOUTHWEST INSTRUMENTS HELLER ASSOCIATES
Affiliated With: HELLER ASSOCIATES
2755 BRISTOL
Plan Type: Group Health
COSTA MESA CA 92626
HELLER ASSOCIATES
HELLER ASSOCIATES
PACIFIC UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
TRUE CHOICE USA
TRUE CHOICE USA
CHECK BENEFIT CARD
PO Box 700307
DALLAS TX 75370
(800) 785-2446
PacificSource Health Plans
Affiliated With: PacificSource Health
Plans
Plan Type: Group Health
(800) 785-2446
PacificSource Health Plans
PacificSource Customer Service
PO Box 7068
Eugene OR 97401-0068
(800) 624-6052
First Health
(800) 449-9905
(800) 624-6052
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-382
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PacificSource Travel Benefit
Affiliated With: PacificSource Health
Plans
Plan Type: Group Health
PACKAGING UNLIMITED
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
PACKERS HOLDING, LLC
Affiliated With: SISCO/Cottingham &
Butler
Plan Type: Group Health
PACKING TECHNOLOGIES
Affiliated With: SISCO/Cottingham &
Butler
Plan Type: Group Health
CLAIMS SUBMISSION
PacificSource Health Plans
250 Country Club Rd
Eugene OR 97401
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PacificSource
(800) 624-6052
UTILIZATION REVIEW
PacificSource Medical Affairs
(800) 624-6052
(800) 624-6052
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
SISCO
SISCO
CHECK BENEFIT CARD
PO Box 389
DUBUQUE IA 52004-0389
(800) 547-4726
(800) 832-8212
(800) 547-4726
BUTLER BENEFIT SERVICES
BUTLER BENEFIT SERVICES
PO Box 3310
Davenport IA 52808-3310
(563) 327-2240
CHECK BENEFIT CARD
(563) 327-2240
PADLOCK RANCH
Affiliated With: MBA OF
WYOMING/MERRILL BOSTROM
ASSOCIATES
Plan Type: Group Health
MBA OF WYOMING
PAINTERS ASSOCIATED TRADES
Affiliated With: PAINTERS
ASSOCIATED TRADES
Plan Type: Group Health
CHECK BENEFIT CARD
MBA OF WYOMING
MBA OF WYOMING
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PO Box 98
WORLAND WY 82401
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-383
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PAINTERS AND ALLIED TRADES
BENEFIT TRUST
Affiliated With: PAINTERS AND ALLIED
TRADES BENEFIT TRUST
Plan Type: Group Health
PAK 2000 INC
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
8007596944
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(800) 532-7575
CARE MANAGEMENT
SERVICES
(866) 325-1550
(508) 752-2480
* Palm Beach Atlantic College
Affiliated With: PIONEER
MANAGEMENT SYSTEMS
Plan Type: Group Health
PALM BEACH COMMUNITY COLLEGE
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
Term Effective: 8/31/2007
PALM BEACH COUNTY
FIREFIGHTERS
Affiliated With: APA PARTNERS INC
Plan Type: Group Health
PALO ALTO HCS 3185
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
PIONEER MANAGEMENT SYSTEMS
PIONEER MANAGEMENT SYSTEMS
123 INTERSTATE DR
W SPRINGFIELD MA 01089
(413) 534-8658
UM NOT APPLICABLE
(413) 534-8658
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
APA Partners Inc
APA Partners Inc
PO Box 1506
Latham NY 12110
(800) 833-3650
APA Partners Inc
(800) 833-3650
PALO ALTO HCS
CHECK BENEFIT CARD
(800) 833-3650
PALO ALTO HCS
Attn: FEE DEPT 640/136C
3801 MIRANDA AVE
PALO ALTO CA 94304
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-384
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PALOMAR COLLEGE
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
Term Effective: 8/31/2007
PALOMAR POMERADO HEALTH
Affiliated With: CENBEN USA INC
Plan Type: Group Health
CLAIMS SUBMISSION
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AMERIBEN SOLUTIONS
UTILIZATION REVIEW
(800) 786-7930
AMERIBEN SOLUTIONS
(800) 786-7930
CENBEN USA
CHECK BENEFIT CARD
(800) 786-7930
CENBEN USA
Attn: Melissa Joseph
4079 Executive Pkwy
Westerville OH 43081
(614) 797-5204
(614) 797-5204
PAM TRANSPORT
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
4040 HUNSAKER STE 110
LANSING MI 38823
(800) 968-6616
CARELINE
(763) 383-4800
(800) 968-6616
PAN WESTERN TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
PANDOL & SONS
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EBA&M
EBA&M
PO Box 5079
WESTLAKE VILLAGE CA 91359
(714) 668-8920
HINES & ASSOCIATES
(800) 528-2498
CHECK BENEFIT CARD
(714) 668-8920
PAPER PRODUCTS
Affiliated With: CAROLINA BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PAPPAS TELECASTING
Affiliated With: PAPPAS TELECASTING
Plan Type: Group Health
RIVERSIDE COUNTY FOUNDATION
FOR MEDICAL CARE
RIVERSIDE CNTY FOUNDATION FOR RIVERSIDE COUNTY
FOUNDATION FOR MEDICAL
MEDICAL CARE C/O CCN
CARE
(800) 825-3540
3993 Jurupa Ave.
RIVERSIDE CA 92506
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-385
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PARADIGM
Affiliated With: GLOBAL EMERGENCY
MEDICAL SERVICES, INC. (GEMS)
Plan Type: Group Health
PARADIGM HEALTH CORPORATION
Affiliated With: PARADIGM HEALTH
CORPORATION (GROUP HLTH)
Plan Type: Group Health
CLAIMS SUBMISSION
GLOBAL EMERGENCY MEDICAL
SERVICES (GEMS)
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GLOBAL EMERGENCY MEDICAL
SERVICES (GEMS)
UTILIZATION REVIEW
GLOBAL EMERGENCY
MEDICAL SERVICES (GEMS)
2001 Westside Pkwy. #120
ALPHARETTA GA 30004
PARADIGM HEALTH CORPORATION
1001 Galaxy Way #300
CONCORD CA 94520
PARADIGM HEALTH CORPORATION PARADIGM HEALTH
CORPORATION
Paradigm Health Systems Auto
CONTACT EMPLOYER
Affiliated With: Paradigm Health Systems Attn:
Plan Type: Auto
CONTACT EMPLOYER
CONTACT EMPLOYER
Paradigm Management Services, LLC
Affiliated With: Paradigm Management
Services, LLC
Plan Type: Workers' Compensation
Paradigm Health Claims Department
Paradigm Health (David Vargas)
1001 Galaxy Way Ste 300
Concord CA 94520
(925) 677-4719
Paradigm Health (David Vargas)
(925) 677-4719
(925) 677-4719
PARADISE VALLEY HOSPITAL - PPO
Affiliated With: ADVENTIST HEALTH
SYSTEM/WEST
Plan Type: Group Health
ADVENTIST HEALTH SYSTEM WEST
PARAMETRIX
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS
INC
Plan Type: Group Health
CHECK BENEFIT CARD
ADVENTIST HEALTH SYSTEM WEST CHECK BENEFIT CARD
PO Box 619031
ROSEVILLE CA 95661-9002
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-386
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PARKVIEW HOSPITAL
Affiliated With: WATERSTONE
BENEFITS ADMINISTRATORS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
UTILIZATION REVIEW
CHECK BENEFIT CARD
(405) 440-8888
(405) 440-8888
Parsons Company
Affiliated With: OSF Healthplans Inc
Plan Type: Group Health
OSF HealthPlans, Inc.
OSF HealthPlans, Inc.
PO Box 5128
PEORIA IL 61601-5128
(800) 673-5222
OSF HealthPlans, Inc.
(800) 673-5222
(309) 677-8356
PASO ROBLES JOINT UNIFIED
SCHOOL DISTRICT
Affiliated With: K-12 STUDENT
INSURANCE, A DIVISION OF UICI
Plan Type: Group Health
PASSION PARTIES
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
PAT CLARK ENTERPRISES TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
PATE CONSRUCTION CO. INC.
Affiliated With: MARSH ADVANTAGE
AMERICA
Plan Type: Group Health
MARSH ADVANTAGE AMERICA
MARSH ADVANTAGE AMERICA
501 N BROADWAY STE 500
ST. LOUIS MO 63102
(800) 394-6888
CHECK BENEFIT CARD
(800) 394-6888
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-387
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PATRICK INDUSTRIES, INC.
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PATRIOT HEALTHCARE - JMS
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATOR
Plan Type: Group Health
CLAIMS SUBMISSION
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PRINCIPAL FINANCIAL GROUP
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 533-5044
(800) 533-5044
EBPA
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
EBPA
CHECK BENEFIT CARD
(800) 578-3272
(800) 578-3272
PATRIOT HOMES, INC
Affiliated With: BENEFIT
ADMINISTRATIVE SYSTEM
Plan Type: Group Health
BENEFIT ADMINISTRATIVE
SYSTEMS
BENEFIT ADMINISTRATIVE
SYSTEMS
17475 JOVANNA DR
HOMEWOOD IL 60430
(708) 799-7400
CHECK BENEFIT CARD
(708) 799-7400
Patriot Risk Services
Affiliated With: TIMCO/Guarantee
Insurance Co
Plan Type: Workers' Compensation
Patriot Risk Services
PAUL FISHER OIL COMPANY
Affiliated With: FISERV HEALTH
KANSAS - 11297
Plan Type: Group Health
PAUL G WHITE TILE COMPANY-PEPM
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
Patriot Risk Services
Patriot Risk Services
FISERV HEALTH KANSAS
FISERV HEALTH KANSAS
CHECK BENEFIT CARD
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
1061 521 Corporate Center Dr Ste 140
Fort Mill SC 29715
(800) 235-7160
HEALTH PLAN INC
HEALTH PLAN INC
PO Box 5199
WESTBOROUGH MA 01581
(508) 752-2480
CARE MANAGEMENT
SERVICES
(866) 325-1550
(508) 752-2480
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-388
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
PAWN SHOP MANAGEMENT
SIERRA HEALTH & LIFE/HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN OF NEVADA
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
EVEREST ADMINISTRATORS, INC.
C/O CCN
CHECK BENEFIT CARD
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
PBM Corp - Paper
Affiliated With: MCO Advantage / PBM
Corporation
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
Peace Corps Volunteers
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
International Medical Group, Inc.
International Medical Group, Inc.
CHECK BENEFIT CARD
407 N Fulton St
Indianapolis IN 46202-3684
(317) 655-4500 Outside US
(800) 628-4664 Inside US
PAYROLL SOLUTIONS
Affiliated With: EVEREST
ADMINISTRATORS, INC.
Plan Type: Group Health
EVEREST ADMINISTRATORS, INC.
C/O CCN
PBM Corp - EDI
Affiliated With: MCO Advantage / PBM
Corporation
Plan Type: Workers' Compensation
PEACE RIVER CENTER FOR
PERSONAL DEVELOPMENT INC
Affiliated With: HERITAGE
CONSULTANTS INC
Plan Type: Group Health
PO Box 3000
SCOTTSDALE AZ 85271-3000
(317) 655-4500 Outside US
(800) 628-4664 Inside US
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8002822460
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-389
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* PEARCE INDUSTRIES
Affiliated With: BENEFIT PLANNERS
Plan Type: Group Health
CLAIMS SUBMISSION
Benefit Planners
PO Box 690450
SAN ANTONIO TX 78269
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Benefit Planners
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 292-5386
(800) 292-5386
PEDDINGHAUS CORPORATION
Affiliated With: GLOBALCARE
Plan Type: Group Health
GLOBALCARE
GLOBALCARE
6875 SHILOH RD E
ALPHARETTA GA 30005
(678) 341-1922
UM NOT APPLICABLE
(678) 341-1922
PEGGY LAWTON KITCHENS, INC.
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
PELTRAM PLUMBING INC
Affiliated With: TRUSTED PLANS
SERVICE CORPORATION
Plan Type: Group Health
TRUSTEED PLANS SERVICE
CORPORATION
TRUSTEED PLANS SERVICE
CORPORATION
PO Box 1984
TACOMA WA 98406
(253) 564-5850
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
AMERICAN HEALTH HOLDING
(888) 877-7994
(253) 564-5850
Pemaquid Underwriting Brokerage
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
PENDER MEMORIAL HOSPITAL
Affiliated With: J SMITH LANIER &
COMPANY
Plan Type: Group Health
J SMITH LANIER & CO
J SMITH LANIER & CO
201 HAY STREET, STE 302
FAYETTEVILLE NC 28301
(910) 480-3100
DOCTORS DIRECT
HEALTHCARE
(910) 480-3100
PENMORE LITHOGRAPHERS - PEPM
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
(910) 480-3100
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-390
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PENN WESTERN - NEW POSEIDON
ENTERPRISES
Affiliated With: GLOBALCARE INC
Plan Type: Group Health
PENN WESTERN -AMSOL
Affiliated With: GLOBALCARE
Plan Type: Group Health
CLAIMS SUBMISSION
GLOBALCARE, INC.
6875 Shiloh Rd E
ALPHARETTA GA 30005
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GLOBALCARE, INC.
UTILIZATION REVIEW
UM NOT APPLICABLE
(678) 341-1922
(678) 341-1922
GLOBALCARE
GLOBALCARE
6875 SHILOH RD E
ALPHARETTA GA 30005
(678) 341-1922
MEDCOST
(800) 722-2157
GLOBALCARE
GLOBALCARE
UM NOT APPLICABLE
6875 Shiloh Rd E
ALPHARETTA GA 30005
(678) 341-1922
(678) 341-1922
PENN WESTERN -AMSOL TRAVEL
NETWORK GEORGIA
Affiliated With: GLOBALCARE
Plan Type: Group Health
(678) 341-1922
PENSACOLA CHRISTIAN COLLEGE
Affiliated With: AMERICAN
HEALTHCARE ALLIANCE
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PEPPERMILL HOTEL AND CASINO
Affiliated With: CDS GROUP HEALTH
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PEPPERMILL HOTEL CASINO
Affiliated With: PEPPERMILL HOTEL
CASINO
Plan Type: Group Health
HOMETOWN HEALTH PROVIDERS
INSURANCE
HOMETOWN HEALTH PROVIDERS
INSURANCE
830 HARVARD WAY
RENO NV 89502
(775) 982-3039
7753526901
HOMETOWN HEALTH
PROVIDERS INSURANCE
(775) 982-3039
(775) 982-3039
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-391
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Performance Bankers
Affiliated With: American Administrative
Group
Plan Type: Group Health
CLAIMS SUBMISSION
American Administrative Group
PO Box 5227
Lisle IL 60532-5227
ECS Payor ID 37283
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
American Administrative Group
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 323-1726
(800) 323-1726
PREFERRED BENEFIT
ADMINISTRATORS INC
CHECK BENEFIT CARD
NHBC
NHBC
CHECK BENEFIT CARD
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
PERFORMANCE CONTRACTORS
Affiliated With: PREFERRED BENEFIT
ADMINISTRATORS, INC.
Plan Type: Group Health
PREFERRED BENEFIT
ADMINISTRATORS INC
PERFORMANCE HEALTH (PHA)
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
* PERMIAN MUD SERVICES INC
Affiliated With: BENEFIT PLANNERS
Plan Type: Group Health
PO Box 916188
LONGWOOD FL 32791-6188
(888) 621-7900
Benefit Planners
Benefit Planners
PO Box 690450
SAN ANTONIO TX 78269
(800) 292-5386
CHECK BENEFIT CARD
(800) 292-5386
PERRY POINT/BALTIMORE VA
MEDICAL CENTER 3131
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
PERRY POINT / BALTIMORE VA
MEDICAL CENTER
Attn: MAS/FEE SERVICES - 136
BLDG G 4H, RM 120
PERRY POINT MD 21902
PERRY POINT / BALTIMORE VA
MEDICAL CENTER
CHECK BENEFIT CARD
PERRYSBURG SCHOOL
Affiliated With: EMPLOYEE BENEFIT
MANAGEMENT CORP
Plan Type: Group Health
Employee Benefit Management Corp
(EBMC)
Employee Benefit Management Corp
(EBMC)
CHECK BENEFIT CARD
4789 Rings Rd
Dublin OH 43017-1599
(614) 766-5800
(614) 766-5800
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-392
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PERSE TECHNOLOGIES
Affiliated With: COMMERCE BENEFITS
GROUP
Plan Type: Group Health
PersonalCare Freedom PPO
Affiliated With: Coventry Health Care
Plan Type: Group Health
CLAIMS SUBMISSION
COMMERCE BENEFITS GROUP
33479 LAKE RD
AVON LAKE OH 44012
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
COMMERCE BENEFITS GROUP
(800) 223-9941
UTILIZATION REVIEW
UM COMPANY
(800) 666-5551
(800) 223-9941
PERSONALCARE
PERSONALCARE
PO Box 7141
LONDON KY 40742-7141
(800) 562-5792
PERSONALCARE
(800) 562-5792
PERSONNEL MANAGEMENT, INC.
MARSH ADVANTAGE AMERICA
Affiliated With: SEABURY & SMITH, INC. (SEABURY & SMITH) C/O CCN
PO Box 5190
Plan Type: Group Health
TAMPA FL 33675-5190
HEALTH CARE SAVINGS
HEALTH CARE SAVINGS
Peter Chang Enterprises
Affiliated With: Peter Chang Enterprises
Plan Type: Workers' Compensation
Peter Chang Enterprises
Peter Chang Enterprises
28530 Orchard Lake Rd Ste 101
Farmington Hills MI 48334
(248) 455-8972
Peter Chang Enterprises
(248) 455-8972
(800) 562-5792
(248) 455-8972
PETERSON TRACTOR COMPANY
Affiliated With: CAPITOL
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PHC OF NEVADA
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH & LIFE /
HEALTH PLAN
(702) 242-7345
PHILADELPHIA VAMC
CHECK BENEFIT CARD
(702) 242-7700
PHILADELPHIA VAMC 3127
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
PHILADELPHIA VAMC
Attn: FEE BASIS 04F
UNIVERSITY & WOODLANDS AVE
PHILADELPHIA PA 19104
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-393
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
PHILCOR TV & ELECTRONIC TRAVEL SIERRA HEALTH & LIFE/HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN OF NEVADA
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
PHOENIX CEMENT COMPANY
Affiliated With: CORESOURCE
Plan Type: Group Health
CORESOURCE
CORESOURCE
PO Box 2920
CLINTON OH 52733-2920
(866) 280-4120
CORESOURCE
(866) 794-0770
BENEFIT CONCEPTS, INC.
BENEFIT CONCEPTS, INC.
CHECK BENEFIT CARD
1021 W. 8TH AVE STE 200
KING OF PRUSSIA PA 19406
(610) 337-2600
(866) 280-4120
PHOENIX COLOR CORPORATION
Affiliated With: BROKERAGE
CONCEPTS BENEFIT CONCEPTS
Plan Type: Group Health
* PHOENIX VAMC 3173
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
(610) 337-2600
PHOENIX VAMC
Attn: FEE BASIS 136E5
620 E INDIAN SCHOOL RD
PHOENIX AZ 85012
PHOENIX VAMC
CHECK BENEFIT CARD
PHP HEALTH PLAN
Affiliated With: SHASTA
ADMINISTRATIVE SERVICES
Plan Type: Group Health
SHASTA ADMINISTRATIVE
SERVICES
SHASTA ADMINISTRATIVE
SERVICES
SHASTA ADMINISTRATIVE
SERVICES
PHP INDIVIDUAL PLANS
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
2751 S.W. Airport Way
REDMOND OR 97756
(541) 312-8512
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-394
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PHP OF NORTHERN INDIANA ASO
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
GLOBALCARE, INC.
6875 Shiloh Rd E
ALPHARETTA GA 30005
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GLOBALCARE, INC.
8008601111
UTILIZATION REVIEW
PHP Management
(800) 982-6257
6783411722
PHP SMALL GROUP
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
PHYSICIANS HEALTH PLAN OF MIDMICHIGAN
Affiliated With: GLOBALCARE
Plan Type: Group Health
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
(541) 312-8512
GLOBALCARE
GLOBALCARE
6875 SHILOH RD E
ALPHARETTA GA 30005
(678) 341-1811
UM NOT APPLICABLE
(678) 341-1811
PHYSICIANS HEALTH PLAN OF
NORTHERN INDIANA
Affiliated With: GLOBALCARE
Plan Type: Group Health
CHECK BENEFIT CARD
PHYSICIANS MUTUAL INSURANCE
COMPANY-CARRIER
Affiliated With: GILSBAR INC
Plan Type: Group Health
GILSBAR
GILSBAR
2100 COVINGTON CENTRE
COVINGTON LA 70433
(985) 871-1863
PHYSICIANS MUTUAL INSURANCE
COMPANY-MEICARE SELECT
Affiliated With: GILSBAR INC
Plan Type: Group Health
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
CHECK BENEFIT CARD
CHECK BENEFIT CARD
6783411722
CHECK BENEFIT CARD
(985) 871-1863
GILSBAR
GILSBAR
2100 COVINGTON CENTRE
COVINGTON LA 70433
(985) 871-1863
CHECK BENEFIT CARD
(985) 871-1863
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-395
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Piccadilly Cafeterias, Inc.
Affiliated With: Benesight
Plan Type: Group Health
CLAIMS SUBMISSION
Piccadilly Cafeterias, Inc.
PO Box 2467
Baton Rouge LA 70821
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Benesight
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 752-3473
(800) 752-3473
Pictorial Offset Corporation
CBCA Administrators Inc
Affiliated With: CBCA Administrators, Inc. PO Box 8130
Plan Type: Group Health
Scottsdale AZ 85252-8130
(800) 831-7783
Capp Care
(800) 937-2277
GROUP ADMINISTRATORS, LTD.
GROUP ADMINISTRATORS, LTD.
CHECK BENEFIT CARD
450 E Remington Rd
Schaumburg IL 60173
(847) 519-1880
CBCA Administrators Inc
(800) 831-7783
PIERCE, COUCN, HENDRICKSON,
BAYSINGER & GREEN, LLP
Affiliated With: GROUP
ADMINISTRATORS, LTD.
