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LIST OF PAYORS October 1, 2009
Here is your First Choice Health Network (FCHN) List of Payors for the 4th Quarter of 2009. The information in this publication is current as of 10/1/09. Please refer to the instructions below for submission of claims: Service Area Definition: Identifies geographic area accessed by FCHN clients. Physician/facility claims: Please submit all claims billed on CMS-1500s to the address shown in the “Submit claims to:” column shown in the List of Payors. Hospital claims: Please submit all claims billed on UB-04s to the address shown in the “Submit claims to:” column shown in the List of Payors.
KEY UPDATES FOR OCTOBER 2009:
Terminating Payors:
Samaritan Health Plans terminates 10/31/09.
Other Updates:
International Longshore & Warehouse Union (ILWU) will add its Oregon and Southwestern Washington locations to FCHN effective 12/1/09. At that time, ILWU will expand their FCHN service area to include Oregon and Clark County, Washington.
Providence Health Plans (PHP) will administer claims for Providence Services of Eastern Washington starting 1/1/10. At that time, PHP will expand their FCHN service area to include Northern Idaho, specifically Benewah, Bonner, Boundary, Clearwater, Idaho, Latah, Lewis, Nez Perce, and Shoshone Counties.
Stein Distributing has changed their venue of access to FCHN from a direct relationship to access via Allegiance Benefit Plan Management effective 10/1/09.
Other News: ** All other changes made to the October 2009 List of Payors will appear as bold, italics. Payor and group search functionality is also available on-line at www.fchn.com. If you have questions regarding the information on this List of Payors, or you cannot find a payor, please contact our Provider Relations department at 800-231-6935 x2103.
Page 1 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
A&I BENEFIT PLAN ADMINISTRATORS Contracted with First Choice since: 10/1/1999 Service Area Definition: Washington, Alaska, Idaho, and Oregon
503-224-0048 800-547-4457
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 503-224-0048
ALLEGIANCE BENEFIT PLAN MANAGEMENT INC Contracted with First Choice since: 10/1/1992 Service Area Definition: Washington, Alaska, Idaho, and Oregon
406-721-2222 800-877-1122
Allegiance Benefit Plan Management PO Box 3018 Missoula, MT 59806 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call StarPoint 800-342-6510
ALLIED METAL CRAFTS SECURITY PLAN TRUST FUND Contracted with First Choice since: 1/1/2006 Service Area Definition: Washington, Alaska, Idaho, and Oregon
206-441-7574 800-735-7053
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
First Choice Health Network 800-467-5281
Page 2 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
ALTERNATIVE RISK MANAGEMENT Contracted with First Choice since: 1/1/2000 Service Area Definition: Washington, Alaska, Idaho, and Oregon
503-968-6831 877-544-1770
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 503-574-4227
AMERIBEN/IEC GROUP Contracted with First Choice since: 2/1/2006 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-786-7930
AmeriBen/IEC Group PO Box 7186 Boise, ID 83707 Emdeon, RelayHealth, or SSI Payor ID 91131
AmeriBen/IEC Group PO Box 7186 Boise, ID 83707 Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card
AMERICAN TRUST ADMINISTRATORS Contracted with First Choice since: 12/1/2001 Service Area Definition: Washington, Alaska, and Idaho
800-843-4121
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 800-422-4991
Page 3 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
ASSURANT HEALTH Contracted with First Choice since: 3/1/1992 Service Area Definition: Washington, Alaska (except no access in Alaska for members domiciled in Alaska), Idaho, and Oregon
414-271-3011 800-743-8463 John Alden: 800-328-4316 Key Benefits: 866-387-0489
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 800-800-8463
BEECH STREET CORPORATION, a Viant Company Contracted with First Choice since: 5/1/1989 Service Area Definition: Washington and Idaho (FCHN-only in Benewah, Bonner, Boundary, Clearwater, Idaho, Latah, Lewis, Nez Perce, and Shoshone Counties, and all/statewide hospitals. Beech Street and FCHN in remaining counties.)