Plan Type: Group Health
Piercy Bowler Taylor & Kern Travel
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
(847) 519-1880
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
PINE STATE TRADING COMPANY JMS
Affiliated With: EMPLOYEE BENEFIT
PLAN ADMINISTRATORS
Plan Type: Group Health
EBPA
Attn: Denise Oberg
PO Box 2000
Exeter NH 03833
EBPA
CHECK BENEFIT CARD
(800) 578-3272
(800) 578-3272
PINNACLE RESTAURANT GROUP, LLC
Affiliated With: PENN WESTERN
BENEFITS, INC.
Plan Type: Group Health
PENN WESTERN BENEFITS, INC.
C/O CCN
PENN WESTERN BENEFITS, INC.
CHECK BENEFIT CARD
PO Box 5190
TAMPA FL 33675-5190
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-396
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PINNACLE RISK MANAGEMENT
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
PINNACLE RISK MANAGEMENT
One Sierra Gale Plaza, Suite A200
Roseville CA 95678
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PINNACLE RISK MANAGEMENT
UTILIZATION REVIEW
(916) 780-9250
PINNACLE RISK MANAGEMENT
(916) 780-9250
SRT ADMINISTRATORS, INC.
CHECK BENEFIT CARD
(916) 780-9250
PINON COMMUNITY SCHOOL
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
SRT ADMINISTRATORS, INC.
Pioneer Manor
Affiliated With: Rapid City Regional
Hospital DBA Western Health
Plan Type: Group Health
Western Health
Western Health
529 Kansas City St Ste 200
Rapid City SD 57701
(605) 719-4600 or (888) 3411766
Western Health
(605) 719-4640 or (800) 2290892
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
PIONEER TELEPHONE
Affiliated With: PIONEER TELEPHONE
Plan Type: Group Health
* Pipe Maintenance Travel
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
PO Box 25160
SCOTTSDALE AZ 85255-0102
(605) 719-4600 or (888) 3411766
(702) 242-7700
PITTSBURGH VA MEDICAL CENTER
3130
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
PITTSBURGH VA MEDICAL CENTER
Attn: FEE BASIS 04D4-H
7180 HIGHLAND DR
PITTSBURGH PA 15206
PITTSBURGH VA MEDICAL CENTER CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-397
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PIZZA HUT OF IDAHO
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NEW YORK
Plan Type: Group Health
CLAIMS SUBMISSION
NORTH AMERICAN
ADMINISTRATORS-NY
PO Box 9501
AMHERST NY 14226
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NORTH AMERICAN
ADMINISTRATORS-NY
(800) 397-2122
UTILIZATION REVIEW
NORTH AMERICAN
ADMINISTRATORS-NY
(800) 397-2122
(800) 397-2122
PLAN HANDLERS INC
Affiliated With: HEALTHSCOPE
BENEFITS INC #11491
Plan Type: Group Health
PLASTIC MOLDINGS
Affiliated With: INTERPLAN HEALTH
GROUP
Plan Type: Group Health
CENBEN USA
CENBEN USA
PO Box 612900
DALLAS TX 75261-2900
(888) 633-7879
CENTRAL BENEFITS
(800) 882-9889
(888) 633-7879
INTERPLAN HEALTH GROUP
Attn: Supervisor of the Claims Dept
PO Box 2388 C
STOW OH 44224
(800) 266-5896
CUSTOM DESIGN BENEFITS
(800) 598-2929
SEABURY & SMITH/MARSH
ADVANTAGE AMERICA
SEABURY & SMITH/MARSH
ADVANTAGE AMERICA
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
INTERPLAN HEALTH GROUP
(800) 266-5896
PLAYBOY ENTERPRISES, INC.
Affiliated With: PLAYBOY
ENTERPRISES, INC.
Plan Type: Group Health
SEABURY & SMITH/MARSH
ADVANTAGE AMERICA
PLAYLV GAMING OPERATION, LLC
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
PO Box 1520
IOWA CITY IA 52240
(702) 242-7700
PLEASANT VALLEY JT UNION
ELEMENTARY
Affiliated With: K-12 STUDENT
INSURANCE, A DIVISION OF UICI
Plan Type: Group Health
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-398
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PLUMB HOUSE INC.
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
CLAIMS SUBMISSION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
DIVERSIFIED ADMINISTRATION
CORPORATION
(888) 322-2524
UTILIZATION REVIEW
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
PLUMBERS PIPEFITTERS LOCAL
421 HEALTH WELFARE FUND
Affiliated With: CORE MANAGEMENT
RESOURCES GROUP INC
Plan Type: Group Health
CHECK BENEFIT CARD
PLUMBERS AND PIPEFITTERS H AND
S FUND
Affiliated With: PLUMBERS AND
PIPEFITTERS H AND S FUND
Plan Type: Group Health
LEO A. RILEY
LEO A. RILEY
141 S CENTER STE 200
CASPER WY 82601
(307) 266-2877
PMA Insurance Group The
Affiliated With: PMA Insurance Group
Plan Type: Workers' Compensation
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8887412673
HEALTH SERVICES ADVISORY
GROUP
(602) 264-6382
(307) 266-2877
PMA Insurance Group The
CONTACT EMPLOYER
PMA Insurance Group The
(888) 476-2669
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
CHECK BENEFIT CARD
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
PO Box 25249
Lehigh Valley PA 18002-5249
(888) 476-2669
* PointBank (TRAVEL)
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
(800) 827-7223
POMPANOOSUC MILLS
CORPORATION
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-399
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
POPLAR BLUFF VA MEDICAL
POPLAR BLUFF VA MEDICAL CNTER
CENTER 3527
Attn: FEE BASIS 04
Affiliated With: HEALTH NET FEDERAL 1500 N WESTWOOD BLVD
SERVICES
POPLAR BLUFF MO 63901
Plan Type: Group Health
POPULATION REFERENCE BUREAU
(PRB)
Affiliated With: ASSURECARE
Plan Type: Group Health
PORT TOWNSEND PAPER
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
POPLAR BLUFF VA MEDICAL CNTER
ASSURECARE
ASSURECARE
340 Quadrangle Dr
Bolingbrook IL 60440
(800) 759-1311
Careline UR
(763) 383-4800
(800) 759-1311
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
220 120th Ave Ste D200
Bellevue WA 98005
(425) 482-1000
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
(425) 482-1000
(425) 482-1000
PORTAGE ENVIRONMENTAL INC
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PORTAGE SCHOOLS TEACHERS AND
ADMINISTRATORS
Affiliated With: UNITED CLAIMS
SOLUTIONS
Plan Type: Group Health
PROFESSIONAL BUSINESS
SERVICES
PROFESSIONAL BUSINESS
SERVICES
CHECK BENEFIT CARD
2959 LUCERNE DR
GRAND RAPIDS MI 48546
(800) 732-3412
PORTER COUNTY GOVERNMENT
Affiliated With: PORTER COUNTY
GOVERNMENT
Plan Type: Group Health
(800) 732-3412
STEWART C. MILLER
STEWART C. MILLER
STEWART C. MILLER
PO Box 5769
LA FAYETTE IN 47903
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-400
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PORTLAND STATE UNIVERSITY
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
CLAIMS SUBMISSION
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AMERIBEN SOLUTIONS
(800) 786-7930
UTILIZATION REVIEW
AMERIBEN SOLUTIONS
(800) 786-7930
(800) 786-7930
PORTLAND STATE UNIVERSITY
INTERNATIONAL
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 786-7930
AMERIBEN SOLUTIONS
(800) 786-7930
(800) 786-7930
PORTLAND VAMC 3178
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
PORTLAND VAMC
Attn: FEE BASIS 136F
3710 SW US VETERANS HOSPITAL
RD
PORTLAND OR 97239
PORTLAND VAMC
CHECK BENEFIT CARD
PORTOLA PLAZA HOTEL AT
MONTEREY BAY
Affiliated With: BENESIGHT, INC.
Plan Type: Group Health
FISERV HEALTH INC
FISERV HEALTH INC
FISERV HEALTH INC
POS
Affiliated With: OSF HEALTHPLANS,
INC.
Plan Type: Group Health
OSF HealthPlans, Inc.
OSF HealthPlans, Inc.
PO Box 1229
Peoria IL 61601-5128
(800) 673-5222
OSF HealthPlans, Inc.
(800) 284-2273
CHECK BENEFIT CARD
CHECK BENEFIT CARD
POST REGISTER
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
PO Box 375
PUEBLO CO 81002
(800) 673-5222
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-401
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
POTANDON PRODUCE
Affiliated With: MERCER
ADMINISTRATION
Plan Type: Group Health
CLAIMS SUBMISSION
MERCER ADMINISTRATION
701 Market St Ste 1350
St Louis MO 63101
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MERCER ADMINISTRATION
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 394-6888
(314) 982-5616
POTOMAC ELECTRIC POWER
COMPANY (PEPCO)
Affiliated With: POTOMAC ELECTRIC
POWER COMPANY (PEPCO)
Plan Type: Group Health
NATIONAL CLAIMS
ADMINISTRATIVE SERVICES, INC.
POUDRE VALLEY RURAL ELECTRIC
ASSOCIATION INC.
Affiliated With: MOUNTAIN MEDICAL
AFFILIATES (MMA)
Plan Type: Group Health
ZENITH ADMINISTRATORS C/O CCN
POWER HOUSE GYM
Affiliated With: CAROLINA BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CAROLINA BENEFIT
ADMINISTRATORS
CAROLINA BENEFIT
ADMINISTRATORS
333 SOUTH PINE ST
SPARTANBURG SC 29302
(800) 476-2295
NATIONAL CLAIMS
ADMINISTRATIVE SERVICES, INC.
PO Box 10104
FAIRFAX VA 22030
NATIONAL CLAIMS
ADMINISTRATIVE SERVICES,
INC.
ZENITH ADMINISTRATORS C/O CCN CHECK BENEFIT CARD
PO Box 3000
SCOTTSDALE AZ 85271-3000
CHECK BENEFIT CARD
(800) 476-2295
POWER SHOT UTILITY
CONSTRUCTION SERVICES, LLC
Affiliated With: GROUP INSURANCE
SERVICE CENTER INC
Plan Type: Group Health
POWERWORKS INDUSTRIES, INC
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
GISC, INC
GISC, INC
20 WINTER ST
PEMBROKE MA 02359
(800) 242-4472
CHECK BENEFIT CARD
(800) 242-4472
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-402
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PPI MOTORSPORTS LLC
Affiliated With: UNITED BENEFITS
DIVISION
Plan Type: Group Health
CLAIMS SUBMISSION
UNITED BENEFITS
PO Box 2480
DAYTONA BEACH FL 32115-2480
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
UNITED BENEFITS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(386) 239-4350
(386) 239-4350
PRATT FEEDERS/BUFFALO FEEDERS THE EPOCH GROUP, LC
Affiliated With: THE EPOCH GROUP
PO Box 12170
Plan Type: Group Health
OVERLAND PARK KS 66282
EPOCH GROUP LC THE
UM NOT APPLICABLE
(800) 255-6065
(800) 255-6065
PRATT REGIONAL MEDICAL CENTER
Affiliated With: WATERSTONE
BENEFIT ADMINISTRATORS
#962501227
Plan Type: Group Health
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
(800) 816-6049
WATERSTONE UTILIZATION
MANAGEMENT
(800) 460-0238
PRECEPT MEDICAL PRODUCTS, INC. CBCA Administrators Inc
Affiliated With: CBCA Administrators, Inc. PO Box 9000
Plan Type: Group Health
LONDON KY 40742
CBCA Administrators Inc
CBCA Administrators Inc
PREFERRED BENEFIT
ADMINISTRATORS
Affiliated With: PREFERRED PLUS OF
KANSAS INC
Plan Type: Group Health
Preferred Plus of Kansas, Inc
Preferred Plus of Kansas, Inc
8535 E 21st St North
Wichita KS 67206
(316) 609-2308
PREFERRED HEALTH
SYSTEMS
(800) 289-0345
PREFERRED CARE
Affiliated With: PREFERRED CARE
Plan Type: Group Health
(800) 816-6049
(316) 609-2308
PREFERRED CARE
PREFERRED CARE
PREFERRED CARE
6 Neshaminy Interplex #205
TREVOSE PA 19053
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-403
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PREFERRED HEALTH ALLIANCE
Affiliated With: PREFERRED HEALTH
ALLIANCE
Plan Type: Group Health
PREFERRED PLUS OF KANSAS INC
Affiliated With: PREFERRED PLUS OF
KANSAS INC / AHA
Plan Type: Group Health
PREFERRED SOURCING
Affiliated With: NORTH AMERICAN
Plan Type: Group Health
CLAIMS SUBMISSION
PREFERRED HEALTH ALLIANCE
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PREFERRED HEALTH ALLIANCE
300 Corporate Pkwy, #3
BIRMINGHAM AL 35242
Preferred Plus of Kansas, Inc
Preferred Plus of Kansas, Inc
8535 E 21st St North
Wichita KS 67206
(316) 609-2308
UTILIZATION REVIEW
PREFERRED HEALTH
ALLIANCE
PREFERRED HEALTH
SYSTEMS
(800) 424-0345
(316) 609-2308
MERITAIN HEALTH
MERITAIN HEALTH
PO Box 80884
Indianapolis IN 46280
(800) 824-8316
CHECK BENEFIT CARD
(800) 824-8316
PREMIER ACCESS (OUT OF AREA)
Affiliated With: PREMIER ACCESS
Plan Type: Group Health
PREMIER ACCESS
PREMIER ACCESS
PO Box 150275
ARLINGTON TX 76015
(888) 463-4137
CHECK BENEFIT CARD
(888) 463-4137
PREMIER CLUB BENEFITS DBA BALD
CREEK COLONY CLUB
Affiliated With: MBA OF MARYLAND
Plan Type: Group Health
MBA OF MARYLAND
MBA OF MARYLAND
3103 EMMORTON RD
ABINGDON MD 21009
(410) 505-0507
STRATEGIC HEALTH
DEVELOPMENT
(410) 505-0507
PREMIER CLUB BENEFITS DBA BOCA MBA OF MARYLAND
LAGO COUNTRY CLUB, INC.
3103 EMMORTON RD
Affiliated With: MBA OF MARYLAND
ABINGDON MD 21009
Plan Type: Group Health
(410) 505-0507
MBA OF MARYLAND
Premier Control Services
Affiliated With: GENEX Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
CONTACT EMPLOYER
Attn:
(410) 505-0507
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
STRATEGIC HEALTH
DEVELOPMENT
CONTACT EMPLOYER
Info as of 12/13/2007
Page PIRCA-404
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PREMIER LABORATORY LLC
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
CLAIMS SUBMISSION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
DIVERSIFIED ADMINISTRATION
CORPORATION
(888) 322-2524
UTILIZATION REVIEW
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
NORTH AMERICAN BENEFITS
NETWORK, INC.
NORTH AMERICAN BENEFITS
NETWORK, INC.
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
CHECK BENEFIT CARD
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
PREMIER MANUFACTURING
CORPORATIONS
Affiliated With: NORTH AMERICAN
BENEFITS NETWORK, INC.
Plan Type: Group Health
NORTH AMERICAN BENEFITS
NETWORK, INC.
PREMIER RESORTS INTERNATIONAL
INC
Affiliated With: CNIC HEALTH
SOLUTIONS
Plan Type: Group Health
PREMIUM BEERS OF OKLAHOMA
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
19800 Detroit Rd.
ROCKY RIVER OH 44116
(800) 825-3540
PREMIUM STANDARD FARMS
Affiliated With: FMH BENEFIT
SERVICES, INC. A DIVISION OF
CORESOURC
Plan Type: Group Health
PRENT CORPORATION
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC
Plan Type: Group Health
FMH BENEFIT SERVICES INC
FMH BENEFIT SERVICES INC
PO Box 25946
OVERLAND PARK KS 66225-5946
(800) 990-9058
HCM
(800) 990-9058
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
(800) 990-9058
MIDWEST SECURITY
ADMINISTRATORS, INC.
PO Box 574
ONALASKA WI 54650
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-405
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PRESBYTERIAN INTERCOMMUNITY
HOSPITAL
Affiliated With: PHYSICIANS CARE
INSURANCE SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
PHYSICIANS CARE INSURANCE
SERVICES, INC.
PO Box 15165
SANTA ANA CA 92735
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PHYSICIANS CARE INSURANCE
SERVICES, INC.
UTILIZATION REVIEW
(714) 540-5882
PHYSICIAN CARE OF
CALIFORNIA
(714) 540-5882
(714) 540-5882
PRESCOTT VAMC (N ARIZONA) 3175
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
PRESCOTT VAMC
Attn: FEE - 144BF
500 HWY 89 NORTH
PRESCOTT AZ 86313
PRESCOTT VAMC
CHECK BENEFIT CARD
PRESS SEAL GASKET
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
4040 HUNSAKER STE 110
LANSING MI 38823
(800) 968-6616
CARELINE
(763) 383-4800
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PRICE EDWARDS, HENDERSON & CO EQUITABLE PLAN SERVICES
Affiliated With: EQUITABLE PLAN
PO Box 720460
SERVICES
OKLAHOMA CITY OK 73172
Plan Type: Group Health
(405) 755-2929
EQUITABLE PLAN SERVICES
CHECK BENEFIT CARD
PRIDE
Affiliated With: AMERICAS TPA
Plan Type: Group Health
America's TPA
America's TPA
PO Box 398220
Bloomington MN 55439
(952) 896-1255
(800) 968-6616
PRETIUM PACKAGING LLC
Affiliated With: THE EPOCH GROUP L
C
Plan Type: Group Health
CHECK BENEFIT CARD
(405) 755-2929
CHECK BENEFIT CARD
(952) 896-1255
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-406
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
PRIDE FEEDERS I LTD COMPANY
KEMPTON GROUP
Affiliated With: THE KEMPTON GROUP ADMINISTRATORS INC
INC
PO Box 54889
Plan Type: Group Health
OKLAHOMA CITY OK 73154
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
KEMPTON GROUP
ADMINISTRATORS INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(405) 521-1711
(405) 521-1711
PRIMARY PROVIDER MANAGEMENT
COMPANY, INC.
Affiliated With: PRIMARY PROVIDER
MANAGEMENT COMPANY, INC.
Plan Type: Group Health
PRIMERA HEALTHCARE SERVICES,
INC
Plan Type: Group Health
PRIMARY PROVIDER MANAGEMENT
COMPANY, INC.
2525 Camino del Rio South Ste 300
San Diego CA 92108
PRIMARY PROVIDER MANAGEMENT PRIMARY PROVIDER
MANAGEMENT COMPANY, INC
COMPANY, INC.
(909)
778-6118
(619) 742-3223
(619) 742-3223
MSO, INC. OF SOUTHERN
CALIFORNIA
MSO, INC. OF SOUTHERN
CALIFORNIA
2360 HUNTINGTON DR
SAN MARINO CA 91108
(626) 656-2370
CHECK BENEFIT CARD
(626) 656-2370
PRIMO MANAGEMENT GROUP INC
Affiliated With: MANAGED BENEFITS
ADMINISTRATOR AND INSURANCE
CONSU
Plan Type: Group Health
CHECK BENEFIT CARD
PRINCIPAL FINANCIAL GROUP
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
PRINTING SPEC. & PAPER PRODS.
JOINT EMP/UNION HLTH & WEL
Affiliated With: PRINTING SPEC. &
PAPER PRODS. JOINT EMP/UNION
HLTH
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8008773727
CHECK BENEFIT CARD
(800) 533-5044
NORTHWEST ADMINISTRATORS,
INC
NORTHWEST ADMINISTRATORS,
INC
2323 Eastlake Avenue East
Seattle WA 98102
(206) 726-3259
UNICARE
(800) 762-3029
(206) 726-3259
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-407
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PRISON HEALTH SERVICES, INC.
Affiliated With: PRISON HEALTH
SERVICES, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
PRISON HEALTH SERVICES, INC.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PRISON HEALTH SERVICES, INC.
105 W Park Dr STE 300
BRENTWOOD TN 37027
Procura
Procura
Plan Type: Workers' Compensation
2435 Blvd of the Generals Ste 201
Norristown PA 19403
UTILIZATION REVIEW
PRISON HEALTH SERVICES,
INC.
CONTACT EMPLOYER
CONTACT EMPLOYER
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
(610) 290-7202
PRODUCTION METAL FORMING, INC.
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
PROFESIONAL ELECTRICAL
CONTRACTORS OF CT, INC.
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
PROFESSIONAL OFFICE SERVICES,
INC.
Affiliated With: MERCER
ADMINISTRATOR
Plan Type: Group Health
* Professional Performance Development
Corporation
Affiliated With: RESOURCEONE
ADMINISTRATORS
Plan Type: Group Health
(541) 312-8512
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(508) 752-2480
CMS
(866) 325-1550
MERCER ADMINISTRATION
MERCER ADMINISTRATION
CHECK BENEFIT CARD
701 Market St Ste 1350
St Louis MO 63101
(800) 394-6888
(508) 752-2480
(800) 394-6888
RESOURCEONE ADMINSTRATORS
Attn: Mary Shepherd
PO Box 489
BUCKEYSTOWN MD 21717
RESOURCEONE ADMINSTRATORS
(800) 967-2077
MEDCAREONE CORP
(800) 816-1206
(918) 967-2077
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-408
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Progressive Insurance (Auto)
Affiliated With: Mitchell Medical
Plan Type: Auto
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
Progressive: Administered by Mitchell
Medical
Progressive Insurance Company
Affiliated With: Progressive Insurance
Company
Plan Type: Group Health
Accordia National
Accordia National
PO Box 3262
CHARLESTON WV 25332
(800) 428-1291
Accordia National
(800) 428-1291
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PROGRESSIVE MEDICAL INC
Affiliated With: HEALTHSCOPE
BENEFITS INC
Plan Type: Group Health
BUSINESS ADMINISTRATORS &
CONSULTANTS INC
BUSINESS ADMINISTRATORS &
CONSULTANTS INC
CHECK BENEFIT CARD
6331 E LIVINGSTON AVE
REYNOLDSBURG OH 43068
(800) 521-2654
PROJECT ADVENTURES
Affiliated With: HEALTH PLANS INC
Plan Type: Group Health
HEALTH PLAN INC
HEALTH PLAN INC
1500 WEST PARK DR STE 330
WESTBOROUGH MA 01581
(508) 752-2480
PROGRESSIVE INSURANCE
COMPANY AUTO
Affiliated With: MITCHELL MEDICAL
Plan Type: Auto
(800) 428-1291
Progressive: Administered by Mitchell
Medical
Exclude Physical Therapists,
Chiropractors & Behavioral Health
providers (OCN ONLY)
CARE MANAGEMENT
SERVICES
(866) 325-1550
(508) 752-2480
PROLOG SERVICES
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
340 Quadrangle Dr
Bolingbrook IL 60440
(800) 759-1311
Careline UR
(763) 383-4800
(800) 759-1311
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-409
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
PROVIDENCE AND WORCESTER
RAILROAD
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
PROVIDENCE COLLEGE
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
Term Effective: 8/31/2007
CLAIMS SUBMISSION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
DIVERSIFIED ADMINISTRATION
CORPORATION
(888) 322-2524
UTILIZATION REVIEW
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 PLANO
PLANO TX 75075
(800) 767-0700
STUDENT INSURANCE A
DIVISION OF UICI
(800) 767-0700
PROVIDENCE VA MEDICAL CENTER
3114
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
PROVIDENCE VA MEDICAL CENTER
Providence Washington
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
PROVIDER NETWORKS OF
AMERICA - PEPM
Affiliated With: PROVIDER NETWORKS
OF AMERICA
Plan Type: Group Health
PROVIDER NETWORKS OF
AMERICA, INC
PROVIDER NETWORKS OF
AMERICA, INC
CHECK BENEFIT CARD
PO Box 850778
RICHARDSON TX 75085
(817) 417-2839
PUGET SOUND FREIGHT LINES
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS,
INC.