Check patient’s ID card or call 800-877-1444 PPO Department
GTESS Corporation c/o Beech Street Corp 1323 Columbia Dr Ste 315 Richardson, TX 75082 Emdeon or SSI Payor ID 95377
GTESS Corporation c/o Beech Street Corp 1323 Columbia Dr Ste 315 Richardson, TX 75082 Emdeon or SSI Payor ID 95377 DRG Contracted Hospitals: send claims to address below First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 800-877-1444
Page 4 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
BENEFIT MANAGEMENT INC (BMI) Contracted with First Choice since: 6/1/2007 Service Area Definition: Washington, Alaska, Idaho, and Oregon
253-207-4347 800-877-5187
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 800-877-5187
BENEFIT MANAGEMENT SERVICES, INC (BMSI) Contracted with First Choice since: 7/1/2008 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-228-1803
Benefit Management Services, Inc PO Box 1178 Matthews, NC 28106 Emdeon, RelayHealth, or SSI Payor ID 91131
Benefit Management Services, Inc PO Box 1178 Matthews, NC 28106 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address below First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 800-228-1803
BENEFIT MD, formerly known as Health Systems Innovations Contracted with First Choice since: 8/1/2006 Service Area Definition: Washington, Alaska, Idaho, and Oregon
253-207-4347 866-288-8052
BenefitMD PO Box 1818 Tacoma, WA 98401 Emdeon, RelayHealth, or SSI Payor ID 91131
BenefitMD PO Box 1818 Tacoma, WA 98401 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card
Page 5 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
CAPITOL ADMINISTRATORS Contracted with First Choice since: 8/1/2008 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-331-5301
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card
CARPENTERS TRUST OF WESTERN WASHINGTON Contracted with First Choice since: 10/1/1990 Service Area Definition: Washington, Alaska, Idaho, and Oregon
206-260-2280 877-738-6655
Carpenters Trust PO Box 1929 Seattle, WA 98111 Emdeon, RelayHealth, or SSI Payor ID 91131
Carpenters Trust PO Box 1929 Seattle, WA 98111 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 877-738-6655
CEMENT MASONS & PLASTERERS HEALTH & WELFARE TRUST Contracted with First Choice since: 5/1/1991 Service Area Definition: Washington, Alaska, and Idaho
800-735-7053
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
First Choice Health Network 206-292-8255 800-231-6935 Referral required for:
Outpatient Surgery Inpatient Mental Health In/Outpatient Chem Dep
Page 6 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
CENTRAL WASHINGTON COMPREHENSIVE MENTAL HEALTH Contracted with First Choice since: 1/1/2004 Service Area Definition: Washington, Alaska, and Idaho
866-801-0316
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
First Choice Health Network 206-292-8255 800-231-6935 Referral required for:
Outpatient Surgery Inpatient Mental Health Inpatient Chem Dep
CLEAR CHOICE HEALTH PLANS Contracted with First Choice since: 1/1/2003 Service Area Definition: Washington, Alaska, Idaho, and Oregon (excluding cities of Bend, Burns, The Dalles, Hood River, John Day, Lapine, Madras, Prineville, Redmond, and Terrebonne, and the Salem Clinic in Salem, however Providence Hood River Hospital is included)
888-677-5582
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 888-677-5582
COASTAL ADMINISTRATIVE SERVICES INC Contracted with First Choice since: 7/1/2003 Service Area Definition: Washington, Alaska, and Idaho
800-870-1831
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Managed Care Review Services 800-410-0699
Page 7 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
COLVILLE CONFEDERATED TRIBES Contracted with First Choice since: 8/1/1998 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-872-8979
Colville Confederated Tribes c/o Rehn & Associates PO Box 5433 Spokane, WA 99205 Emdeon, RelayHealth, or SSI Payor ID 91131
Colville Confederated Tribes c/o Rehn & Associates PO Box 5433 Spokane, WA 99205 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
No pre-authorization required
CONFEDERATED TRIBES OF COOS, LOWER UMPQUA, & SIUSLAW INDIANS Contracted with First Choice since: 6/1/2007 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-227-0392
CLUSIT Contract Health Service 1245 Fulton Ave Coos Bay, OR 97420 Emdeon, RelayHealth, or SSI Payor ID 91131
CLUSIT Contract Health Service 1245 Fulton Ave Coos Bay, OR 97420 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 800-227-0392
CONFEDERATED TRIBES OF SILETZ Contracted with First Choice since: 1/1/2009 Service Area Definition: Washington, Alaska, Idaho, and Oregon
866-511-4757
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 866-511-4757
Page 8 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
COQUILLE INDIAN TRIBE CONTRACT HEALTH SERVICES Contracted with First Choice since: 6/1/2007 Service Area Definition: Washington, Alaska, Idaho, and Oregon
866-862-7506
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 866-862-7506
THE COVENANT Contracted with First Choice since: 1/1/2007 Service Area Definition: Oregon
208-452-7979
The Covenant PO Box 11853 Spring, TX 77391 Emdeon, RelayHealth, or SSI Payor ID 91131
The Covenant PO Box 11853 Spring, TX 77391 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 208-452-7979
COW CREEK HEALTH & WELLNESS CENTER Contracted with First Choice since: 6/1/2008 Service Area Definition: Washington, Alaska, Idaho, and Oregon
541-672-8533
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 541-672-8533
Page 9 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
DESERET MUTUAL BENEFIT ADMINISTRATORS Contracted with First Choice since: 9/1/1989 Service Area Definition: Washington
800-777-3622
Deseret Healthcare Attn: Network Claims AdministratorPO Box 45530 Salt Lake City, UT 84145 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 800-777-3622
EMPLOYEE BENEFIT MANAGEMENT SERVICES (EBMS) Contracted with First Choice since: 11/1/1993 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-777-3575
EBMS PO Box 21367 Billings, MT 59104-1367 Emdeon Payor ID SX182
EBMS PO Box 21367 Billings, MT 59104-1367 Emdeon Payor ID 12X44 DRG Contracted Hospitals: send claims to address below First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 800-777-3575
Page 10 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
FIRST CHOICE HEALTH ADMINISTRATORS Contracted with First Choice since: 1/1/2003 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-430-3818
First Choice Health Administrators PO Box 12659 Seattle, WA 98111-4659 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Administrators PO Box 12659 Seattle, WA 98111-4659 DRG Contracted Hospitals: send claims to address below: First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 800-808-0450 Some referrals required.
GOVERNMENT EMPLOYEES HEALTH ASSOCIATION (GEHA) Contracted with First Choice since: 9/1/2000 Service Area Definition: Washington (excluding Clark County)
800-821-6136
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card
GROUP HEALTH OPTIONS Contracted with First Choice since: 1/1/1997 Service Area Definition: Washington, Alaska, Idaho, and Oregon
888-767-4670
Group Health Options PO Box 34585 Seattle, WA 98124 Emdeon, RelayHealth, or SSI Payor ID 91131
Group Health Options PO Box 34585 Seattle, WA 98124 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 888-901-4636
Page 11 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
GUARDIAN LIFE INSURANCE Contracted with First Choice since: 2/15/1991 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-624-4050
Guardian Life Insurance PO Box 8019 Appleton, WI 54912 Emdeon Payor ID 64246
Guardian Life Insurance PO Box 8019 Appleton, WI 54912 Emdeon Payor ID 64246 DRG Contracted Hospitals: send claims to address above
Active Health Management 800-227-6921
HEALTH INFONET INC Contracted with First Choice since: 01/01/1999 Service Area Definition: Washington, Alaska, and Idaho
888-256-6556
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card
HEALTH NET HEALTH PLAN OF OREGON Contracted with First Choice since: 4/1/1995 Service Area Definition: Washington (excluding Clark, Cowlitz, Klickitat, Pacific, Skamania, and Wahkiakum Counties)
888-802-7001
Health Net Oregon PO Box 14130 Lexington, KY 40512 Emdeon or SSI Payor ID 95567
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 888-802-7001
Page 12 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
HEALTHCOMP Contracted with First Choice since: 3/1/1998 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-442-7247 800-960-7247
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 503-224-0048