Plan Type: Group Health
PROVIDENCE VA MEDICAL CENTER CHECK BENEFIT CARD
5504 HILL HEAVEN CT
FRISCO TX 75035
(817) 417-2839
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
PO Box 85008
BELLEVUE WA 98015
(800) 869-7093 Ext 117
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
(425) 462-1000 Ext 400
(800) 869-7093 Ext 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.
Info as of 12/13/2007
Page PIRCA-410
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
PUGET SOUND VA HCS AMERICAN
PUGET SOUND VA HCS - AMIRICAN
LAKE DIVISION 3179
LAKE DIVISION
Affiliated With: HEALTH NET FEDERAL Attn: A-136-FEE
SERVICES
9600 VETERANS DR
Plan Type: Group Health
TACOMA WA 98493
PULLEN AND ASSOCIATES
Affiliated With: FISERV HEALTH
TENNESSEE
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
PUGET SOUND VA HCS - AMIRICAN
LAKE DIVISION
FISERV HEALTH TENNESSEE
FISERV HEALTH TENNESSEE
PO Box 530
PUEBLO CO 81002-0530
(800) 255-8109
INTRACORP
(800) 866-8899
(800) 255-8109
PULMONARY ASSOCIATES
Affiliated With: ADVANCED BENEFIT
SOLUTIONS LLC
Plan Type: Group Health
CHECK BENEFIT CARD
PYROMATION, INC.
Affiliated With: NORTH AMERICAN
ADMINISTRATOR - NY
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
QUAIL MOUNTAIN PEPSI COLA
Affiliated With: QVI RISK SOLUTIONS,
INC.
Plan Type: Group Health
QVI RISK SOLUTIONS INC
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
(541) 312-8512
CASCADE COMPREHENSIVE
CARE
(541) 883-2947
QUALITY PROJECT MANAGEMENT
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
CHECK BENEFIT CARD
8884191094
ADVANCED BENEFITS
SOLUTIONS
(541) 312-8512
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
PO Box 495
Stockton CA 95201
(209) 939-3992
ARIZONA FOUNDATION FOR
MEDICAL CARE
(602) 417-2337
(209) 939-3992
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-411
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
QUALITY WOOD PRODUCTS
SIERRA HEALTH & LIFE/HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN OF NEVADA
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
Quanta Services Group
Affiliated With: Gallagher Benefit
Administrators, Inc.
Plan Type: Group Health
QUANTUM SERVICES
Affiliated With: BUSINESS
ADMINISTRATORS AND
CONSULTANTS
Plan Type: Group Health
QUECHAN TRIBE - PARADISE
CASINOS
Affiliated With: SRT ADMINISTRATORS
Plan Type: Group Health
Quanta Services Group
Gallagher Benefit Administrators Inc
PO Box 8429
Scottsdale AZ 85252-8429
(800) 323-1726
IntraCorp
(800) 535-5222
(800) 323-1726
BAC
BAC
6331 E LIVINGSTON AVE
REYNOLDSBURG OH 43068
(614) 863-8780
BAC
(614) 863-8780
(614) 863-8780
SRT ADMINISTRATORS
SRT ADMINISTRATORS
PO Box 25160
SCOTTSDALE AZ 85255-0102
(888) 690-2020
Action HealthCare
(800) 433-6915
NORTH AMERICA
ADMINISTRATORS, L.P.
NORTH AMERICA
ADMINISTRATORS, L.P.
HEALTH WATCH
(972) 238-7900
(888) 690-2020
QUEST PHARMACEUTICALS, INC.
Affiliated With: NORTH AMERICA
ADMINISTRATORS, L.P.-TENNESSEE
Plan Type: Group Health
NORTH AMERICA
ADMINISTRATORS, L.P.
QUICKSILVER RESOURCES, INC
Affiliated With: GROUP & PENSIONS
ADMINISTRATORS
Plan Type: Group Health
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
PO Box 1984
NASHVILLE TN 37202
(800) 827-7223 Ext 2325
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-412
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
QUIK PRINT/DOCUMART
Affiliated With: EQUITABLE PLAN
SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
EQUITABLE PLAN SERVICES
PO Box 720460
OKLAHOMA CITY OK 73172
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EQUITABLE PLAN SERVICES
UTILIZATION REVIEW
CHECK BENEFIT CARD
(405) 755-2929
(405) 755-2929
QUINCY COMPRESSOR DIVISION
SALES UNIT
Affiliated With: THE EPOCH GROUP L
C
Plan Type: Group Health
CHECK BENEFIT CARD
QUINNIPIAC COLLEGE SPORTS
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Quixote Corporation
Affiliated With: American Administrative
Group
Plan Type: Group Health
American Administrative Group Inc.
American Administrative Group Inc.
PO Box 5227
LISLE IL 60532
ECS Payor ID 37283
(800) 323-1726
American Administrative Group
Inc.
(800) 538-5222
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8002556065
(800) 323-1726
R & B EXPRESS
Affiliated With: FISERV HEALTH KANSAS
Plan Type: Group Health
R AND O CONSTRUCTION
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
FISERV HEALTH KANSAS
FISERV HEALTH KANSAS
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
AVIDYN HEALTH
(866) 802-1328
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(800) 235-7160
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-413
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
R G RAY CORPORATION
Affiliated With: ALLIED BENEFIT
SYSTEMS INC
Plan Type: Group Health
RADIO FREQUENCY COMPANY
Affiliated With: DIVERSIFIED
ADMINISTRATION CORPORATION
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
3129068080
DIVERSIFIED ADMINISTRATION
CORPORATION
DIVERSIFIED ADMINISTRATION
CORPORATION
PO Box 299
MARLBOROUGH CT 06447
(888) 322-2524
DIVERSIFIED
ADMINISTRATION
CORPORATION
(888) 322-2524
(888) 322-2524
RAIN FOR RENT
Affiliated With: BENEFIT PLANNERS
LTD
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
RAM
Affiliated With: Liberty
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
RAMAHA NAVAJO CHAPTER
Affiliated With: EMPLOYEE BENEFIT
CONSULTANTS INC
Plan Type: Group Health
HCH ADMINISTRATION INC
HCH ADMINISTRATION INC
CHECK BENEFIT CARD
PO Box 285
PEORIA IL 61650
(800) 447-3227
RAMPART RESORT MANAGEMENT
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
(309) 673-7330
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-414
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
RAMSEY INDUSTRIES, INC
Affiliated With: THE EPOCH GROUP
Plan Type: Group Health
CLAIMS SUBMISSION
THE EPOCH GROUP
6717 SHAWNEE MISSION PARKWAY
OVERLAND PARK KS 66202
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
THE EPOCH GROUP
UTILIZATION REVIEW
(800) 255-6065
THE EPOCH GROUP
(800) 255-6065
(800) 255-6065
RANCHO SAN MARCOS
Affiliated With: CNIC HEALTH
SOLUTIONS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Rapid Chevrolet
Affiliated With: Rapid City Regional
Hospital DBA Western Health
Plan Type: Group Health
Western Health
Western Health
529 Kansas City St Ste 200
Rapid City SD 57701
(605) 719-4600 or (888) 3411766
Western Health
(605) 719-4640 or (800) 2290892
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
CBCA Administrators Inc
(800) 831-7783
Capp Care
(800) 937-2277
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
RATH MANUFACTURING
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC
Plan Type: Group Health
(605) 719-4600 or (888) 3411766
MIDWEST SECURITY
ADMINISTRATORS, INC.
PO Box 574
ONALASKA WI 54650
Rayonier Inc.
CBCA Administrators Inc
Affiliated With: CBCA Administrators, Inc. PO Box 8130
Plan Type: Group Health
Scottsdale AZ 85252-8130
(800) 831-7783
RAYPAK, INC.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
PO Box 3000
SCOTTSDALE AZ 85271-3000
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-415
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
RCI
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
RDT EMPLOYEE BENEFIT TRUST
Affiliated With: MOUNTAIN STATES
ADMINISTRATIVE SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
NHBC
8990 E. Raintree Dr.
Scottsdale AZ 85260
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NHBC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(888) 621-7900
(888) 621-7900
Mountain States Administrative
Services
Mountain States Administrative
Services
7202 E ROSEWOOD STE 200
TUCSON AZ 85710
(520) 722-7133
Hines and Associates
(847) 214-2780
(520) 722-7133
REAL SERVICES
Affiliated With: NORTH AMERICA
ADMINISTRATORS
Plan Type: Group Health
NORTH AMERICA
ADMINISTRATORS, L.P.
NORTH AMERICA
ADMINISTRATORS, L.P.
PO Box 1984
NASHVILLE TN 37202
(800) 411-3650
MED-CERT
(800) 356-7126
(800) 411-3650
RED INC
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
RED MESA UNIFIED SCHOOL
DISTRICT - PEPM
Affiliated With: SRT
ADMINISTRATORS, INC
Plan Type: Group Health
REDBUD COMMUNITY HOSPITAL
Affiliated With: ADVENTIST HEALTH
SYSTEM/WEST
Plan Type: Group Health
SMITH ADMINISTRATORS
SMITH ADMINISTRATORS
428 E WINCHESTER ST, STE 200
SALT LAKE CITY UT 84107
(801) 261-5511
SERVICE ADVOCATES
(877) 261-5511
(801) 261-5511
SRT ADMINISTRATORS, INC.
SRT ADMINISTRATORS, INC.
14646 N. Kierland Blvd
Scottsdale AZ 85255-0102
(480) 505-0424
HINES AND ASSOCIATES
(800) 528-2498
(480) 505-0424
ADVENTIST HEALTH SYSTEM/WEST
C/O CCN
ADVENTIST HEALTH SYSTEM/WEST CHECK BENEFIT CARD
C/O CCN
PO Box 3000
SCOTTSDALE AZ 85271-3000
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-416
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
REDDING PAINT MART
Affiliated With: KEY BENEFIT
ADMINISTRATORS 962501149
Plan Type: Group Health
REDGINTON-FAIRVIEW GENERAL
HOSPITAL
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC.
Plan Type: Group Health
REED COLLEGE
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
KEY BENEFIT ADMINISTRATORS
PO Box 1239
FORT MILL SC 29716
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
KEY BENEFIT ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(866) 387-0489
(866) 387-0489
COMPREHENSIVE BENEFITS
ADMINISTRATOR
COMPREHENSIVE BENEFITS
ADMINISTRATOR
PO Box 2365
SOUTH BURLINGTON VT 05407
(800) 525-8788
CHECK BENEFIT CARD
(800) 525-8788
PERSONAL INSURANCE
ADMINISTRATORS
PERSONAL INSURANCE
ADMINISTRATORS
30401 Agoura Rd #250
Agoura Hills CA 91376
(800) 468-4343
CHECK BENEFIT CARD
(800) 468-4343
Regional Health
Affiliated With: Western Health
Plan Type: Group Health
Western Health
Western Health
529 Kansas City St Ste 200
Rapid City SD 57701
(605) 719-4600 or (888) 3411766
Western Health
(605) 719-4640 or (800) 2290892
(605) 719-4600 or (888) 3411766
REGIONAL MEDICAL
ADMINISTRATORS
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
REGIS COLLEGE
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
Term Effective: 8/31/2007
GLOBALCARE, INC.
GLOBALCARE, INC.
6875 Shiloh Rd E
ALPHARETTA GA 30005
8008601111
GLOBALCARE
8008601111
STUDENT RESOURCES
STUDENT RESOURCES
CHECK BENEFIT CARD
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 237-0903 Ext 6352
6783411722
(800) 237-0903 Ext 6352
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-417
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* RELIEF ENTERPRISE, INC.
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
RELIGIOUS COMP TRUST/HMSRCHRISTIAN BROTHER SERVICES
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
* REMINGTON ARMS COMPANY INC
Affiliated With: WELLS FARGO THIRD
PARTY ADMINISTRATOR
Plan Type: Group Health
CLAIMS SUBMISSION
FCE BENEFIT ADMINISTRATORS INC
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
FCE BENEFIT ADMINISTRATORS INC
(800) 899-9355
(800) 899-9355
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
CHECK BENEFIT CARD
(800) 533-5044
Accordia National
Accordia National
PO Box 3262
CHARLESTON WV 25332
(888) 685-7774
CHECK BENEFIT CARD
(888) 685-7774
RENO VAMC 3186
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
RENO VAMC
Attn: FEE BASIS 04FB
1000 LOCUST ST
RENO NV 89502
RENO VAMC
CHECK BENEFIT CARD
RENY Company
Affiliated With: CompIQ
Plan Type: Workers' Compensation
CompIQ Corporation
CompIQ Corporation
CONTACT EMPLOYER
2 South Pointe
Lake Forest CA 92630
(800) 293-3131
(800) 293-3131
RENY Company The
Affiliated With: RENY Company The
Plan Type: Workers' Compensation
RENY Company The
RENY Company The
16610 Dallas Parkway Ste 2400
Dallas TX 75248
(972) 250-0189
RENY Company The
(972) 250-0189
(972) 250-0189
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-418
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
REPUBLIC MORTGAGE TRAVEL PLAN SIERRA HEALTH & LIFE/HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN OF NEVADA
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
REPUBLIC MORTGAGE, LLC
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
REPUBLIC PARKING SYSTEMS, INC.
Affiliated With: ACS BENEFIT
SERVICES, INC.
Plan Type: Group Health
ACS BENEFIT SERVICES, INC.
RESOURCE MANAGEMENT INC
Affiliated With: EBMS EMPLOYEE
BENEFIT MANAGEMENT SERVICES
Plan Type: Group Health
CHECK BENEFIT CARD
ACS BENEFIT SERVICES, INC.
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PO Box 2000
Winston-Salem SC 27102
8007773575
RESTAURANT CONCEPTS INC
APPALACHIAN BENEFITS
Affiliated With: PPALACHAIN BENEFITS PO Box 780
Plan Type: Group Health
STOCKTON CA 94565
APPALACHIAN BENEFITS
CHECK BENEFIT CARD
(828) 926-4040
(828) 926-4040
RETALIX USA
Affiliated With: CENBEN USA INC /
HEALTHSCOPE
Plan Type: Group Health
CENBEN USA
Attn: Melissa Joseph
4079 Executive Pkwy
Westerville OH 43081
CENBEN USA
CHECK BENEFIT CARD
(614) 797-5204
(614) 797-5204
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-419
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
REVIEW MED L.P.
Affiliated With: CompIQ
Plan Type: Group Health
CLAIMS SUBMISSION
Review Med
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Review Med
UTILIZATION REVIEW
CHECK BENEFIT CARD
10300 N Central Expressway Ste 450
Dallas TX 75231
(214) 696-3855
Review Works AUTO
Affiliated With: Review Works
Plan Type: Auto
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
RGIS INVENTORY SPECIAL
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
PO Box 5319
TAMPA FL 33675-5319
(800) 533-5044
(800) 533-5044
RHODE & SCHWARZ, INC
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY PO Box 7011
Plan Type: Group Health
WYOMISSING PA 19610-6011
(800) 346-1223
HINES & ASSOCIATES
(888) 826-5769
THE LOOMIS COMPANY
(800) 346-1223
RHODE ISLAND COLLEGE SPORTS
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
RHODE ISLAND SCHOOL OF DESIGN
Affiliated With: KLAIS & COMPANY
Plan Type: Group Health
KLAIS & COMPANY INC
KLAIS & COMPANY INC
CHECK BENEFIT CARD
1867 W MARKET ST
AKRON OH 44313
(330) 867-8443
(330) 867-8443
RHODES INTERNATIONAL INC
Affiliated With: EVEREST
ADMINISTRATORS INC
Plan Type: Group Health
EVEREST ADMINISTRATORS, INC.
EVEREST ADMINISTRATORS, INC.
PO Box 19002
PROVO UT 84605-9002
(800) 286-4160
CHECK BENEFIT CARD
(800) 286-4160
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-420
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
RHYTHM & HUES, INC.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
CLAIMS SUBMISSION
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
UTILIZATION REVIEW
HINES & ASSOCIATES
(800) 528-2498
PO Box 3000
SCOTTSDALE AZ 85271-3000
RICHMOND (H HOLMES MCGUIRE)
VA 3137
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
RICHMOND (H HOLMES MCGUIRE)
VA
Attn: FEE 04A
1201 BROAD ROCK BLVD
RICHMOND VA 23249
RICHMOND (H HOLMES MCGUIRE)
VA
CHECK BENEFIT CARD
RIDLEYS SUPERMARKETS INC
Affiliated With: SMITH
ADMINISTRATORS INC
Plan Type: Group Health
SMITH ADMINISTRATORS, INC.
SMITH ADMINISTRATORS, INC.
3761 S 700 E SUITE 202
SALT LAKE CITY UT 84106
(801) 261-5511
SERVICE ADVOCATES
(801) 261-5511
CONTACT EMPLOYER
CONTACT EMPLOYER
RINGLING SCHOOL OF ART AND
PEARCE ADMINISTRATION
DESIGN - AMH9076276
PO Box 2438
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(800) 722-1668
Plan Type: Group Health
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
RIO ALGOM MINING CORPORATION
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
RIMCO
Affiliated With: STRATACARE
Plan Type: Workers' Compensation
(801) 261-5511
CONTACT EMPLOYER
(888) 722-1668
CHECK BENEFIT CARD
(800) 825-3540
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-421
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
RIO GRANDE ACTIVE EMPLOYEES
HOSPITAL ASSOCIATION
Affiliated With: RIO GRANDE
EMPLOYEES HOSPITAL
ASSOCIATION
Plan Type: Group Health
CLAIMS SUBMISSION
RIO GRANDE EMPLOYEES
HOSPITAL ASSOCIATION
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
RIO GRANDE EMPLOYEES
HOSPITAL ASSOCIATION
RIO GRANDE EMPLOYEES
HOSPITAL ASSOCIATION
UTILIZATION REVIEW
1675 Carr St. #200-S
LAKEWOOD CO 80215
Risk Administration Services Inc
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
Risk Administration Services, Inc.
Affiliated With: STRATACARE
Plan Type: Workers' Compensation
Risk Administration Services, Inc.
Risk Administration Services, Inc.
CHECK BENEFIT CARD
3900 W 53rd St
Sioux Falls SD 57109-1008
(605) 361-5701
(605) 361-5701
Risk Enterprise Management
Affiliated With: Risk Enterprise
Management
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
RISK REDUCTION
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
NHBC
NHBC
CHECK BENEFIT CARD
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
RITE HITE HOLDING CORPORATION
Affiliated With: EMPLOYEE BENEFIT
CONSULTANTS
Plan Type: Group Health
(888) 621-7900
EMPLOYEE BENEFIT CONSULTANTS EMPLOYEE BENEFIT CONSULTANTS AHH/EBC REVIEW
PO Box 928
FINDLAY OH 45839
(800) 558-7798
(800) 558-7798
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-422
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
RITEMADE PAPER CONVERTERS
Affiliated With: THE EPOCH GROUP
Plan Type: Group Health
CLAIMS SUBMISSION
THE EPOCH GROUP, LC
PO Box 12170
OVERLAND PARK KS 66282
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
THE EPOCH GROUP, LC
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 255-6065
(800) 255-6065
RITTAL CORP.
Affiliated With: UNDERWRITERS
SAFETY & CLAIMS, INC.
Plan Type: Group Health
UNDERWRITERS SAFETY & CLAIMS
RIVERSIDE GENERAL HOSPITAL
Affiliated With: PHYSICIAN CHOICE
NETWORK LLC
Plan Type: Group Health
SELECT BENEFIT ADMINISTRATORS
OF AMERICA
SELECT BENEFIT ADMINISTRATORS CHECK BENEFIT CARD
OF AMERICA
Laguna Springs Dr Ste 320
Elk Grove CA 95758
(916) 226-2020
PO Box 23507
LOUISVILLE KY 40223
UNDERWRITERS SAFETY & CLAIMS UNDERWRITERS SAFETY &
CLAIMS
(916) 226-2020
RIVERSIDE SAN BERNARDINO CNTY
INDIAN HEALTH INC
Affiliated With: RIVERSIDE SAN
BERNARDINO CNTY INDIAN HEALTH
CLINIC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
RIVERSIDE-SAN BERNARDINO
COUNTY INDIAN HEALTH, INC.
Affiliated With: PRIMARY PROVIDER
MANAGEMENT COMPANY
Plan Type: Group Health
ACCESS HEALTH DIRECT
ACCESS HEALTH DIRECT
9275 SKY PARK CT STE 400
SAN DIEGO CA 92123
(858) 467-7630
ACCESS HEALTH DIRECT
(951) 778-6118
RMSCO
Affiliated With: RMSCO INC
Plan Type: Workers' Compensation
(858) 467-7630
RMSCO INC
RMSCO INC
115 CONTINUUM DR
LIVEPOOL NY 13088
(315) 448-9000
RMSCO INC
(315) 448-9000
(315) 448-9000
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-423
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
RO MAC LUMBER SUPPLY INC
Affiliated With: HERITAGE
CONSULTANTS INC
Plan Type: Group Health
ROBERT C BOUK-MERCANTILE
BANCORP, INC
Affiliated With: GLOBALCARE
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
8639674139
GLOBALCARE
GLOBALCARE
6875 SHILOH RD E
ALPHARETTA GA 30005
(678) 341-1811
CHECK BENEFIT CARD
(678) 341-1811
ROBERT F KENNEDY MEDICAL PLAN
Affiliated With: ROBERT F KENNEDY
MEDICAL PLAN
Plan Type: Group Health
CHECK BENEFIT CARD
ROBERT MANN PACKAGING
Affiliated With: COASTAL TPA INC
Plan Type: Group Health
COASTAL HEALTHCARE
ADMINISTRATORS
ROBERTS BROTHERS REALTORS
Affiliated With: CAROLINA BENEFIT
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8003216607
COASTAL HEALTHCARE
ADMINISTRATORS
COASTAL HEALTHCARE
ADMINISTRATORS
CAROLINA BENEFIT
ADMINISTRATORS
CAROLINA BENEFIT
ADMINISTRATORS
CHECK BENEFIT CARD
333 SOUTH PINE ST
SPARTANBURG SC 29302
(800) 476-2295
PO Box 80308
SALINAS CA 93912
(800) 476-2295
* Rochester
Affiliated With: New York State
Insurance Fund
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CONTACT EMPLOYER
Info as of 12/13/2007
Page PIRCA-424
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ROCK COUNTY
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC
Plan Type: Group Health
ROCKHURST UNIVERSITY
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
CHECK BENEFIT CARD
PO Box 7186
BOISE ID 83707
(800) 953-1801
CLAIMS SUBMISSION
MIDWEST SECURITY
ADMINISTRATORS, INC.
UTILIZATION REVIEW
PO Box 574
ONALASKA WI 54650
(800) 953-1801
ROCKWAY INC
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
ROCKY MOUNTAIN CARE
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ROCKY MOUNTAIN CHOCOLATE
FACTORY, INC.
Affiliated With: WAUSAU BENEFITS
Plan Type: Group Health
WAUSAU BENEFITS, INC.
Attn: LeAnn Fichtner
PO Box 8046
WAUSAU WI 54401-8046
WAUSAU BENEFITS, INC.
CHECK BENEFIT CARD
(715) 841-7802
(715) 841-7802
ROCKY MOUNTAIN THERAPY
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-425
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Rocor International
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
RODMAN COMPANIES
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
CONTACT EMPLOYER
GROUP & PENSION
ADMINISTRATORS INC
GROUP & PENSION
ADMINISTRATORS INC
HEALTH WATCH
(972) 238-7900
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
UTILIZATION REVIEW
(972) 238-7900
ROGER WILLIAMS UNIVERSITY
Affiliated With: CONSOLIDATED
HEALTH PLANS
Plan Type: Group Health
CONSOLIDATED HEALTH PLANS
CONSOLIDATED HEALTH PLANS
195 STAFFORD ST
SPRINGFIELD MA 01104
(800) 633-7867
CHECK BENEFIT CARD
(800) 633-7867
ROHRER CORPORATION
BENEFIT SERVICES, INC.
Affiliated With: BENEFIT SERVICES INC 3636 COPLEY RD
Plan Type: Group Health
AKRON OH 44216
BENEFIT SERVICES, INC.
RONNOCO SPECIALTY COFFEE
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
8003673762
Med-Valu
(800) 349-8587
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
ROSE HULMAN - DOMESTIC
Affiliated With: COMMERCIAL
TRAVELERS MUTUAL INSURANCE
COMPANY
Plan Type: Group Health
COMMERCIAL TRAVELERS
COMMERCIAL TRAVELERS
70 GENESEE ST
UTICA NY 13502
(800) 756-3702
CHECK BENEFIT CARD
(800) 756-3702
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-426
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ROSE HULMAN - INTERNATIONAL
Affiliated With: COMMERCIAL
TRAVELERS MUTUAL INSURANCE
COMPANY
Plan Type: Group Health
ROSE HULMAN - SPORTS
Affiliated With: COMMERCIAL
TRAVELERS MUTUAL INSURANCE
COMPANY
Plan Type: Group Health
ROSEBURG VA HCS 3180
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
ROSENS DIVERSIFIED, INC
Affiliated With: SELF INSURED
SERVICES COMPANY SISCO
Plan Type: Group Health
ROSENSTEIN FIST AND RINGOLD
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
COMMERCIAL TRAVELERS
70 GENESEE ST
UTICA NY 13502
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
COMMERCIAL TRAVELERS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 756-3702
(800) 756-3702
COMMERCIAL TRAVELERS
COMMERCIAL TRAVELERS
70 GENESEE ST
UTICA NY 13502
(800) 756-3702
CHECK BENEFIT CARD
(800) 756-3702
HEALTH NET FEDERAL SERVICES
HEALTH NET FEDERAL SERVICES
2025 AEROJET RD
RANCHO CORDOVA CA 95742
(916) 985-1259
CHECK BENEFIT CARD
(916) 985-1259
SISCO
SISCO
PO Box 389
DUBUQUE IA 52004-0389
(800) 457-4726
CHECK BENEFIT CARD
(800) 457-4726
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
ROTATION DYNAMICS CORP.
Affiliated With: SELF INSURED
SERVICES COMPANY SISCO
Plan Type: Group Health
SELF INSURED SERVICES
COMPANY (SISCO)
SELF INSURED SERVICES
COMPANY (SISCO)
PO Box 389
DUBUQUE IA 52004-0389
(319) 583-7301 Ext 285
CHECK BENEFIT CARD
(319) 583-7301 Ext 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.
Info as of 12/13/2007
Page PIRCA-427
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ROTATIONAL MOLDING
TECHNOLOGIES
Affiliated With: BENEFITS SERVICES,
INC.
Plan Type: Group Health
CLAIMS SUBMISSION
BENEFIT SERVICES, INC.
3636 Copley Rd
Akron OH 44321
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 367-3762
(800) 367-3762
ROUGH ROCK COMMUNITY SCHOOL
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
SRT ADMINISTRATORS, INC.
ROYAL INSTITUTIONAL SERVICES
PAWTUCKET ANGELICA
Affiliated With: BENEFIT PLAN
MANAGEMENT
Plan Type: Group Health
ROYAL OAKS
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BENEFIT SERVICES, INC.
SRT ADMINISTRATORS, INC.
CHECK BENEFIT CARD
BENEFIT PLAN MANAGEMENT
BENEFIT PLAN MANAGEMENT
CHECK BENEFIT CARD
PO Box 536
ROCKLAND MA 02370
(781) 753-7559
PO Box 25160
SCOTTSDALE AZ 85255-0102
(781) 753-7559
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
HEALTH WATCH
(972) 238-7900
(972) 238-7900
RPM MANAGEMENT, INC
Affiliated With: BUSINESS
ADMINISTRATORS AND
CONSULTANTS
Plan Type: Group Health
* RS STAFFING
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
BAC
BAC
6331 E LIVINGSTON AVE
REYNOLDSBURG OH 43068
(614) 863-8780
BAC
(614) 863-8780
(614) 863-8780
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC CHECK BENEFIT CARD
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-428
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
RS STAFFING
Affiliated With: FCE BENEFIT
ADMINISTRATORS
Plan Type: Group Health
RSA-USA, INC.
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
CLAIMS SUBMISSION
FCE BENEFIT ADMINISTRATORS INC
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
UM
NOT APPLICABLE
FCE BENEFIT ADMINISTRATORS INC
(800) 899-9355
(800) 899-9355
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
CONTACT EMPLOYER
CONTACT EMPLOYER
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
EMPLOYEE BENEFITS
ADMINISTRATION & MGMT. (EBA&M)
30501 Agoura Rd. #101
WESTLAKE VILLAGE CA 90301
CONTACT EMPLOYER
RSKCO Cunningham and Lindsey
Channeling
Attn:
Affiliated With: RSKCO Cunningham and
Lindsey
Plan Type: Workers' Compensation
Participates in California Select Network
RSVP TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
(702) 242-7700
RUIZ FOOD PRODUCTS
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
RUSH UNIVERSITY
Affiliated With: JOHN RILEY
INSURANCE
Plan Type: Group Health
JOHN RILEY INSURANCE
Attn: SUSAN RINDFLEISCH
PO Box 356
WEST BOYLSTON MA 01453
JOHN RILEY INSURANCE
HINES AND ASSOCIATES
(800) 246-4127
(800) 541-1101
(800) 541-1101
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-429
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
RUSTIN CONCRETE
Affiliated With: EQUITABLE PLAN
SERVICES
Plan Type: Group Health
RYAN BUILDING GROUP
Affiliated With: ALLIED BENEFIT
SYSTEMS, INC.
Plan Type: Group Health
S C JOHNSON & SONS
Affiliated With: FISERV HEALTH
Plan Type: Group Health
CLAIMS SUBMISSION
EQUITABLE PLAN SERVICES
PO Box 720460
OKLAHOMA CITY OK 73172
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EQUITABLE PLAN SERVICES
UTILIZATION REVIEW
CHECK BENEFIT CARD
(405) 755-2929
(405) 755-2929
ALLIED BENEFIT SYSTEMS, INC
ALLIED BENEFIT SYSTEMS, INC
208 S LASALLE ST STE 1300
CHICAGO IL 60604
(312) 906-8080 Ext 259
CHECK BENEFIT CARD
(312) 906-8080 Ext 259
FISERV HEALTH INC
FISERV HEALTH INC
PO Box 8013
WAUSAU WI 54402-8013
(800) 826-9781
BOWERS & ASSOCIATES
(800) 827-6730
BENEFIT SYSTEMS & SERVICES,
INC.
BENEFIT SYSTEMS &
SERVICES, INC.
(800) 826-9781
S E T ENVIRONMENTAL, INC.
Affiliated With: BENEFIT SYSTEMS &
SERVICES, INC.
Plan Type: Group Health
BENEFIT SYSTEMS & SERVICES,
INC.
SABROSO COMPANY
Affiliated With: ASSOCIATED
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SAC FINANCE
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
4040 HUNSAKER STE 110
LANSING MI 38823
(800) 968-6616
CARELINE
(763) 383-4800
760 Pasquinelli Dr. STE 320
WESTMONT IL 60559
(800) 968-6616
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-430
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SADDLEBACK COLLEGE
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
CLAIMS SUBMISSION
PERSONAL INSURANCE
ADMINISTRATORS
30401 Agoura Rd #250
Agoura Hills CA 91376
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PERSONAL INSURANCE
ADMINISTRATORS
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 468-4343
(800) 468-4343
SADDLEBACK VALLEY COMMUNITY
CHURCH
Affiliated With: HEALTHCOMP
ADMINISTRATORS INC
Plan Type: Group Health
* Safety Group Office 1
Affiliated With: New York State
Insurance Fund
Plan Type: Workers' Compensation
* Safety Group Office 2
Affiliated With: New York State
Insurance Fund
Plan Type: Workers' Compensation
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8004427247
8005287936
New York State Insurance Fund
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
199 Church St
New York NY 10007
(212) 312-7306
New York State Insurance Fund
199 Church St
New York NY 10007
(212) 312-7306
SAFEWAY
SAFEWAY
SAFEWAY
(925) 467-3828
SAFEWAY
(925) 467-3828
Plan Type: Workers' Compensation
5918 Stoneridge Mall Rd.
Pleasanton CA 94588-3229
MERITAIN HEALTH
MERITAIN HEALTH
CHECK BENEFIT CARD
19800 Detroit Rd.
ROCKY RIVER OH 44116
(877) 801-1500
(925) 467-3828
SAFY
Affiliated With: MERITAIN HEALTH
Plan Type: Group Health
(877) 801-1500
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-431
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Sagamore Insurance Company
Affiliated With: GENEX Services, Inc
Plan Type: Workers' Compensation
SAGE PUBLICATIONS
Affiliated With: HEALTHCOMP THIRD
PARTY ADMOINISTRATORS
Plan Type: Group Health
SAGEBRUSH - RHODES HOMES
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
HEALTHCOMP TPA
HEALTHCOMP TPA
PO Box 45018
Fresno CA 93718
(800) 442-7247
UTILIZATION REVIEW
CONTACT EMPLOYER
HEALTHCOMP TPA
(800) 755-7247
(800) 442-7247
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
SAGEBRUSH-TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
SAGINAW VA MEDICAL CENTER 3158
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
* SAIA BURGES AUTOMOTIVE
CURATORS
Affiliated With: WELLS FARGO THIRD
PARTY ADMINISTRATOR
Plan Type: Group Health
SAGINAW VA MEDICAL CENTER
Attn: FEE BASIS 136F
1500 WEISS ST
SAGINAW MI 48602
SAGINAW VA MEDICAL CENTER
CHECK BENEFIT CARD
ACORDIA NATIONAL
ACORDIA NATIONAL
CHECK BENEFIT CARD
(888) 685-7774
(888) 685-7774
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-432
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SAINT FRANCIS UNIVERSITY
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
CLAIMS SUBMISSION
ADMINISTRATIVE CONCEPTS INC
Attn: Customer Service Dept
997 Old Eagle School Rd. #215
WAYNE PA 19087-1706
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ADMINISTRATIVE CONCEPTS INC
UTILIZATION REVIEW
UM NOT APPLICABLE
(888) 293-9229
(888) 293-9229
SUMMIT AMERICA INSURANCE
SERVICES
SUMMIT AMERICA INSURANCE
SERVICES
EMPLOYEE BENEFIT
ADMINISTRATORS
CHECK BENEFIT CARD
SALEM VAMC
Attn: FEE BASIS 04H
1970 ROANOKE BLVD
SALEM VA 24153
SALEM VAMC
CHECK BENEFIT CARD
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
CHECK BENEFIT CARD
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
SAINT MARTIN'S COLLEGE
ATHLETICS
Affiliated With: SUMMIT AMERICA
INSURANCE SERVICES
Plan Type: Group Health
SUMMIT AMERICA INSURANCE
SERVICES
SAKURA FINETEK
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATORS
Plan Type: Group Health
EMPLOYEE BENEFIT
ADMINISTRATORS
SALEM VAMC 3138
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
* Sales Partners Southwest (TRAVEL)
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
5001 College Blvd., #216
LEAWOOD KS 66211
424 N. First Ave.
ARCADIA CA 91006-2804
(800) 827-7223
SALINAS FIREFIGHTERS
Affiliated With: COASTAL TPA INC
Plan Type: Group Health
COASTAL HEALTHCARE
ADMINISTRATORS
COASTAL HEALTHCARE
ADMINISTRATORS
PO Box 80308
SALINAS CA 93912
8006547475 Ext 322
COASTAL HEALTHCARE
ADMINISTRATORS
8006547475 Ext 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.
Info as of 12/13/2007
Page PIRCA-433
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SALINAS GOLF & COUNTRY CLUB
Affiliated With: KEY BENEFIT
ADMINISTRATORS
Plan Type: Group Health
SALINAS VALLEY MEMORIAL HOSP
(NON-WRAP)
Affiliated With: COASTAL TPA, INC.
Plan Type: Group Health
SALINAS VALLEY MEMORIAL
HOSPITAL
Affiliated With: COASTAL TPA INC
Plan Type: Group Health
CLAIMS SUBMISSION
KEY BENEFIT ADMINISTRATORS
PO Box 1239
FORT MILL SC 29716
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
KEY BENEFIT ADMINISTRATORS
(866) 387-0489
UTILIZATION REVIEW
Health Care Management
(317) 284-7650
(866) 387-0489
COASTAL TPA, INC.
COASTAL TPA, INC.
PO Box 80308
SALINAS CA 93912
(800) 564-7475
SVMH
(831) 757-4333
(800) 564-7475
COASTAL TPA, INC.
COASTAL TPA, INC.
PO Box 80308
SALINAS CA 93912
(831) 455-1833
SALINAS VALLEY MEMORIAL
HOSPITAL
(831) 757-4333
(831) 455-1833
SALISBURY VAMC 3139
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
SALISBURY VAMC
Attn: FEE BASIS (04J)
1601 BRENNER RD
SALISBURY NC 28144
SALISBURY VAMC
CHECK BENEFIT CARD
SALT LAKE CITY VAMC 3535
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
SALT LAKE CITY VAMC
SALT LAKE CITY VAMC
CHECK BENEFIT CARD
SALT LAKE ORTHOPAEDIC CLINIC
Affiliated With: SMITH
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
500 FOOTHILL DR
SALT LAKE CITY UT 84148
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-434
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
SALT RIVER PIMA MARICOPA INDIAN AMERIBEN SOLUTIONS
COMMUNITY
PO Box 7186
Affiliated With: SALT RIVER PIMA
BOISE ID 83707
MARICOPA INDIAN COMMUNITY
(800) 786-7930 Ext 9234
Plan Type: Group Health
SALT RIVER SAND & ROCK
Affiliated With: CORESOURCE
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
AMERIBEN SOLUTIONS
UTILIZATION REVIEW
AMERIBEN SOLUTIONS
(800) 786-7930 Ext 9234
CORESOURCE
CORESOURCE
PO Box 2920
CLINTON OH 52733-2920
(866) 280-4120
CORESOURCE
(866) 794-0770
ADMINISTRATIVE CONCEPTS, INC.
ADMINISTRATIVE CONCEPTS, INC.
CHECK BENEFIT CARD
997 OLD EAGLE SCHOOL
WAYNE PA 19087-1706
(888) 293-9229
(866) 280-4120
SALVE REGINA UNIVERSITY
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
SAM HOUSTON STATE UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
SAMARITAN HEALTH PLANS
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
SAMC
Affiliated With: OSF HEALTHPLANS,
INC.
Plan Type: Group Health
(888) 293-9229
TRUE CHOICE USA
TRUE CHOICE USA
PO Box 700307
DALLAS TX 75370
(800) 785-2446
CHECK BENEFIT CARD
(800) 785-2446
NHBC
NHBC
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
CHECK BENEFIT CARD
(888) 621-7900
OSF HealthPlans, Inc.
OSF HealthPlans, Inc.
PO Box 1229
Peoria IL 61601-5128
(800) 673-5222
OSF HealthPlans, Inc.
(800) 284-2273
(800) 673-5222
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-435
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SAMMON TRUCKING, INC.
Affiliated With: TRUSTEED PLANS
SERVICE GROUP
Plan Type: Group Health
CLAIMS SUBMISSION
TRUSTEED PLANS SERVICE
CORPORATION
PO Box 1894
TACOMA WA 98406-1705
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
TRUSTEED PLANS SERVICE
CORPORATION
UTILIZATION REVIEW
AMERICAN HEALTH HOLDING
(888) 877-7994
(253) 564-5850
(253) 564-5850
SAN ANTONIO AEROSPACE - TRAVEL
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
GROUP & PENSION
ADMINISTRATORS INC
GROUP & PENSION
ADMINISTRATORS INC
12770 MERIT DR STE 200
DALLAS TX 75251
(800) 827-7223
HEALTH WATCH
(972) 238-7900
(972) 238-7900
SAN DIEGO CEMENT MASONS TRUST ALLIED ADMINISTRATORS
Affiliated With: SAN DIEGO CEMENT
2831 Camino del Rio S STE 311
MASONS TRUST
SAN DIEGO CA 92108
Plan Type: Group Health
SAN DIEGO CO. TEAMSTERS EMPLOYERS INSURANCE TRUST
Affiliated With: SAN DIEGO CO.
TEAMSTERS-EMPLOYERS
INSURANCE TRUST
Plan Type: Group Health
ASSOCIATED THIRD PARTY
ADMINISTRATORS
SAN DIEGO CO. TEAMSTERS
HEALTH & WELFARE TRUST
Affiliated With: SAN DIEGO CO.
TEAMSTERS HEALTH & WELFARE
TRUST
Plan Type: Group Health
ALLIED ADMINISTRATORS
SAN DIEGO FIREMAN RELIEF
ASSOCIATION
Affiliated With: THE PLAN HANDLERS
INC
Plan Type: Group Health
THE PLAN HANDLERS, INC. C/O CCN
ALLIED ADMINISTRATORS
ALLIED ADMINISTRATORS
ASSOCIATED THIRD PARTY
ADMINIATRATORS
ASSOCIATED THIRD PARTY
ADMINIATRATORS
ALLIED ADMINISTRATORS
ALLIED ADMINISTRATORS
THE PLAN HANDLERS INC
THE PLAN HANDLERS INC
2831 Camino del Rio S STE 207
SAN DIEGO CA 92108
2831 Camino del Rio S STE 311
SAN DIEGO CA 92108
PO Box 3000
SCOTTSDALE AZ 85271-3000
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-436
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
SAN DIEGO HCS 3192
SAN DIEGO HCS
Affiliated With: HEALTH NET FEDERAL Attn: FEE BASIS 136B-SV
SERVICES
3350 LA JOLLA VILLAGE DR
Plan Type: Group Health
SAN DIEGO CA 92161
SAN DIEGO HOTEL & REST.
EMPLOYEE HLTH & PENSION FUND
Affiliated With: SAN DIEGO HOTEL &
REST. EMPLOYEE HLTH & PENS.
FUND
Plan Type: Group Health
Term Effective: 8/31/2007
ALLIED ADMINISTRATORS
SAN DIEGO READER
Affiliated With: CENBEN USA INC /
HEALTHSCOPE
Plan Type: Group Health
CENBEN USA
Attn: Melissa Joseph
4079 Executive Pkwy
Westerville OH 43081
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SAN DIEGO HCS
CHECK BENEFIT CARD
ALLIED ADMINISTRATORS
ALLIED ADMINISTRATORS
CENBEN USA
CHECK BENEFIT CARD
UTILIZATION REVIEW
2831 Camino del Rio S STE 311
SAN DIEGO CA 92108
(614) 797-5204
(614) 797-5204
SAN DIEGO TRANSIT CORPORATION
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATORS
Plan Type: Group Health
EMPLOYEE BENEFIT
ADMINISTRATORS
SAN FRANCISCO ELECTRICAL
WORKERS H&W TRUST
Affiliated With: SAN FRANCISCO
ELECTRICAL WORKERS H&W TRUST
Plan Type: Group Health
EISB C/O HEALTH ASPEX, INC.
SAN FRANCISCO VAMC 3187
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
SAN FRANSISCO VAMC
Attn: FEE BASIS 04F
4150 CLEMENT ST BLDG 6
SAN FRANSISCO CA 94121
EMPLOYEE BENEFIT
ADMINISTRATORS
CHECK BENEFIT CARD
EISB C/O HEALTH ASPEX, INC.
EISB C/O HEALTH ASPEX, INC.
SAN FRANSISCO VAMC
CHECK BENEFIT CARD
424 N. First Ave.
ARCADIA CA 91006-2804
5301 Buckeystown Pike #455
FREDERICK MD 21704
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-437
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
SAN JOAQUIN COMMUNITY HOSPITAL ADVENTIST HEALTH SYSTEM WEST
Affiliated With: ADVENTIST HEALTH
PO Box 619031
SYSTEM/WEST
ROSEVILLE CA 95661-9002
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
ADVENTIST HEALTH SYSTEM WEST
ADVENTIST HEALTH
SYSTEMS/WEST
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SAN JUAN VA MEDICAL CENTER 3145
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
SAN JUAN VA MEDICAL CENTER
Attn: 672-B01D
10 CASIA ST
SAN JUAN PR 00921
SAN JUAN VA MEDICAL CENTER
CHECK BENEFIT CARD
SANDVIK
Affiliated With: ALLIED BENEFIT
SYSTEMS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SANTA BARBARA COUNTY MAIN JAIL
Affiliated With: PRISON HEALTH
SERVICES, INC.
Plan Type: Group Health
PRISON HEALTH SERVICES, INC.
PRISON HEALTH SERVICES, INC.
PRISON HEALTH SERVICES,
INC.
SAN JOAQUIN COMMUNITY
HOSPITAL EXCLUSIVE
Affiliated With: ADVENTIST HEALTH
SYSTEM/WEST
Plan Type: Group Health
ADVENTIST HEALTH
SYSTEMS/WEST
SAN JUAN IPA
Affiliated With: NATIONAL HEALTH
BENEFIT CORPORATION (NHBC)
Plan Type: Group Health
PO Box 619031
ROSEVILLE CA 95661-9002
105 W Park Dr STE 300
BRENTWOOD TN 37027
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-438
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SANTA CLARA UNIVERSITY
Affiliated With: ASSOCIATED
ADMINISTRATORS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
ASSOCIATED ADMINISTRATORS,
INC.
PO Box 5096
PORTLAND OR 97208
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ASSOCIATED ADMINISTRATORS,
INC.
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 770-6672
(800) 770-6672
SANTA CRUZ MEDICAL CLINIC
Affiliated With: CAPITOL
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SANTA MONICA COLLEGE
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
STAR HEALTHCARE NETWORK
STAR HEALTHCARE NETWORK
CHECK BENEFIT CARD
850 Seventh Ave STE 803
New York NY 10019
(212) 581-8228
* SANUS HEALTH
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
SANUS HEALTH
Affiliated With: SANUS HEALTH
CORPORATION
Plan Type: Group Health
SAPAUGH MOTORS, INC
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
(212) 581-8228
SANUS HEALTH CORPORATION
SANUS HEALTH CORPORATION
12501 KENDALL DR STE 2
MIAMI FL 33186
(469) 417-1755
SANUS HEALTH
CORPORATION
(469) 417-1755
(469) 417-1755
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-439
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SARGENT CORP JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
SAVANNAH STATE UNIV AIH0058417
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
SAVANNAH STATE UNIVERSITY
UNDERGRAD MANDATORY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
CLAIMS SUBMISSION
EBPA
PO Box 2365
SOUTH BURLINGTON VT 05403
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EBPA
UTILIZATION REVIEW
CHECK BENEFIT CARD
(802) 846-8060
(802) 846-8060
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2271
Florence SC 29503
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
419 S. COIT ST
FLORENCE SC 29501
PEARCE ADMINISTRATION
UM NOT APPLICABLE
(800) 222-6491
(800) 222-6491
SAYRE MEMORIAL HOSPITAL
Affiliated With: WATERSTONE
BENEFITS ADMINISTRATORS, INC.
Plan Type: Group Health
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
(405) 440-8888
CHECK BENEFIT CARD
(405) 440-8888
SCC INDUSTRIES
Affiliated With: CORESOURCE
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SCHAFFER COMPANIES GH
Affiliated With: STRATACARE
Plan Type: Group Health
CONTACT EMPLOYER
CONTACT EMPLOYER
CONTACT EMPLOYER
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-440
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SCHAFFER COMPANIES WC
Affiliated With: STRATACARE
Plan Type: Workers' Compensation
SCHALLER ANDERSON BEHAVIORAL
HEALTH OF CALIFORNIA
ADMINISTRATORS
Affiliated With: SCHALLER ANDERSON
HEALTHCARE
Plan Type: Group Health
CLAIMS SUBMISSION
CONTACT EMPLOYER
SCHALER ANDERSON HEALTHCARE CHECK BENEFIT CARD
4645 E. COTTON CENTER BLVD
BLDG 1 #200
PHOENIX AZ 85040
(602) 659-1403
(602) 659-1403
THE CALENDS GROUP
SCHMIEDESKAMP, ROBERTSON,
NEW & MITCHELL
Affiliated With: NORTH AMERICAN
ADMINISTRATORS
Plan Type: Group Health
SCHOOL CITY OF EAST CHICAGO
Affiliated With: PROFESIONAL CLAIMS
MANAGEMENT
Plan Type: Group Health
UTILIZATION REVIEW
CONTACT EMPLOYER
SCHALER ANDERSON HEALTHCARE
SCHEPEL BUICK-GMC TRUCK, INC.
Affiliated With: THE CALENDS GROUP
Plan Type: Group Health
SCHMITT, SUSSMAN, ENTERPRISES
dba PFP
Affiliated With: BROKERAGE
CONCEPTS INC
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
THE CALENDS GROUP
THE CALENDS GROUP
NORTH AMERICA
ADMINISTRATORS, L.P.
NORTH AMERICA
ADMINISTRATORS, L.P.
MED-CERT
(800) 356-7126
PO Box 1984
NASHVILLE TN 37202
(615) 255-6654
5972 Stellhorn Rd.
FORT WAYNE IN 46815
(615) 255-6654
CLAIMS MANAGER
(800) 220-2600
CHECK BENEFIT CARD
PROFESSIONAL CLAIMS MGMT
PROFESSIONAL CLAIMS MGMT
CHECK BENEFIT CARD
16 W 455 S FRONTGATE RD STE 216
BURR RIDGE IL 60527
(800) 590-6500
PO Box 61553
KING OF PRUSSIA PA 19406
(610) 337-2600
(800) 590-6500
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-441
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SCHOOL DISTRICT OF JANESVILLE
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC
Plan Type: Group Health
SCHWARZ PARTNERS-PACKAGING
Affiliated With: NGS AMERICAN INC
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
MIDWEST SECURITY
ADMINISTRATORS, INC.
MIDWEST SECURITY
ADMINISTRATORS, INC.
NGS AMERICAN, INC.
NGS AMERICAN, INC.
UM NOT APPLICABLE
PO Box 7676
DETROIT MI 48080
8005211555
CLAIMS SUBMISSION
MIDWEST SECURITY
ADMINISTRATORS, INC.
UTILIZATION REVIEW
PO Box 574
ONALASKA WI 54650
8005211555
SCICOM INC
Affiliated With: MAYO MANAGEMENT
SERVICES INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SCOLARI S FOOD DRUG
Affiliated With: CDS GROUP HEALTH
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SCOTIABANK
Affiliated With: COLONIAL GROUP
INTERNATIONAL LTD
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SCOTLAND YARD SECURITY
SERVICES LTD
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
7753526959
(800) 283-4927
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-442
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
SCRIPPS HEALTH INC EPO
SCHALLER ANDERSON
Affiliated With: SCHALLER ANDERSON HEALTHCARE LLC
HEALTHCARE LLC
PO Box 63065
Plan Type: Group Health
PHOENIX AZ 85082-3065
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SCHALLER ANDERSON
HEALTHCARE LLC
SCHALLER ANDERSON
HEALTHCARE LLC
SCHALLER ANDERSON
HEALTHCARE LLC
SCHALLER ANDERSON
HEALTHCARE LLC
CHECK BENEFIT CARD
SCRIPPS HEALTH INC PPO AND OUT
OF AREA
Affiliated With: SCHALLER ANDERSON
HEALTHCARE LLC
Plan Type: Group Health
SCHALLER ANDERSON
HEALTHCARE LLC
SD CEMENT MASONS TRUST
Affiliated With: SD CEMENT MASONS
TRUST
Plan Type: Group Health
ALLIED ADMINISTRATORS
ALLIED ADMINISTRATORS
2831 Camino del Rio S STE 311
SAN DIEGO CA 92108
(619) 297-8235
SD COUNTY TEAMSTER TRUST
Affiliated With: SD COUNTY
TEAMSTER TRUST
Plan Type: Group Health
SD IRELAND CONCRETE
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS
Plan Type: Group Health
SEABOARD INTERNATIONAL
Affiliated With: ENTRUST INC
Plan Type: Group Health
UTILIZATION REVIEW
PO Box 63065
PHOENIX AZ 85082-3065
(619) 297-8235
ALLIED ADMINISTRATORS
ALLIED ADMINISTRATORS
2831 Camino del Rio S STE 311
SAN DIEGO CA 92108
(619) 297-8235
CHECK BENEFIT CARD
(619) 297-8235
CBA
CBA
PO Box 2365
SOUTH BURLINGTON VT 05407
(800) 525-8788
UM NOT APPLICABLE
(800) 525-8788
ENTRUST INC
ENTRUST INC
14701 ST MARY'S LN STE 150
HOUSTON TX 77079
(281) 368-7878
MEDICAL HELPLINE
(877) 463-3435
(281) 368-7878
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-443
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SEAMAN CORPORATION
Affiliated With: SUPERIEN HEALTH
NETWORK
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SEASONAL CONCEPTS INC
Affiliated With: AMERICAS TPA
Plan Type: Group Health
America's TPA
America's TPA
CHECK BENEFIT CARD
PO Box 398220
Bloomington MN 55439
(952) 896-1255
PAYOR NAME
SEALMASTER EPT HOURLY
Affiliated With: SEALMASTER EPT
HOURLY
Plan Type: Group Health
UTILIZATION REVIEW
(952) 896-1255
SEATTLE FINANCIAL GROUP
Affiliated With: EMPLOYEE BENEFIT
MANAGEMENT SERVICES, INC.
Plan Type: Group Health
EBMS
EBMS
PO Box 21367
BILLINGS MT 59104-1367
(800) 777-3575
CHECK BENEFIT CARD
(800) 777-3575
SEATTLE PACIFIC INDUSTRIES
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS
INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SEATTLE TACOMA BOX CO
Affiliated With: TRUSTEED PLANS
SERVICE CORPORATION
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-444
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* SECURIGUARD
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
SECURITIES AMERICA FINANCIAL
CORPORATION
Affiliated With: AMERICAN
HEALTHCARE ALLIANCE
Plan Type: Group Health
* Security Forces
Affiliated With: KANAWHA
HEALTHCARE
Plan Type: Group Health
CLAIMS SUBMISSION
FCE BENEFIT ADMINISTRATORS INC
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
FCE BENEFIT ADMINISTRATORS INC
(800) 899-9355
(800) 899-9355
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
KHS
KHS
UM NOT APPLICABLE
PO Box 1000
LANCASTER SC 29720
(800) 822-1274
(800) 822-1274
Sedgwick Claims Management Services
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
Selective Insurance Agency
Affiliated With: Fair Isaac Corporation
Plan Type: Workers' Compensation
Selective Insurance Agency
Selective Insurance Agency
CHECK BENEFIT CARD
40 Wantage Ave
Branchville NJ 07890
(973) 948-1638
SENECA CENTER
Affiliated With: HEALTHCOMP
Plan Type: Group Health
HEALTHCOMP ADMINISTRATORS
INC
HEALTHCOMP ADMINISTRATORS
INC
621 SANTA FE
FRESNO CA 93703
(800) 755-7247
HEALTHCOMP
ADMINISTRATORS INC
(800) 755-7247
(800) 755-7247
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-445
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SENENET, INC
Affiliated With: HEALTHCOMP TPA
#10473
Plan Type: Group Health
SENIOR MANAGEMENT CONCEPTS
Affiliated With: QUALIFIED BENEFIT
SERVICES
Plan Type: Group Health
Sentry Employee Medical Plan
Affiliated With: Sentry Insurance
Plan Type: Group Health
CLAIMS SUBMISSION
JEANNE SHIMODA
PO Box 45018
FRESNO CA 93721
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
JEANNE SHIMODA
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 442-7247
(800) 442-7247
QUALIFIED BENEFIT SERVICES LLC
75 S 500 W
BOUNTIFUL UT 84010
QUALIFIED BENEFIT SERVICES LLC UM NOT APPLICABLE
(801) 269-8723
(800) 853-3234
(800) 853-3234
Sentry Insurance
Sentry Insurance
PO Box 10983
Scottsdale AZ 85271-0983
(800) 426-7234
First Health
(800) 722-5200
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Sentry Insurance
CONTACT EMPLOYER
CONTACT EMPLOYER
THE LOOMIS COMPANY
HINES & ASSOCIATES
(888) 826-5769
(800) 426-7234
SENTRY INSURANCE
Affiliated With: MITCHELL MEDICAL
Plan Type: Auto
Sentry: Administered by Mitchell Medical
Exclude Physical Therapists,
Chiropractors & Behavioral Health
providers (OCN ONLY)
Sentry Insurance
Affiliated With: Sentry Insurance A
Mutual Company
Plan Type: Workers' Compensation
1800 N Point Dr
Stevens Point WI 54481
SEQUEL YOUTH AND FAMILY
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY PO Box 7011
Plan Type: Group Health
WYOMISSING PA 19610-6011
(866) 425-7244
(866) 425-7244
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-446
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SEQUEL YOUTH SERVICES CLARINDA ACADEMY
Affiliated With: HEALTH NETWORK
AMERICA
Plan Type: Group Health
Service Corporation International (SCI
Management)
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
* SERVICE SOURCE EMPLOYMENT
SERVICES, INC.
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTH NETWORK AMERICA
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTH NETWORK AMERICA
UTILIZATION REVIEW
(888) 200-8537
HEALTH NETWORK AMERICA
(732) 676-2637
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC CHECK BENEFIT CARD
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
PO Box 607
W LONG BRANCH NJ 07764
(888) 200-8537
(800) 899-9355
SEVEN-UP/RC BOTTLING COMPANY
SEVEN-UP/RC BOTTLING COMPANY
Plan Type: Workers' Compensation
3220 East 26th Street
Los Angeles CA 90023
SEVEN-UP/RC BOTTLING COMPANY SEVEN-UP/RC BOTTLING
COMPANY
(323) 267-6459
(323) 267-6459
(323) 267-6459
SFI
Affiliated With: OSF HEALTHPLANS,
INC.
Plan Type: Group Health
SFMC
Affiliated With: OSF HEALTHPLANS,
INC.
Plan Type: Group Health
OSF HealthPlans, Inc.
OSF HealthPlans, Inc.
PO Box 1229
Peoria IL 61601-5128
(800) 673-5222
OSF HealthPlans, Inc.
(800) 284-2273
(800) 673-5222
OSF HealthPlans, Inc.
OSF HealthPlans, Inc.
PO Box 1229
Peoria IL 61601-5128
(800) 673-5222
OSF HealthPlans, Inc.
(800) 284-2273
(800) 673-5222
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-447
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SHAMROCK MANAGEMENT LLC
Affiliated With: BUSINESS
ADMINISTRATORS & CONSULTANTS,
INC.
Plan Type: Group Health
CLAIMS SUBMISSION
BAC
PO Box 107
REYNOLDSBURG OH 43068
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
BAC
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 521-2654
(614) 863-2120 Ext 3102
SHANKLIN CORPORATION
Affiliated With: T R PAUL INC.
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SHARE BUILDERS
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS
INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SHARE CORPORATION
Affiliated With: PROFESSIONAL
BENEFIT ADMINISTRATORS INC (PBA)
Plan Type: Group Health
PROFESSIONAL BENEFIT
ADMINISTRATORS, INC.
PROFESSIONAL BENEFIT
ADMINISTRATORS, INC.
CHECK BENEFIT CARD
900 Jorie Blvd Ste 250
Oakbrook IL 60523
(630) 655-3755
(630) 655-3755
SHARE MEDICAL CENTER
Affiliated With: C L FRATES &
COMPANY
Plan Type: Group Health
SHARON HOSPITAL
Affiliated With: MCA
ADMINISTRATORS, INC.
Plan Type: Group Health
C.L. FRATES AND COMPANY
C.L. FRATES AND COMPANY
PO Box 26967
OKLAHOMA CITY OK 73126-0967
(405) 290-5696
CHECK BENEFIT CARD
(405) 290-5696
MCA ADMINISTRATORS INC
MCA ADMINISTRATORS INC
820 PARISH ST
PITTSBURGH PA 15220
(800) 922-4966
CHECK BENEFIT CARD
(800) 922-4966
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-448
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SHARP PRIMARY CARE PERINATAL
SERVICES, INC.
Affiliated With: THE PLAN HANDLERS
INC
Plan Type: Group Health
SHAWNEE MEDICAL CENTER
CLINIC - 001
Affiliated With: WATERSTONE
BENEFITS ADMINISTRATORS, INC.
Plan Type: Group Health
SHEBESTER-BECHTEL
Affiliated With: THE KEMPTON GROUP
INC
Plan Type: Group Health
CLAIMS SUBMISSION
THE PLAN HANDLERS, INC.
930 Canterbury Pl.
ESCONDIDO CA 92025
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
THE PLAN HANDLERS INC
UTILIZATION REVIEW
THE PLAN HANDLERS INC
(800) 538-5512
(800) 538-5512
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
(405) 440-8888
CHECK BENEFIT CARD
(405) 440-8888
KEMPTON GROUP
ADMINISTRATORS INC
KEMPTON GROUP
ADMINISTRATORS INC
PO Box 54889
OKLAHOMA CITY OK 73154
(405) 521-1711
QUANTUM CARE
(866) 412-8252
(405) 521-1711
SHEET METAL WORKERS #16
HEALTH PLAN
Affiliated With: SHEET METAL
WORKERS #16 HEALTH PLAN
Plan Type: Group Health
WILLIAM C. EARHART CO. INC.
WILLIAM C. EARHART CO. INC.
BENESYS
(248) 822-4200
HEALTH CARE EVALUATION
(209) 951-6711
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PO Box 4148
PORTLAND OR 97208
BENESYS
SHEET METAL WORKERS DBA
"LOCAL 104" HEALTH CARE PLAN
PO Box 1618
Affiliated With: SHEET METAL
SAN RAMON CA 94583
WORKERS LOCAL 104 HEALTH CARE
(248) 822-4200
PLAN
Plan Type: Group Health
SHEET METAL WORKERS' HEALTH
AND WELFARE FUND OF NORTHERN
CAROLINA
Affiliated With: SOUTHERN BENEFIT
ADMINISTRATORS INC
Plan Type: Group Health
WILLIAM C. EARHART CO. INC.
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-449
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
SHELBY AUTOMOTIVE
SIERRA HEALTH & LIFE / HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE / HEALTH
PLAN
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH & LIFE /
HEALTH PLAN
(702) 242-7345
(702) 242-7700
SHEPLEY WOOD PRODUCTS INC
Affiliated With: BENEFIRST LLC
Plan Type: Group Health
AMERICA'S CHOICE HEALTHPLANS,
LLC
13111 Northwest Fwy, Ste 510
Houston TX 77040
AMERICA'S CHOICE HEALTHPLANS, AMERICAN HEALTH
HOLDINGS INC
LLC
(888)
578-1812
(877) 224-3627
(877) 224-3627
SHERIDAN VAMC 3536
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
SHERIDAN VAMC
SHERIDAN VAMC
CHECK BENEFIT CARD
SHIMADZU MEDICAL SYSTEMS
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
SHIPPERS RENTAL COMPANY
Affiliated With: NORTH AMERICAN
ADMINISTRATORS LLC
Plan Type: Group Health
NORTH AMERICA
ADMINISTRATORS, L.P.
NORTH AMERICA
ADMINISTRATORS, L.P.
MED-CERT
(800) 356-7126
PO Box 1984
NASHVILLE TN 37202
(800) 411-3650
1898 FORT RD
SHERIDAN WY 82801
PO Box 3000
SCOTTSDALE AZ 85271-3000
(800) 411-3650
SHIPROCK ALTERNATIVE SCHOOLS
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
SRT ADMINISTRATORS, INC.
SRT ADMINISTRATORS, INC.
CHECK BENEFIT CARD
PO Box 25160
SCOTTSDALE AZ 85255-0102
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-450
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SHOOK BUILDER SUPPLY CO
Affiliated With: JSL ADMINISTRATORS,
INC
Plan Type: Group Health
CLAIMS SUBMISSION
JSL ADMINISTRATORS, INC.
201 HAY STREET, STE 302
FAYETTEVILLE NC 28301
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
JSL ADMINISTRATORS, INC.
UTILIZATION REVIEW
(910) 480-3100
DOCTORS DIRECT
(800) 443-9178
SHORMAN & ASSOCIATES
SHORMAN & ASSOCIATES
(910) 480-3100
SHORMAN & ASSOCIATES
Affiliated With: SHORMAN &
ASSOCIATES
Plan Type: Group Health
SHORMAN & ASSOCIATES
SHREVEPORT VAMC 3108
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
SHREVEPORTVAMC
Attn: FEE 136C2
510 E ESTONER AVE
SHREVEPORT LA 71101
SHREVEPORTVAMC
CHECK BENEFIT CARD
SIERRA ALUMINUM COMPANY
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
SIERRA COLLEGE
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
SUMMIT AMERICA INSURANCE
SERVICES
SUMMIT AMERICA INSURANCE
SERVICES
7299 W. 98th Terrace #100
OVERLAND PARK KS 66212
PO Box 3000
SCOTTSDALE AZ 85271-3000
PO Box 7186
BOISE ID 83707
(800) 786-7930
SIERRA COLLEGE ATHLETIC
INSURANCE
Affiliated With: SUMMIT AMERICA
INSURANCE SERVICES
Plan Type: Group Health
SUMMIT AMERICA INSURANCE
SERVICES
5001 College Blvd. #216
LEAWOOD KS 66211
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-451
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SIERRA HEALTH & LIFE INSURANCE
Affiliated With: GLOBALCARE, INC.
Plan Type: Group Health
SIERRA HEALTH SERVICES
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
GLOBALCARE, INC.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
GLOBALCARE, INC.
UTILIZATION REVIEW
GLOBALCARE, INC.
6875 Shiloh Rd E
ALPHARETTA GA 30005
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
Sierra Health Services
Sierra Heatlh Services
Sierra Heatlh Services
(818) 846-5297
Sierra Heatlh Services
(800) 373-3054
Plan Type: Workers' Compensation
PO Box 7858
Burbank CA 91510-7858
SIERRA HEALTH-CARE OPTIONS, INC. GLOBALCARE, INC.
Affiliated With: GLOBALCARE, INC.
6875 Shiloh Rd E
Plan Type: Group Health
ALPHARETTA GA 30005
GLOBALCARE, INC.
GLOBALCARE, INC.
SIERRA INSURANCE CO.
SIERRA INSURANCE CO.
SIERRA INSURANCE CO.
(702) 242-7162
SIERRA INSURANCE CO.
(702) 242-7162
Plan Type: Workers' Compensation
2720 N. Tenaya Way, Room 507
Las Vegas NV 89128
(818) 846-5297
(702) 242-7162
SIGMA CORPORATION
Affiliated With: BROKERAGE
CONCEPTS INC BENEFIT
CONCEPTS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SIGNATURE LABEL
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
Careline UR
(763) 383-4800
(800) 422-2026
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-452
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SILK TREE FACTORY, INC.
Affiliated With: SILK TREE FACTORY,
INC.
Plan Type: Group Health
SILVER STATE BANK
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
EBC MID-AMERICA C/O CCN
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EBC MID-AMERICA C/O CCN
UTILIZATION REVIEW
CHECK BENEFIT CARD
PO Box 5190
TAMPA FL 33675-5190
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
SILVER STATE FORD-TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
SILVERTON CASINO LLC
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
SIMI VALLEY HOSPITAL - EPO
Affiliated With: ADVENTIST HEALTH
SYSTEM/WEST
Plan Type: Group Health
ADVENTIST HEALTH SYSTEM WEST
SIMPSON COLLEGE ATHLETIC
INSURANCE
Affiliated With: SUMMIT AMERICA
INSURANCE SERVICES
Plan Type: Group Health
SUMMIT AMERICA INSURANCE
SERVICES
ADVENTIST HEALTH SYSTEM WEST CHECK BENEFIT CARD
PO Box 619031
ROSEVILLE CA 95661-9002
SUMMIT AMERICA INSURANCE
SERVICES
SUMMIT AMERICA INSURANCE
SERVICES
5001 College Blvd. #216
LEAWOOD KS 66211
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-453
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SIMPSON NORTON CORPORATION
Affiliated With: NORTH AMERICAN
ADMINISTRATORS - NEW YORK
Plan Type: Group Health
CLAIMS SUBMISSION
NORTH AMERICAN
ADMINISTRATORS
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
NORTH AMERICAN
ADMINISTRATORS
UTILIZATION REVIEW
(800) 397-2122
NORTH AMERICAN
ADMINISTRATORS
(800) 397-2122
HEALTHCOMP TPA
HEALTHCOMP TPA
CHECK BENEFIT CARD
PO Box 45018
Fresno CA 93718
(800) 442-7247
PO Box 1065
AMHERST NY 14226
(800) 397-2122
SIMPSON UNIVERSITY
Affiliated With: HEALTHCOMP TPA
#10473
Plan Type: Group Health
(800) 442-7247
SIOUX FALLS VA MEDICAL CENTER
3711
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
SIOUX FALLS VA MEDICAL CENTER
Attn: FEE 00143G
2501 W 22ND STREET
SIOUX FALLS SD 57117
SIOUX FALLS VA MEDICAL CENTER CHECK BENEFIT CARD
SIOUX MANUFACTURING
Affiliated With: GROUP BENEFIT
SERVICES, INC
Plan Type: Group Health
GROUP BENEFIT SERVICES, INC.
GROUP BENEFIT SERVICES, INC.
1736 E. Sunshine Ste 200
Springfield MO 65804
(800) 995-3569
SIS IMPERIAL PALACE
Affiliated With: NATIONAL HEALTH
BENEFITS CORPORATION (NHBC)
Plan Type: Group Health
SISBRO INC
Affiliated With: NORTH AMERICAN
ADMINISTRATORS LLC
Plan Type: Group Health
GROUP BENEFIT SERVICES,
INC.
(800) 995-3569
(800) 995-3569
NHBC
NHBC
8990 E. Raintree Dr.
Scottsdale AZ 85260
(888) 621-7900
CHECK BENEFIT CARD
(888) 621-7900
NORTH AMERICA
ADMINISTRATORS, L.P.
NORTH AMERICA
ADMINISTRATORS, L.P.
PO Box 1984
NASHVILLE TN 37202
(800) 411-3650
MED-CERT
(800) 356-7126
(800) 411-3650
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-454
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SISCO
Affiliated With: SISCO/Cottingham &
Butler
Plan Type: Group Health
CLAIMS SUBMISSION
SISCO
PO Box 389
DUBUQUE IA 52004-0389
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SISCO
UTILIZATION REVIEW
(800) 457-4726
SISCO
(800) 457-4726
HCH ADMINISTRATORS
HCH ADMINISTRATORS
(800) 457-4726
SIVAGE-THOMAS HOMES
Affiliated With: HCH ADMINISTRATION
Plan Type: Group Health
HCH ADMINISTRATORS
SIZEMORE INC
Affiliated With: NATIONAL CLAIMS
ADMINISTRATIVE SERVICES INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SIZZLER, USA
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
SJH
Affiliated With: OSF HEALTHPLANS,
INC.
Plan Type: Group Health
OSF HealthPlans, Inc.
OSF HealthPlans, Inc.
PO Box 1229
Peoria IL 61601-5128
(800) 673-5222
OSF HealthPlans, Inc.
(800) 284-2273
OSF HealthPlans, Inc.
OSF HealthPlans, Inc.
SJMC
Affiliated With: OSF HEALTHPLANS,
INC.
Plan Type: Group Health
PO Box 1986
PEORIA IL 61656
PO Box 3000
SCOTTSDALE AZ 85271-3000
(800) 673-5222
OSF HealthPlans, Inc.
PO Box 1229
Peoria IL 61601-5128
(800) 673-5222
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-455
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SKF USA INC
Affiliated With: ALLIED BENEFITS
SYSTEMS
Plan Type: Group Health
CLAIMS SUBMISSION
ALLIED BENEFIT SYSTEMS, INC
PO Box 909786
CHICAGO IL 606090
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ALLIED BENEFIT SYSTEMS, INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(312) 906-8080 Ext 259
(312) 906-8080 Ext 259
SKF USA INCORPORATED
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY 850 N PARK RD
Plan Type: Group Health
WYOMISSING PA 19610
THE LOOMIS COMPANY
CHECK BENEFIT CARD
(800) 782-0392
(800) 782-0392
SKILSTAF INC
Affiliated With: SKILSTAF INC
Plan Type: Group Health
RISK REDUCTION INC
RISK REDUCTION INC
GENEX SERVICES, INC.
(800) 477-3502
SKY RIVER MANAGEMENT, LLC
TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
PO Box 729
ALEXANDER CITY AL 35011
(702) 242-7700
SLAM COLLABORATIVE THE
Affiliated With: T R PAUL INC.
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
Smart Management Inc
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
GISC, INC
GISC, INC
PO Box 9120
MARSHFIELD MA 02050
(800) 242-4472
TOTALCARE W / APS
HEALTHCARE
(866) 598-3973
(800) 242-4472
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-456
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SMITH AND LOVELESS
Affiliated With: THE EPOCH GROUP,
L.C.
Plan Type: Group Health
SMITH COLLEGE
Affiliated With: PIONEER
MANAGEMENT SYSTEMS
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
EPOCH GROUP LC
CHECK BENEFIT CARD
PIONEER MANAGEMENT SYSTEMS
PIONEER MANAGEMENT SYSTEMS
CHECK BENEFIT CARD
123 INTERSTATE DR
W SPRINGFIELD MA 01090
(877) 868-9060
CLAIMS SUBMISSION
EPOCH GROUP LC
UTILIZATION REVIEW
PO Box 12170
OVERLAND PARK KS 66282
(877) 868-9060
SMITH COLLEGE SPORTS
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SMITH DETROIT DIESEL ALLISON
Affiliated With: SMITH
ADMINISTRATORS
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SMITH INTERNATIONAL
Affiliated With: TOWER LIFE
Plan Type: Group Health
TOWER LIFE INSURANCE
TOWER LIFE INSURANCE
CHECK BENEFIT CARD
310 S. ST. MARY'S STREET #400
SAN ANTONIO TX 78205-3164
(888) 830-4927
(888) 830-4927
SMITH MEDIA
Affiliated With: CORESOURCE, INC.
Plan Type: Group Health
CORESOURCE INC
CORESOURCE INC
PO Box 2920
CLINTON OH 52733-2920
(800) 624-7143
CORESOURCE INC
(800) 480-6658
(800) 624-7143
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-457
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SMMC
Affiliated With: OSF HEALTHPLANS,
INC.
Plan Type: Group Health
SMYTH SYSTEMS
Affiliated With: THE CHANDLER
GROUP #13352
Plan Type: Group Health
SN SERVICING CORPORATION
Affiliated With: AFFORDABLE BENEFIT
ADMINISTRATORS, INC. (ABA)
Plan Type: Group Health
CLAIMS SUBMISSION
OSF HealthPlans, Inc.
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
OSF HealthPlans, Inc.
UTILIZATION REVIEW
(800) 673-5222
OSF HealthPlans, Inc.
(800) 284-2273
DIRECT CARE AMERICA
DIRECT CARE AMERICA
CHECK BENEFIT CARD
PO Box 2090 C
STOW OH 44224
(800) 266-5896
PO Box 1229
Peoria IL 61601-5128
(800) 673-5222
(800) 266-5896
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
PO Box 10787
BURBANK CA 91510
(800) 350-0148 Ext 240
CHECK BENEFIT CARD
(800) 350-0148 Ext 240
SNELL & WILMER, LLC
Affiliated With: HARRINGTON BENEFIT
SERVICES INC
Plan Type: Group Health
HARRINGTON BENEFITS, DIV OF
FISERV
HARRINGTON BENEFITS, DIV OF
FISERV
PO Box 845
PUEBLO CO 81002
(602) 906-5042
FISERV HEALTH CARE
MANAGEMENT
(877) 294-7839
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(602) 906-5042
SNOW SUMMIT SKI CORPORATION
Affiliated With: EBMS EMPLOYEE
BENEFIT MANAGEMENT SERVICES
Plan Type: Group Health
CHECK BENEFIT CARD
SO CAL BAKER & CONFECTIONARY
UNION & INDUSTRY WELFARE FUND
Affiliated With: SUPERIEN HEALTH
NETWORK #18373
Plan Type: Group Health
SUPERIEN HEALTH NETWORK
Attn: Supervisor of the Claims Dept
8007773575
SUPERIEN HEALTH NETWORK
CHECK BENEFIT CARD
(800) 266-5896
PO Box 2388 C
STOW OH 44224
(800) 266-5896
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-458
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
* SODEXHO MANAGEMENT
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
CLAIMS SUBMISSION
FCE BENEFIT ADMINISTRATORS INC
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
FCE BENEFIT ADMINISTRATORS INC
(800) 899-9355
(800) 899-9355
AFFORDABLE BENEFIT
ADMINISTRATORS INC
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
CHECK BENEFIT CARD
CHECK BENEFIT CARD
ADVANCED BENEFIT
SOLUTIONS
Solin USA
Solin USA
CONTACT EMPLOYER
CONTACT EMPLOYER
Plan Type: Workers' Compensation
520 N Semoran Blvd Ste 220
Orlando FL 32807
SOKA UNIVERSITY OF AMERICA
Affiliated With: AFFORDABLE BENEFIT
ADMINISTRATORS, INC. (ABA)
Plan Type: Group Health
AFFORDABLE BENEFIT
ADMINISTRATORS, INC.
SOLAR INDUSTRIES
Affiliated With: ADVANCED BENEFIT
SOLUTIONS LLC
Plan Type: Group Health
Participates in California Select Network
PO Box 10787
BURBANK CA 91510
(800) 293-3131
Solo Voyager Plan
Affiliated With: Cambridge Life
Insurance Company
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SOLUTIONS 4
Affiliated With: MCMC LLC
Plan Type: Workers' Compensation
MCMC LLC
CONTACT EMPLOYER
CONTACT EMPLOYER
MCMC LLC
MCMC LLC
701 Technology Dr Ste 100
Canonsburg PA 15317
(888) 350-1150 Ext 228
MCMC LLC
(888) 350-1150 Ext 228
701 Technology Dr Ste 100
Canonsburg PA 15317
(888) 350-1150 Ext 228
Solutions4 - Nashvile Auto
Affiliated With: MCMC LLC
Plan Type: Auto
(888) 350-1150 Ext 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.
Info as of 12/13/2007
Page PIRCA-459
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SOLUTIONS4 AUTO
Affiliated With: MCMC LLC
Plan Type: Auto
CLAIMS SUBMISSION
MCMC LLC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
701 Technology Dr Ste 100
Canonsburg PA 15317
(888) 350-1150 Ext 228
SOMA - STUDENT OSTEOPATHIC
MEDICAL ASSOC 1
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
SOMA - STUDENT OSTEOPATHIC
MEDICAL ASSOC 2
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
SOMA HIGH DEDUCTIBLE PLAN
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
SOMERS ISLE
Affiliated With: LIBERTY MUTUAL
Plan Type: Group Health
LIBERTY MUTUAL
SONIC INDUSTRIES INC
Affiliated With: AMERICAN
ADMINISTRATIVE GROUP
Plan Type: Group Health
American Administrative Group
LIBERTY MUTUAL
LIBERTY MUTUAL
American Administrative Group
IntraCorp
(800) 538-5222
100 Main St., Box 1525
DOVER NH 03320
PO Box 93670
LUBBOCK TX 79493-3670
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-460
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SONORA COMMUNITY HOSPITAL
Affiliated With: ADVENTIST HEALTH
SYSTEM/WEST
Plan Type: Group Health
SOONER PHARMACY OF
TISHOMINGO, INC
Affiliated With: FISERV HEALTH
KANSAS - 11297
Plan Type: Group Health
SOPREMA INC
Affiliated With: KLAIS & COMPANY
Plan Type: Group Health
CLAIMS SUBMISSION
ADVENTIST HEALTH SYSTEM WEST
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
ADVENTIST HEALTH SYSTEM WEST
PO Box 619031
ROSEVILLE CA 95661-9002
FISERV HEALTH INC
FISERV HEALTH INC
PO Box 520
Pueblo CO 81002-0520
(800) 235-7160
AVIDYN HEALTH
(214) 647-6194
DIRECT CARE AMERICA
DIRECT CARE AMERICA
CHECK BENEFIT CARD
PO Box 2090 C
STOW OH 44224
(800) 266-5896
(800) 235-7160
(800) 266-5896
SOPREMA, INC
Affiliated With: KLAIS & COMPANY
Plan Type: Group Health
KLAIS & COMPANY INC
KLAIS & COMPANY INC
1867 W MARKET ST
AKRON OH 44313
(330) 867-8443
CHECK BENEFIT CARD
(330) 867-8443
SOS STAFFING
Affiliated With: P5 HEALTH PLAN
SOLUTIONS
Plan Type: Group Health
CHECK BENEFIT CARD
SOS STAFFING SERVICES, INC.
(COLORADE EEs-TRAVEL)
Affiliated With: CNIC HEALTH
SOLUTIONS
Plan Type: Group Health
CNIC HEALTH SOLUTIONS
CNIC HEALTH SOLUTIONS
PO Box 3559
ENGLEWOOD CO 80155-3559
(800) 426-7453
CHECK BENEFIT CARD
CHECK BENEFIT CARD
8882650387
CNIC HEALTH SOLUTIONS
(800) 426-7453
(800) 426-7453
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-461
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SOUTH COAST MEDICAL CENTER
Affiliated With: ADVENTIST HEALTH
SYSTEM WEST
Plan Type: Group Health
CLAIMS SUBMISSION
ADVENTIST HEALTH SYSTEM WEST
PO Box 619031
ROSEVILLE CA 95661-9002
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
ADVENTIST HEALTH SYSTEM WEST
(800) 441-2524
(800) 441-2524
SOUTH GEORGIA COLLEGE
PEARCE ADMINISTRATION
AIH0058437
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
SOUTH GEORGIA COLLEGE
PEARCE ADMINISTRATION
AIH0058447
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
Attn: WHIT WALTERS
PEARCE ADMINISTRATION
SOUTH GEORGIA COLLEGE
UNDERGRAD UNIVERSITY
Affiliated With: MAKSIN MANAGEMENT
CORP
Plan Type: Group Health
CHECK BENEFIT CARD
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
UM NOT APPLICABLE
(800) 222-6491
419 S. COIT ST
FLORENCE SC 29501
(800) 222-6491
* South Maine Community College
Affiliated With: PIONEER
MANAGEMENT SYSTEMS
Plan Type: Group Health
SOUTH UNIVERSITY
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
PIONEER MANAGEMENT SYSTEMS
PIONEER MANAGEMENT SYSTEMS
123 INTERSTATE DR
W SPRINGFIELD MA 01089
(413) 534-8658
UM NOT APPLICABLE
(413) 534-8658
ADMINISTRATIVE CONCEPTS, INC.
Attn: Customer Service Dept
997 Old Eagle School Rd. #215
WAYNE PA 19087-1706
ADMINISTRATIVE CONCEPTS, INC.
CHECK BENEFIT CARD
(610) 293-9229
(610) 293-9229
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-462
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SOUTH UNIVERSITY
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
CLAIMS SUBMISSION
ADMINISTRATIVE CONCEPTS, INC.
Attn: Customer Service Dept
997 Old Eagle School Rd. #215
WAYNE PA 19087-1706
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
ADMINISTRATIVE CONCEPTS, INC.
UTILIZATION REVIEW
CHECK BENEFIT CARD
(610) 293-9229
(610) 293-9229
SOUTH UNIVERSITY
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
ADMINISTRATIVE CONCEPTS INC
Attn: Customer Service Dept
997 Old Eagle School Rd. #215
WAYNE PA 19087-1706
ADMINISTRATIVE CONCEPTS INC
UM NOT APPLICABLE
(610) 293-9229
(610) 293-9229
SOUTH VALLEY BANK
Affiliated With: ECOM PPO ADVISORS
INC
Plan Type: Group Health
ECOM PPO ADVISORS, INC
Attn: ACCOUNTING
8350 N. CENTRAL EXPWY, STE 600
DALLAS TX 75206
ECOM PPO ADVISORS, INC
CHECK BENEFIT CARD
(828) 281-9000
(828) 281-9000
SOUTHEASTERN CARPENTERS AND
MILLWRIGHTS HEALTH TRUST
Affiliated With: SOUTHERN BENEFIT
ADMINISTRATORS, INC
Plan Type: Group Health
SOUTHERN BENEFIT
ADMINISTRATORS INC
SOUTHERN BENEFIT
ADMINISTRATORS INC
907 TWO MILE PKWY STE C-5
GOODLETTSVILLE TN 37072
(800) 831-4914
UM NOT APPLICABLE
(800) 831-4914
Southeastern Claims Services Inc
Affiliated With: Genex Services, Inc.
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
SOUTHEASTERN CONTAINER
Affiliated With: PRIMARY
PHYSICIANCARE INC
Plan Type: Group Health
PRIMARY PHYSICIAN CARE
PRIMARY PHYSICIAN CARE
1515 SENECA MOCKINGBIRD LN
CHARLOTTE NC 28220
(800) 446-5439
PRIMARY PHYSICIAN CARE
(800) 582-7774
(800) 446-5439
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-463
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SOUTHEASTERN LOUISIANA
UNIVERSITY
Affiliated With: STUDENT ASSURANCE
SERVICES INC
Plan Type: Group Health
SOUTHER NAZARENE UNIVERSITY
(STUDENTS)
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
TRUE CHOICE
CI
PO Box 700307
DALLAS TX 75370
(817) 479-2115
UTILIZATION REVIEW
CHECK BENEFIT CARD
CI
(817) 479-2115
(800) 785-2446
SOUTHERN CALIF. LATHING
INDUSTRY HEALTH & WELFARE
TRUST
Affiliated With: SOUTHERN CALIF.
LATHING INDUSTRY HEALTH &
WELFARE
Plan Type: Group Health
SO CALIF. LATHING INDUSTRY
HLTH & WELFARE C/O ABPA
SO CALIF. LATHING INDUSTRY
HLTH & WELFARE C/O ABPA
CHECK BENEFIT CARD
Southern California Dairy Industry
Security Fund
Affiliated With: Southern California Dairy
Industry Security Fund
Plan Type: Group Health
Southwest Administrators, Inc.
Southwest Administrators, Inc.
PO Box 1121
Alhambra CA 91802-1121
(877) 350-4792 Ext 618
First Health
(800) 599-8723
CHECK BENEFIT CARD
CHECK BENEFIT CARD
4401 SANTA ANITA
EL MONTE CA 91731-1607
(877) 350-4792 Ext 618
Exclude all psych/cd services
SOUTHERN CALIFORNIA INSTITUTE
OF ARCHITECTURE
Affiliated With: PERSONAL
INSURANCE ADMINISTRATORS PIA
Plan Type: Group Health
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-464
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SOUTHERN CALIFORNIA PIPE
TRADES ADMIN CORP
Affiliated With: SOUTHERN
CALIFORNIA PIPE TRADES ADMIN
CORP
Plan Type: Group Health
SOUTHERN COUNCIL OF
INDUSTRIAL WORKERS
Affiliated With: WELLS FARGO THIRD
PARTY ADMINISTRATOR
Plan Type: Group Health
* Southern Farm Bureau
Affiliated With: GILSBAR
Plan Type: Group Health
CLAIMS SUBMISSION
SOUTHERN CALIFORNIA PIPE
TRADES ADMIN
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SOUTHERN CALIFORNIA PIPE
TRADES ADMIN
UTILIZATION REVIEW
(800) 595-7473
SOUTHERN CALIFORNIA PIPE
TRADES ADMIN
(213) 385-6161 Ext 268
ACORDIA NATIONAL
ACORDIA NATIONAL
CHECK BENEFIT CARD
602 VIRGINIA ST EAST
CHARLESTON WV 25301
(888) 685-7774
501 SHATTO PLACE 5TH FLOOR
LOS ANGELES CA 90020
(800) 595-7473
(888) 685-7774
GILSBAR
GILSBAR
PO Box 790
COVINGTON LA 70434
(800) 999-8932
MedCom
(800) 643-4416
(800) 445-7227
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
SOUTHERN NAZARENE
UNIVERSITY - FACILITY AND
EMPLOYEES
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
(800) 825-3540
SOUTHERN NEVADA HCS 3193
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
SOUTHERN NEVADA HCS
Attn: FEE 136C
2455 W CHEYENNE
NORTH LAS VEGAS NV 89032
SOUTHERN NEVADA HCS
CHECK BENEFIT CARD
SOUTHERN NEW ENGLAND SCHOOL
OF LAW
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
Term Effective: 8/31/2007
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
CHECK BENEFIT CARD
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
(800) 237-0903 Ext 6352
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-465
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SOUTHERN OREGON HEAD START
Affiliated With: QVI RISK SOLUTIONS
INC
Plan Type: Group Health
CLAIMS SUBMISSION
QVI RISK SOLUTIONS INC
1011 SW EMKAY DR STE 209
BEND OR 97702
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
QVI RISK SOLUTIONS INC
(541) 312-8512
UTILIZATION REVIEW
INNOVATIVE CARE
MANAGEMENT
(800) 862-3338
(541) 312-8512
SOUTHERN OREGON REHAB
CENTER & CLINICS 3117
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
SOUTHERN OREGON REHAB CTR &
CLINICS
Attn: FEE 136C-7
8495 CRATER LAKE HWY
WHITE CITY OR 97503
SOUTHERN OREGON REHAB CTR & CHECK BENEFIT CARD
CLINICS
SOUTHERN OREGON UNIVERSITY
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 786-7930
AMERIBEN SOLUTIONS
(800) 786-7930
SOUTHERN OREGON UNIVERSITY
USI ADMINISTRATORS
Affiliated With: FIRST UNDERWRITERS PO Box 3357
INC
FORT WORTH TX 76113
Plan Type: Group Health
USI ADMINISTRATORS
USI ADMINISTRATORS
SOUTHERN PAINTERS WELFARE
FUND
Affiliated With: SOUTHERN PAINTERS
WELFARE FUND
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
PEARCE ADMINISTRATION
CHECK BENEFIT CARD
(800) 786-7930
CHECK BENEFIT CARD
PEARCE ADMINISTRATION
SOUTHERN POLYTECHNIC STATE
UNIV AIH0058457
PO Box 2271
Affiliated With: MAKSIN MANAGEMENT Florence SC 29503
CORP #14005
(843) 622-6001
Plan Type: Group Health
(843) 622-6001
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-466
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
PEARCE ADMINISTRATION
SOUTHERN POLYTECHNIC STATE
UNIVERSITY UNDERGRAD
Attn: WHIT WALTERS
MANDATORY
419 S. COIT ST
Affiliated With: MAKSIN MANAGEMENT
FLORENCE SC 29501
CORP
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PEARCE ADMINISTRATION
(800) 222-6491
Plan Type: Group Health
(800) 222-6491
SOUTHLAKE CENTER FOR MENTAL
HEALTH
Affiliated With: MENNONITE MUTUAL
AID ASSOC. AND MMA INS. CO./MMA
Plan Type: Group Health
MENNONITE MUTUAL AID & ASSOC
& MMA INSURANCE
SOUTHWEST BAPTIST UNIVERSITY
Affiliated With: UnitedHealthcare
StudentResources #11689
Plan Type: Group Health
Term Effective: 8/31/2007
STUDENT INSURANCE A DIVISION
OF UICI
STUDENT INSURANCE A DIVISION
OF UICI
2301 W. PLANO PKWY #300
PLANO TX 75075
(800) 767-0700
SOUTHWEST BRAKE
Affiliated With: ASSURECARE
Plan Type: Group Health
UTILIZATION REVIEW
UM NOT APPLICABLE
MENNONITE MUTUAL AID & ASSOC MENNONITE MUTUAL AID &
ASSOC & MMA INSURANCE
& MMA INSURANCE
PO Box 483
GOSHEN IN 46527
CHECK BENEFIT CARD
(800) 237-0903 Ext 6352
ASSURECARE
ASSURECARE
4050 HUNSACKER DR STE 110
EAST LANSING MI 48823
(800) 968-6616
CHECK BENEFIT CARD
(800) 968-6616
SOUTHWEST ELECTRIC COMPANY
Affiliated With: MUTUAL ASSURANCE
ADMINISTRATORS
Plan Type: Group Health
MUTUAL ASSURANCE
ADMINISTRATORS
MUTUAL ASSURANCE
ADMINISTRATORS
PO Box 42096
Oklahoma City OK 73123-3096
(800) 825-3540
CHECK BENEFIT CARD
(800) 825-3540
SOUTHWEST ORTHOPAEDIC
SPECIALIST PLLC
Affiliated With: RESOURCEONE
ADMINISTRATORS
Plan Type: Group Health
RESOURCEONE ADMINSTRATORS
Attn: Mary Shepherd
PO Box 489
BUCKEYSTOWN MD 21717
RESOURCEONE ADMINSTRATORS
(800) 967-2077
MEDCAREONE CORP
(800) 816-1206
(800) 967-2077
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-467
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
SOUTHWEST SERVICES (TRAVEL)
SIERRA HEALTH & LIFE/HEALTH
Affiliated With: SIERRA HEALTH & LIFE PLAN OF NEVADA
/ HEALTH PLAN OF NEVADA
PO Box 15645
Plan Type: Group Health
LAS VEGAS NV 89114
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
(702) 242-7700
UTILIZATION REVIEW
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
PREFERRED BENEFIT
ADMINISTRATORS INC
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
TRUE CHOICE
TRUE CHOICE
UM NOT APPLICABLE
PO Box 700307
DALLAS TX 75370
(800) 251-9665
SOUTHWEST SIGNAL ENGINEERING
COMPANY
Affiliated With: PREFERRED BENEFIT
ADMINISTRATORS, INC.
Plan Type: Group Health
PREFERRED BENEFIT
ADMINISTRATORS INC
Southwestern Benefits
Affiliated With: Amalgamated Life
Insurance Co.
Plan Type: Group Health
Amalgamated Life Insurance Co.
Southwestern Oklahoma State
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
PO Box 916188
LONGWOOD FL 32791-6188
PO Box 3488
Scottsdale AZ 85271
(800) 356-0850
(800) 251-9665
FCE BENEFIT ADMINISTRATORS
FCE BENEFIT ADMINISTRATORS
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
SOUTHWESTERN SECURITY
SERVICES, INC
Affiliated With: FCE BENEFIT
ADMINISTRATORS
Plan Type: Group Health
(800) 899-9355
SOUTHWESTERN VERMONT HEALTH
CARE CORP.
Affiliated With: MERITAIN HEALTH
Plan Type: Group Health
MERITAIN HEALTH
Attn: Claims Dept
PO Box 853921
Richardson TX 75085-3921
MERITAIN HEALTH
CHECK BENEFIT CARD
UM NOT APPLICABLE
(800) 844-7979
(800) 844-7979
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-468
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SOUTHWIRE AND AFFILIATES
EMPLOYEE BENEFIT PLAN
Affiliated With: BENESIGHT, INC.
Plan Type: Group Health
SPACESAVER CORPORATION
Affiliated With: MIDWEST SECURITY
ADMINISTRATORS INC
Plan Type: Group Health
CLAIMS SUBMISSION
BENESIGHT C/O WAUSAU BENEFITS
Attn: LeAnn Fichtner
PO Box 8046
WAUSAU WI 54401-8046
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
VALUECHECK
MIDWEST SECURITY
ADMINISTRATORS INC
MIDWEST SECURITY
ADMINISTRATORS INC
2700 Midwest Dr.
ONALASKA WI 54650
(888) 672-4342
UTILIZATION REVIEW
VALUECHECK
CHECK BENEFIT CARD
(888) 672-4342
Special Agents Mutual Benefits
Association (SAMBA)
Affiliated With: Special Agents Mutual
Benefit Association (SAMBA)
Plan Type: Group Health
First Health
First Health
PO Box 8600
London KY 40742
ECS Payor ID 37259
(800) 638-6589
Encompass Health Management
(800) 638-6589
SPECIAL MARKETS
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
CHECK BENEFIT CARD
(800) 525-8788
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
(800) 283-4927
SPECIALIZED TECHNOLOGY
RESOURCES JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
SPECIALIZED TECHNOLOGY
RESOURCES WRAP JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
(802) 846-8060
EBPA
EBPA
PO Box 2365
SOUTH BURLINGTON VT 05403
(802) 846-8060
CHECK BENEFIT CARD
(802) 846-8060
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-469
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
Specialty Accident Sickness
Affiliated With: International Medical
Group, Inc.
Plan Type: Group Health
Specialty Risk Services (SRS)
Affiliated With: Specialty Risk Services
(SRS) #962500000
Plan Type: Workers' Compensation
SPELLMAN HARDWOODS
Affiliated With: MOUNTAIN STATES
ADMINISTRATIVE SERVICES
Plan Type: Group Health
CLAIMS SUBMISSION
International Medical Group, Inc.
407 N Fulton St
Indianapolis IN 46202-3684
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
International Medical Group, Inc.
UTILIZATION REVIEW
CHECK BENEFIT CARD
(317) 655-4500 Outside US
(800) 628-4664 Inside US
(317) 655-4500 Outside US
(800) 628-4664 Inside US
The Hartford
The Hartford
PO Box 4020
Wheaton IL 60189
(800) 762-0666
CONTACT EMPLOYER
(800) 762-0666
Mountain States Administrative
Services
Mountain States Administrative
Services
7202 E ROSEWOOD STE 200
TUCSON AZ 85710
(520) 722-7133
Hines and Associates
(847) 214-2780
(520) 722-7133
SPELMAN COLLEGE AMH9023747
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
SPELMAN COLLEGE ICS AII9091697
Affiliated With: MAKSIN MANAGEMENT
CORP #14005
Plan Type: Group Health
SPINNAKER COATING LLC
Affiliated With: MARSH ADVANTAGE
AMERICA
Plan Type: Group Health
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2439
Florence SC 29503
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
PEARCE ADMINISTRATION
PEARCE ADMINISTRATION
PO Box 2439
Florence SC 29503
(843) 622-6001
CHECK BENEFIT CARD
(843) 622-6001
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-470
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SPOKANE VAMC 3181
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
SPORTSMANS WAREHOUSE
Affiliated With: AMERIBEN SOLUTIONS
Plan Type: Group Health
CLAIMS SUBMISSION
HEALTH NET FEDERAL SERVICES
2025 AEROJET RD
RANCHO CORDOVA CA 95742
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
HEALTH NET FEDERAL SERVICES
UTILIZATION REVIEW
CHECK BENEFIT CARD
(916) 985-1259
(916) 985-1259
AMERIBEN SOLUTIONS
AMERIBEN SOLUTIONS
PO Box 7186
BOISE ID 83707
(800) 786-7930
CHECK BENEFIT CARD
(800) 786-7930
* Springdale Liquor Association
Affiliated With: RESOURCEONE
ADMINISTRATORS
Plan Type: Group Health
RESOURCEONE ADMINSTRATORS
Attn: Mary Shepherd
PO Box 489
BUCKEYSTOWN MD 21717
RESOURCEONE ADMINSTRATORS
(800) 967-2077
MEDCAREONE CORP
(800) 816-1206
(918) 967-2077
SPRINGFIELD HOSPITAL SYSTEMS
WRAP JMS
Affiliated With: COMPREHENSIVE
BENEFIT ADMINISTRATORS INC
(EBPA)
Plan Type: Group Health
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
COMPREHENSIVE BENEFITS
ADMINISTRATOR INC
PO Box 2365
SOUTH BURLINGTON VT 05403
(800) 525-8788
CHECK BENEFIT CARD
(802) 846-8060
SPRINGFIELD WIRE INC
Affiliated With: T R PAUL INC.
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SPRINGFIELD WIRE, INC.
Affiliated With: T.R. PAUL, INC.
Plan Type: Group Health
T R PAUL INC.
T R PAUL INC.
CHECK BENEFIT CARD
PO Box 5508
NEWTOWN CT 06470-5508
8006788161 Ext 244
8006788161 Ext 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.
Info as of 12/13/2007
Page PIRCA-471
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SRS Standard without Qmedtrix
Affiliated With: The Hartford SRS
#962500000
Plan Type: Workers' Compensation
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SRS TECHNOLOGIES
Affiliated With: HEALTHSCOPE
BENEFITS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SSM HEALTH CARE
Affiliated With: FMH BENEFIT
SERVICES INC
Plan Type: Group Health
FMH BENEFIT SERVICES INC
FMH BENEFIT SERVICES INC
CHECK BENEFIT CARD
PO Box 25946
OVERLAND PARK KS 66225-5946
(800) 990-9058
PAYOR NAME
SRS Standard with Qmedtrix
Affiliated With: The Hartford SRS
#962500000
Plan Type: Workers' Compensation
UTILIZATION REVIEW
(800) 990-9058
ST ANTHONY MEMORIAL HEALTH
CENTERS
Affiliated With: J.F. MOLLOY &
ASSOCIATES, INC.
Plan Type: Group Health
JF MOLLOY & ASSOCIATES
JF MOLLOY & ASSOCIATES
PO Box 68947
INDIANAPOLIS IN 46268
(800) 331-3287 Ext 3905
(800) 331-3287 Ext 3905
ST CLOUD VA MEDICAL CENTER 3705
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
ST CLOUD VA MEDICAL CENTER
Attn: FEE BASIS 136F
4801 VETERANS DRIVE
ST CLOUD MN 56303
ST CLOUD VA MEDICAL CENTER
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
JF MOLLOY & ASSOCIATES
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-472
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ST EDWARDS UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
ST HELENAL HOSPITAL EXCLUSIVE
Affiliated With: ADVENTIST HEALTH
SYSTEM/WEST
Plan Type: Group Health
ST JOHNSBURY ACADEMY
Affiliated With: GROUP INSURANCE
SERVICE CENTER
Plan Type: Group Health
ST JOSEPH CATHOLIC ORPHANAGE
Affiliated With: PREFERRED HEALTH
PLANS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
TRUE CHOICE USA
PO Box 700307
DALLAS TX 75370
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
TRUE CHOICE USA
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 785-2446
(800) 785-2446
ADVENTIST HEALTH SYSTEM/WEST
ADVENTIST HEALTH SYSTEM/WEST CHECK BENEFIT CARD
2100 DOUGLAS
ROSEVILLE CA 95661
(800) 441-2524
(800) 441-2524
GISC, INC
GISC, INC
PO Box 9120
MARSHFIELD MA 02050
(800) 242-4472
TOTALCARE W / APS
HEALTHCARE
(866) 598-3973
(800) 242-4472
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
(800) 832-8212
ST LOUIS VAMEDICAL CENTER 3528
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
ST LOUIS VA MEDICAL CENTER
Attn: FEE BASIS 04FJB
ONE JEFFERSON BARRACKS DR
ST LOUIS MO 63125
ST LOUIS VA MEDICAL CENTER
CHECK BENEFIT CARD
ST MARY'S UNIVERSITY
Affiliated With: ACADEMIC RISK
MANAGEMENT
Plan Type: Group Health
TRUE CHOICE USA
TRUE CHOICE USA
CHECK BENEFIT CARD
PO Box 700307
DALLAS TX 75370
(800) 785-2446
(800) 785-2446
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-473
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
ST. HELENA HOSPITAL PPO
Affiliated With: ADVENTIST HEALTH
SYSTEM/WEST
Plan Type: Group Health
CLAIMS SUBMISSION
ADVENTIST HEALTH SYSTEM WEST
PO Box 619031
ROSEVILLE CA 95661-9002
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
EMPLOYEE BENEFIT
ADMINISTRATION & MGMT
PRIMARY PHYSICIANCARE, INC.
PRIMARY PHYSICIANCARE, INC.
CHECK BENEFIT CARD
PO Box 11088
CHARLOTTE NC 28220
(800) 446-5439
STA TRAVEL
Affiliated With: EMPLOYEE BENEFIT
ADMINISTRATION & MGMT. (EBA&M)
Plan Type: Group Health
EMPLOYEE BENEFIT ADMIN. &
MGMT. (EBA&M) C/O CCN
STABILUS, INC
Affiliated With: PRIMARY
PHYSICIANSCARE INC
Plan Type: Group Health
STAFFORD DEVELOPMENT
Affiliated With: SOVEREIGN
SOLUTIONS LLC
Plan Type: Group Health
Term Effective: 3/31/2008
STANDARD PLUMBING
Affiliated With: TALL TREE
ADMINISTRATORS
Plan Type: Group Health
Standard Security Life Insurance
Company of New York
Affiliated With: Insurers Administrative
Corporation #962500302
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
UTILIZATION REVIEW
COMPENSABILITY
CHECK
BENEFIT CARD
ADVENTIST HEALTH SYSTEM WEST
PO Box 3000
SCOTTSDALE AZ 85271-3000
(800) 446-5439
SOVEREIGN SOLUTIONS, LLC
SOVEREIGN SOLUTIONS, LLC
1805 U.S. HIGHWAY 82 WEST
TIFTON GA 31794
(229) 382-1360
MedWatch
(800) 432-8421
(229) 382-1360
TALL TREE ADMINISTRATORS
TALL TREE ADMINISTRATORS
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
(801) 274-8100
CORVEL
(801) 269-8723
(801) 274-8100
Benefits/Eligibility
Benefits/Eligibility
PO Box 828
Park Ridge IL 60068-0828
(800) 843-3106
CHECK BENEFIT CARD
(800) 522-2161
(800) 843-3106
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-474
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
STANDARD SECURITY LIFE
INSURANCE COMPANY OF NEW
YORK
Affiliated With: INSURERS
ADMINISTRATIVE CORPORATION
#11337
Plan Type: Group Health
STAR AFFORDABLE HEALTH
BENEFITS
CLAIMS SUBMISSION
Insurers Administrative Corporation
(IAC)
PO Box 828
Park Ridge IL 60068-0828
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
Insurers Administrative Corporation
(IAC)
UTILIZATION REVIEW
Med-Valu
(800) 522-2161
(800) 843-3106
(800) 843-3106
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
STAR HEALTHCARE NETWORK
STAR HEALTHCARE NETWORK
UM NOT APPLICABLE
850 Seventh Ave STE 803
New York NY 10019
(212) 581-8228
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
* STAR HEALTHCARE NETWORK INC
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
(212) 581-8228
STAR RELIABLE LIFE
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
STAR VALLEY MEDICAL CENTER
Affiliated With: MANAGED BENEFITS
ADMIN. & INSURANCE CONSULTANTS
Plan Type: Group Health
MANAGED BENEFITS
ADMINISTRATOR & INSURANCE
CONSULTANTS
MANAGED BENEFITS
ADMINISTRATOR & INSURANCE
CONSULTANTS
CRITIQUE
(800) 666-5551
3625 S WEST TEMPLE STE 200
SALT LAKE CITY UT 84115
(800) 877-3727
(800) 877-3727
STARMARK
Affiliated With: STARMARK
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
CHECK BENEFIT CARD
Info as of 12/13/2007
Page PIRCA-475
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
STARR COMPREHENSIVE
SOLUTIONS, INC
Affiliated With: COMP IQ
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
CompIQ Corporation
35 Tesla Way #100
Irvine CA 92618
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CompIQ Corporation
UTILIZATION REVIEW
UM NOT APPLICABLE
(800) 293-3131
(800) 293-3131
State Auto Insurance Company
Affiliated With: State Auto Insurance
Company
Plan Type: Auto
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
STATE COMPENSATION FUND
STATE COMPENSATION FUND
STATE COMPENSATION FUND
(209) 476-2793
STATE COMPENSATION FUND
(209) 476-2793
Plan Type: Workers' Compensation
3247 W. March Lane
Stockton CA 95219
(209) 476-2793
State Farm California
Affiliated With: State Farm Fire and
Casualty Company
Plan Type: Workers' Compensation
State Farm Fire and Casualty Company
State Farm California
31303 Agoura Rd
Westlake Village CA 91363-4635
(818) 707-5317
State Farm California
(818) 707-5317
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
State Farm Fire and Casualty Company
State Farm Fire and Casualty Company State Farm Fire and Casualty
Company
(863) 318-3563
(863) 318-3563
(818) 707-5317
Excludes specific hospitals
State Farm Fire and Casualty Company
Affiliated With: State Farm Fire and
Casualty Company
Plan Type: Workers' Compensation
Excludes specific hospitals
State Farm Florida
Affiliated With: State Farm Fire and
Casualty Company
Plan Type: Workers' Compensation
7401 Cypress Gardens Blvd
Winter Haven FL 33888
(863) 318-3563
Excludes specific hospitals
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-476
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
State Farm Hawaii
Affiliated With: State Farm Fire and
Casualty Company
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
State Farm Fire and Casualty Company
8900 Amberglen Blvd
Austin TX 78729-1110
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
State Farm Hawaii
(512) 918-5608
UTILIZATION REVIEW
State Farm Hawaii
(512) 918-5608
(512) 918-5608
Excludes specific hospitals
CHECK BENEFIT CARD
State Farm Individual Policy Holders
Affiliated With: State Farm Individual
Policy Holders
Plan Type: Group Health
State Farm Health Insurance - Policy
#05
State Farm Health Insurance - Policy
#05
PO Box 8629
Scottsdale AZ 85252-8629
ECS Payor ID 31053
(707) 584-6688
Excludes some freestanding psych/cd
facilities.
(707) 584-6672
State Farm Louisiana
Affiliated With: State Farm Fire and
Casualty Company
Plan Type: Workers' Compensation
State Farm Fire and Casualty Company
State Farm Fire and Casualty Company CONTACT EMPLOYER
PO Box 11980
Monroe LA 71211-1980
(800) 427-1160
(800) 845-6592 ECS Help Desk
(800) 427-1160
Excludes specific hospitals
State Farm New Jersey
Affiliated With: State Farm Fire and
Casualty Company
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
State Farm Fire and Casualty Company
State Farm Fire and Casualty Company State Farm Fire and Casualty
Company
(512) 918-5608
(512) 918-5608
Excludes specific hospitals
State Farm Texas
Affiliated With: State Farm Fire and
Casualty Company
Plan Type: Workers' Compensation
8900 Amberglen Blvd
Austin TX 78729-1110
(512) 918-5608
Excludes specific hospitals
State of Oklahoma
Affiliated With: GLOBALHEALTH AND
GENERATION HEALTHCARE
Plan Type: Group Health
GLOBALHEALTH
GLOBALHEALTH
7001 NE 10th St
Oklahoma City OK 73104
(405) 280-5600
GLOBALHEALTH
(405) 230-8781
(405) 280-5600
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-477
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
State of Vermont
Affiliated With: FairPay Solutions, Inc.
Plan Type: Workers' Compensation
STATER BROS. MARKETS
Affiliated With: AMERICAN INSURANCE
ADMINISTRATORS
Plan Type: Group Health
CLAIMS SUBMISSION
FairPay Solutions
Attn: Jon Peebles
14295 Midway Rd Ste 300
Addison TX 75001
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
FairPay Solutions
(972) 715-8000
AMERICAN INSURANCE
ADMINISTRATORS
AMERICAN INSURANCE
ADMINISTRATORS
13191 CROSSROADS PARK NORTH
STE 205
CITY OF INDUSTRY CA 91746-3434
(800) 654-7900
UTILIZATION REVIEW
FairPay Solutions
(972) 715-8000
CHECK BENEFIT CARD
(800) 654-7900
* STAYWELL HEALTH PLAN
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
STEPHENS MEDIA GROUP
Affiliated With: SRT
ADMINISTRATORS, INC.
Plan Type: Group Health
STAR HEALTHCARE NETWORK
STAR HEALTHCARE NETWORK
850 Seventh Ave STE 803
New York NY 10019
(212) 581-8228
CHECK BENEFIT CARD
(212) 581-8228
SRT ADMINISTRATORS, INC.
SRT ADMINISTRATORS, INC.
CHECK BENEFIT CARD
THE LOOMIS COMPANY
CHECK BENEFIT CARD
PO Box 25160
SCOTTSDALE AZ 85255-0102
STERLING MEDICAL CORPORATION
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY PO Box 7045
Plan Type: Group Health
WYOMISSING PA 19610
(877) 634-9814
(877) 634-9814
STEWART BROTHERS DRILLING
Affiliated With: HEALTH DATA
SERVICES
Plan Type: Group Health
HCH ADMINISTRATORS
HCH ADMINISTRATORS
PO Box 285
PEORIA IL 61650
(309) 282-1288
CHECK BENEFIT CARD
(309) 282-1288
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-478
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
STILLWATER DESIGNS
Affiliated With: WATERSTONE
BENEFITS ADMINISTRATORS, INC.
Plan Type: Group Health
CLAIMS SUBMISSION
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
(888) 440-0971
UTILIZATION REVIEW
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
(800) 460-0238
(888) 440-0971
STILLWATER MEDICAL CENTER
Affiliated With: WATERSTONE
BENEFITS ADMINISTRATORS, INC.
Plan Type: Group Health
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
WATERSTONE BENEFIT
ADMINISTRATORS, INC.
4013 NW EXPRESSWAY STE 575
OKLAHOMA CITY OK 73116
(888) 440-0971
CHECK BENEFIT CARD
(888) 440-0971
STOCK CAR CLUB OF AMERICA
Affiliated With: PREFERRED CARE
Plan Type: Group Health
PREFERRED CARE, INC.
PREFERRED CARE, INC.
6 Neshaminy Interplex #205
TREVOSE PA 19053
(215) 639-6208
PREFERRED CARE, INC.
(215) 639-6208
STOCKMAN'S BANK
Affiliated With: AMERICAN TRUST
ADMINISTRATORS
Plan Type: Group Health
BENEFIT ADMINISTRATIVE
SYSTEMS
BENEFIT ADMINISTRATIVE
SYSTEMS
17475 JOVANNA DR
HOMEWOOD IL 60430
(708) 647-3434
CHECK BENEFIT CARD
(708) 647-3434
STOCKYARD BANK
Affiliated With: PREFERRED HEALTH
PLAN INC 962550088
Plan Type: Group Health
STONEHILL COLLEGE SPORTS
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
PREFERRED HEALTH PLANS INC.
PREFERRED HEALTH PLANS INC.
10160 LINN STATION RD
LOUISVILLE KY 40223
(800) 832-8212
PHCS Utilization Management
(888) 551-7427
CHECK BENEFIT CARD
CHECK BENEFIT CARD
(502) 992-4535
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-479
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
STONEHILL UNIVERSITY
Affiliated With: KLAIS & COMPANY
Plan Type: Group Health
CLAIMS SUBMISSION
KLAIS & COMPANY INC
1867 W MARKET ST
AKRON OH 44313
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
KLAIS & COMPANY INC
UTILIZATION REVIEW
CHECK BENEFIT CARD
(800) 331-1096
(800) 331-1096
STRATACARE
Affiliated With: STRATACARE
Plan Type: Workers' Compensation
StrataCare Inc
StrataCare Inc
StrataCare Inc
THE LOOMIS COMPANY
UM NOT APPLICABLE
16800 Aston 2nd Floor
Irvine CA 92606
STRINE PRINTING
THE LOOMIS COMPANY
Affiliated With: THE LOOMIS COMPANY 850 N PARK RD
Plan Type: Group Health
WYOMISSING PA 19610
(866) 340-7182
(866) 340-7182
STRONGHAVEN
Affiliated With: NEW WORLD
SERVICES
Plan Type: Group Health
NEW WORLD SERVICES
STURNER AND KLEIN
Affiliated With: AMERICA'S CHOICE
HEALTHPLANS, LLC
Plan Type: Group Health
AMERICA'S CHOICE HEALTHPLANS,
LLC
AMERICA'S CHOICE HEALTHPLANS, CHECK BENEFIT CARD
LLC
13111 Northwest Fwy, Ste 510
Houston TX 77040
(713) 895-3900
NEW WORLD SERVICES
NEW WORLD SERVICES
2624 N. 5th St.
NILES MI 49120
(713) 895-3900
* Suffolk
Affiliated With: New York State
Insurance Fund
Plan Type: Workers' Compensation
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
SUFFOLK UNIVERSITY SPORTS
Affiliated With: ADMINISTRATIVE
CONCEPTS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-480
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SUMMIT ELECTRIC SUPPLY
COMPANY INC
Affiliated With: WAUSAU BENEFITS
INC
Plan Type: Group Health
CLAIMS SUBMISSION
WAUSAU BENEFITS, INC.
Attn: LeAnn Fichtner
PO Box 8046
WAUSAU WI 54401-8046
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
WAUSAU BENEFITS, INC.
UTILIZATION REVIEW
CHECK BENEFIT CARD
(715) 841-7802
(715) 841-7802
SUMTER COUNTY - B.O.C.C.
Affiliated With: PROFESSIONAL
BENEFIT ADMINISTRATORS, INC. /
FLORID
Plan Type: Group Health
* Sun Coast Media Group
Affiliated With: PREFERRED BENEFIT
ADMINISTRATORS INC
Plan Type: Group Health
Professional Benefit Administrators, Inc. Professional Benefit Administrators, Inc. CHECK BENEFIT CARD
1265 S. Semoran Blvd. #1213
WINTER PARK FL 32792-5515
PREFERRED BENEFIT
ADMINISTRATORS
PREFERRED BENEFIT
ADMINISTRATORS
PO Box 916188
LONGWOOD FL 32791-6188
(407) 786-2777
CHECK BENEFIT CARD
(407) 786-2777
SUN COUNTY AIRLINES
Affiliated With: AMERICA'S TPA
Plan Type: Group Health
America's TPA
America's TPA
PO Box 398220
Bloomington MN 55439
(952) 896-4888
CHECK BENEFIT CARD
(952) 896-4888
SUN HEALTH
Affiliated With: SCHALLER ANDERSON
HEALTHCARE
Plan Type: Group Health
SCHALLER ANDERSON
HEALTHCARE LLC
SCHALLER ANDERSON
HEALTHCARE LLC
PO Box 60850
Phoenix AZ 85082
(866) 479-1130
SCHALLER ANDERSON
HEALTHCARE LLC
(866) 479-1130
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
UM NOT APPLICABLE
555 W Benjamin Holt Dr
Stockton CA 95207
(800) 422-6099
(866) 479-1130
SUN PACIFIC
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
(800) 422-6099
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-481
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SUN PACIFIC FARMING
Affiliated With: PINNACLE CLAIMS
MANAGEMENT
Plan Type: Group Health
CLAIMS SUBMISSION
PINNACLE CLAIMS MANAGEMENT
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
PINNACLE CLAIMS MANAGEMENT
UTILIZATION REVIEW
CHECK BENEFIT CARD
17620 FITCH ST
IRVINE CA 92614
ADVANCED BENEFIT SOLUTIONS
LLC
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
TRIDENT PLAN ADMINISTRATORS
TRIDENT PLAN ADMINISTRATORS
CHECK BENEFIT CARD
5045 N 12TH St Ste A
Phoenix AZ 85014
(602) 240-2404
SUN STATE COMPONENTS, INC.
Affiliated With: ADVANCED BENEFIT
SOLUTIONS, LLC
Plan Type: Group Health
ADVANCED BENEFIT SOLUTIONS
LLC
SUN VALLEY
Affiliated With: CNIC HEALTH
SOLUTIONS
Plan Type: Group Health
SUN VALLEY MASONRY, INC.
Affiliated With: UNITED CLAIMS
SOLUTIONS
Plan Type: Group Health
PO Box 30570
PHOENIX AZ 85046-0570
(602) 240-2404
COMBINED BENEFIT
ADMINISTRATORS
COMBINED BENEFIT
ADMINISTRATORS
PPC
PPC
PO Box 11088
CHARLOTTE NC 28220
(800) 446-5439
PRIMARY PHYSICIANCARE,
INC.
7045232758
SUN WORLD INTERNATIONAL, LLC
Affiliated With: COMBINED BENEFIT
ADMINIS./VALUE ADDED BENEFITS
Plan Type: Group Health
COMBINED BENEFIT
ADMINISTRATORS
SUNBELT RENTALS
Affiliated With: PRIMARY
PHYSICIANSCARE INC
Plan Type: Group Health
4704 W. Jennifer #104
FRESNO CA 93722
(800) 446-5439
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-482
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SUNNY COVE CITRUS LLC
Affiliated With: TRANSWESTERN
INSURANCE ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SUNRISE CREATIVE GROUP INC
Affiliated With: BENESIGHT
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SUNVIEW VINEYARDS OF
CALIFORNIA
Affiliated With: SUNVIEW VINEYARDS
OF CALIFORNIA
Plan Type: Group Health
SUNVIEW VINEYARDS OF
CALIFORNIA
SUNVIEW VINEYARDS OF
CALIFORNIA
SUNVIEW VINEYARDS OF
CALIFORNIA
SUPERIOR FEDERAL CREDIT UNION
(SFCU)
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
Careline UR
(763) 383-4800
PAYOR NAME
SUNMED
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
* SUPERIOR JANITORIAL
Affiliated With: FCE BENEFIT
ADMINISTRATORS INC #10388
Plan Type: Group Health
UTILIZATION REVIEW
1998 Road 152
DELANO CA 93215
(800) 422-2026
FCE BENEFIT ADMINISTRATORS INC
FCE BENEFIT ADMINISTRATORS INC CHECK BENEFIT CARD
4615 WALZEN RD STE 300
SAN ANTONIO TX 78218
(800) 899-9355
(800) 899-9355
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-483
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SUPERVALU
CLAIMS SUBMISSION
CONTACT EMPLOYER
Attn:
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CONTACT EMPLOYER
CONTACT EMPLOYER
UTILIZATION REVIEW
Plan Type: Workers' Compensation
Participates in California Select Network
Sure Care
Affiliated With: American Life And Health
Insurance Company
Plan Type: Group Health
American Life and Health Insurance Co
Attn: Sure Care Health Insurance
PO Box 11368
Scottsdale AZ 85271-1368
CHECK BENEFIT CARD
CHECK BENEFIT CARD
SURGERY CENTER OF OKLAHOMA
Affiliated With: ADMINONE
CORPORATION
Plan Type: Group Health
RESOURCEONE ADMINSTRATORS
Attn: Mary Shepherd
PO Box 489
BUCKEYSTOWN MD 21717
ADMINONE CORPORATION
(800) 967-2077
MEDCARE ONE INC
(800) 816-1206
BENEFIT CONCEPTS, INC.
BENEFIT CONCEPTS, INC.
CHECK BENEFIT CARD
PO Box 61553
KING OF PRUSSIA PA 19406
(610) 337-2600
(800) 967-2077
SURGICAL MONITORING SERVICES
INC
Affiliated With: BENEFIT CONCEPTS
INC
Plan Type: Group Health
SW RESOURCES INC
Affiliated With: HEALTH & WELFARE
BENEFIT SYSTEMS
Plan Type: Group Health
(610) 337-2600
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
HEALTH AND WELFARE BENEFIT
SYSTEMS INC
PO Box 21109
ROANOKE VA 24018
(800) 283-4927
HEALTH AND WELFARE
BENEFIT SYSTEMS INC
(800) 283-4927
(800) 283-4927
SWANSON GROUP INC
Affiliated With: HEALTHCARE
MANAGEMENT ADMINISTRATORS INC
Plan Type: Group Health
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
HEALTHCARE MANAGEMENT
ADMINISTRATORS, INC.
PO Box 85008
BELLEVUE WA 98015
(800) 869-7093 Ext 117
HEALTHCARE MANAGEMENT
ADMINISTRATORS
(425) 289-5142
(800) 869-7093 Ext 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.
Info as of 12/13/2007
Page PIRCA-484
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
SWEETWATER COUNTY SCHOOL
DISTRICT
Affiliated With: BENESIGHT INC
Plan Type: Group Health
Swift Newspapers, Inc.
Affiliated With: American Administrative
Group
Plan Type: Group Health
Swiss Re
Affiliated With: Swiss Re
Plan Type: Workers' Compensation
CLAIMS SUBMISSION
CHECK BENEFIT CARD
American Administrative Group
PO Box 34297
San Antonio TX 78265
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
CHECK BENEFIT CARD
American Administrative Group
Attn: Claims Dept #60
First Health
(800) 346-3220
UTILIZATION REVIEW
(800) 877-7474
(800) 877-7474
First Health
Broadspire
PO Box 5318
Tampa FL 33675-5318
(860) 282-4960
CONTACT EMPLOYER
Attn:
CONTACT EMPLOYER
CONTACT EMPLOYER
ASSURECARE
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
Careline UR
(763) 383-4800
CONTACT EMPLOYER
Participates in California Select Network
* Syracuse
Affiliated With: New York State
Insurance Fund
Plan Type: Workers' Compensation
SYRACUSE CHINA - ACTIVE
Affiliated With: ASSURECARE
Plan Type: Group Health
(800) 422-2026
SYRACUSE CHINA - RETIRED
Affiliated With: ASSURECARE
Plan Type: Group Health
ASSURECARE
ASSURECARE
1742 GEORGETOWN RD STE E
HUDSON OH 44224
(800) 422-2026
Careline UR
(763) 383-4800
HEALTH NET FEDERAL SERVICES
UM NOT APPLICABLE
(800) 422-2026
SYRACUSE FEE BASIS
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
SYRACUSE FEE BASIS
Attn: FEE BASIS 136E
113 HOLLAND AVE
ALBANY NY 12208
(972) 550-2836
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-485
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
CLAIMS SUBMISSION
SYRACUSE VAMC 3199
SYRACUSE VAMC
Affiliated With: HEALTH NET FEDERAL Attn: FEE BASIS 04
SERVICES
800 IRVING AVE
Plan Type: Group Health
SYRACUSE NY 13210
SYSTEMAX, INC
Affiliated With: FLORIDA HEALTH
ADMINISTRATORS (FHA)
Plan Type: Group Health
UTILIZATION REVIEW
CHECK BENEFIT CARD
FLORIDA HEALTH ADMINISTRATORS FLORIDA HEALTH ADMINISTRATORS DELPHI
(727) 573-5737
PO Box 327810
(954) 366-0111
Fort Lauderdale FL 33332
(954) 366-0111
T.A. ASSOCIATES
Affiliated With: MEDICAL CLAIMS
SERVICE, INC.
Plan Type: Group Health
MEDICAL CLAIMS SERVICES, INC.
T.P. ORTHODONTICS, INC.
Affiliated With: PRINCIPAL FINANCIAL
GROUP
Plan Type: Group Health
TACO BUENO RESTAURANTS
Affiliated With: WEB TPA
Plan Type: Group Health
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
SYRACUSE VAMC
MEDICAL CLAIMS SERVICES, INC.
MEDICAL CLAIMS SERVICES,
INC.
PRINCIPAL FINANCIAL GROUP
PRINCIPAL FINANCIAL GROUP
CHECK BENEFIT CARD
PO Box 5319
TAMPA FL 33675-5319
(317) 879-4054 Ext 281
ONE WALL ST STE 2A
RAVENSWOOD WV 26164
(800) 533-5044
(800) 533-5044
WEB TPA
WEB TPA
PO Box 539508
GRAND PRAIRIE TX 75053
(888) 898-2432
AVIDYN HEALTH
(800) 580-0293
America's TPA
America's TPA
CHECK BENEFIT CARD
PO Box 398220
Bloomington MN 55439
(866) 478-6268
(469) 417-1769
TAHER
Affiliated With: AMERICAS TPA
Plan Type: Group Health
(952) 896-4872
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-486
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
TAHLEQUAH CITY HOSPITAL
Affiliated With: C L FRATES &
COMPANY
Plan Type: Group Health
TAHOE BILTMORE LODGE & CASINO
% OF SAVINGS - TRAVEL
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
TAHOE BILTMORE LODGE & CASINO
PEPM
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
CLAIMS SUBMISSION
C.L. FRATES AND COMPANY
PO Box 26967
OKLAHOMA CITY OK 73126-0967
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
C.L. FRATES AND COMPANY
UTILIZATION REVIEW
CHECK BENEFIT CARD
(405) 290-5696
(405) 290-5696
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
SIERRA HEALTH & LIFE / HEALTH
PLAN
SIERRA HEALTH & LIFE / HEALTH
PLAN
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
TAHOE FOREST HOSPITAL
Affiliated With: DELTA HEALTH
SYSTEMS
Plan Type: Group Health
DELTA HEALTH SYSTEMS
DELTA HEALTH SYSTEMS
CHECK BENEFIT CARD
TAHOE TRUCKEE SIERRA DISPOSAL
COMPANY
Affiliated With: CAPITOL
ADMINISTRATORS INC
Plan Type: Group Health
CHECK BENEFIT CARD
CHECK BENEFIT CARD
CHECK BENEFIT CARD
TAKECARE INSURANCE COMPANY
Affiliated With: STAR HEALTHCARE
NETWORK INC
Plan Type: Group Health
STAR HEALTHCARE NETWORK
STAR HEALTHCARE NETWORK
UM NOT APPLICABLE
850 Seventh Ave STE 803
New York NY 10019
(212) 581-8228
PO Box 1147
STOCKTON CA 95201
(212) 581-8228
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-487
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
TALBOT AGENCY INC
Affiliated With: ADVANCED BENEFIT
RESOURCES CORP
Plan Type: Group Health
CLAIMS SUBMISSION
CHECK BENEFIT CARD
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
CHECK BENEFIT CARD
UTILIZATION REVIEW
CHECK BENEFIT CARD
4194233823
TAMPA VAMC 3141
Affiliated With: HEALTH NET FEDERAL
SERVICES
Plan Type: Group Health
TAMPA VAMC
TANNER MEMORIAL CLINIC
Plan Type: Group Health
TAMPA VAMC
CHECK BENEFIT CARD
TALL TREE ADMINISTRATORS
TALL TREE ADMINISTRATORS
802 E WINCHESTER RD STE 205
SALT LAKE CITY UT 84107
(801) 274-8100
CORVEL
(801) 269-8723
10770 NORTH 46TH ST
TAMPA FL 33617
(801) 274-8100
TANOX INC
Affiliated With: GROUP & PENSION
ADMINISTRATORS
Plan Type: Group Health
GROUP & PENSION
ADMINISTRATORS
GROUP & PENSION
ADMINISTRATORS
PO Box 749075
DALLAS TX 75374-9075
(972) 238-7900
CHECK BENEFIT CARD
(972) 744-2311
TATE & SNYDER ARCHITECTS
Affiliated With: SIERRA HEALTH & LIFE
/ HEALTH PLAN OF NEVADA
Plan Type: Group Health
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
SIERRA HEALTH & LIFE/HEALTH
PLAN OF NEVADA
PO Box 15645
LAS VEGAS NV 89114
(702) 242-7700
SIERRA HEALTH &
LIFE/HEALTH PLAN OF
NEVADA
(702) 242-7345
(702) 242-7700
TAYLORS UNITED AUTO GROUP
Affiliated With: SMITH
ADMINISTRATORS INC
Plan Type: Group Health
SMITH ADMINISTRATORS, INC.
SMITH ADMINISTRATORS, INC.
3761 S 700 E SUITE 202
SALT LAKE CITY UT 84106
(801) 261-5511
SERVICE ADVOCATES
(801) 261-5511
(801) 261-5511
• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health®
Network.
• * Indicates payor information has been revised since the last reporting period.
• Providers may not be eligible for participation in certain Coventry or First Health network products due to client
requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the
telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.
Info as of 12/13/2007
Page PIRCA-488
www.firsthealth.com
The First Health® Network
CALIFORNIA Payor Information Report
PAYOR NAME
TBN OF TENNESSEE, INC.
Affiliated With: WILLIS OF KANSAS,
INC.
Plan Type: Group Health
TBP ARCHITECTURE
Affiliated With: EBA&M #10160
Plan Type: Group Health
CLAIMS SUBMISSION
WILLIS OF KANSAS, INC
ELIGIBILIT/ BENEFITS/
COMPENSABILITY
FISERV HEALTH KANSAS
UTILIZATION REVIEW
FISERV HEALTH KANSAS
PO Box 2697
WICHITA KS 67201
EBA&M
EBA&M
PO Box 5079
WESTLAKE VILLAGE CA 91359
(800) 776-1545
HINES & ASSOCIATES
(800) 528-2498
(800) 776-1545
Teamsters Miscellaneous Security Trust
Fund
Affiliated With: Teamsters Miscellaneous
Security Trust