HEALTHSCOPE BENEFITS Contracted with First Choice since: 1/1/2009 Service Area Definition: Washington, Idaho, and Oregon
800-560-4664
HealthSCOPE PO Box 619059 Dallas, TX 75261-9059 Emdeon, RelayHealth, or SSI Payor ID 91131
HealthSCOPE PO Box 619059 Dallas, TX 75261-9059 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
866-607-2800
HECLA MINING CO Contracted with First Choice since: 1/1/1993 Service Area Definition: Washington, Alaska, Idaho, and Oregon
509-328-0300 800-716-0300
Hecla Mining Co c/o Zenith Administrators PO Box 5434 Spokane, WA 99205 Emdeon, RelayHealth, or SSI Payor ID 91131
Hecla Mining Co c/o Zenith Administrators PO Box 5434 Spokane, WA 99205 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card
Page 13 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
HOTEL EMPLOYEES RESTAURANT EMPLOYEES HEALTH TRUST (dba the HERE Trust) Contracted with First Choice since: 6/1/2003 Service Area Definition: Washington, Alaska, and Idaho
800-735-7053
HERE Trust c/o Welfare & Pension Administrative Services PO Box 34355 Seattle, WA 98124-1355 Emdeon Payor ID 91136
HERE Trust c/o Welfare & Pension Administrative Services PO Box 34355 Seattle, WA 98124-1355 Emdeon Payor ID 91136 DRG Contracted Hospitals: send claims to address above
First Choice Health Network 800-231-6935 Referral required for:
Outpatient Surgery Inpatient Mental Health Inpatient Chem Dep
INLAND EMPIRE ELECTRICAL WORKERS HEALTH & WELFARE TRUST Contracted with First Choice since: 10/1/1992 Service Area Definition: Washington, Alaska, Idaho, and Oregon
509-534-0600 800-872-8979
Inland Empire Electrical Workers Health & Welfare Trust c/o Rehn & Associates PO Box 5433 Spokane, WA 99205-0433 Emdeon, RelayHealth, or SSI Payor ID 91131
Inland Empire Electrical Workers Health & Welfare Trust c/o Rehn & Associates PO Box 5433 Spokane, WA 99205-0433 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s card or call 800-827-5058
INLAND EMPIRE TEAMSTERS TRUST Contracted with First Choice since: 10/1/1992 Service Area Definition: Washington, Alaska, Idaho and Oregon
509-534-0300 800-872-8979
Inland Empire Teamsters Trust c/o Rehn & Associates PO Box 5433 Spokane, WA 99205 Emdeon, RelayHealth, or SSI Payor ID 91131
Inland Empire Teamsters Trust c/o Rehn & Associates PO Box 5433 Spokane, WA 99205 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s card or call 509-534-0300 800-827-5058
Page 14 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
INSURANCE RISK & MANAGEMENT Contracted with First Choice since: 1/1/2007 Service Area Definition: Washington
877-863-7528
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s card or call 877-863-7528
INTERNATIONAL ASSOCIATION OF MACHINISTS (IAM) Contracted with First Choice since: 8/1/1996 Service Area Definition: Washington, Alaska, and Idaho
503-274-1600 800-654-4411
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
No pre-authorization required
INTERNATIONAL LONGSHORE & WAREHOUSE UNION (ILWU) Contracted with First Choice since: 9/1/1991 Service Area Definition: Washington (excluding Clark County), Alaska, Idaho, and, effective 12/1/2009, Oregon
415-543-0114 800-955-7376
ILWU-PMA Coastwise Claims Office 814 Mission St, Ste 300 San Francisco, CA 94103 Emdeon, RelayHealth, or SSI Payor ID 91131
ILWU-PMA Coastwise Claims Office 814 Mission St, Ste 300 San Francisco, CA 94103 DRG Contracted Hospitals: send claims to address below First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 415-543-0114
Page 15 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
IRONWORKERS INTERMOUNTAIN HEALTH & WELFARE TRUST Contracted with First Choice since: 6/1/2001 Service Area Definition: Washington, Alaska, and Idaho
801-973-1001 888-867-9510
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
No pre-authorization required
KIPP & COMPANY ADMINISTRATORS, now known as EBMS Contracted with First Choice since: 1/1/1991 Service Area Definition: Washington, Alaska, Idaho, and Oregon
503-279-9943 800-824-9789
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 800-824-9789
KPS HEALTH PLANS Contracted with First Choice since: 1/1/2001 Service Area Definition: Washington (restricted access in Clallam, Grays Harbor, Jefferson, Kitsap, and Mason Counties), Alaska, Idaho, and Oregon
360-478-6796 800-552-7114
KPS Health Plans PO Box 339 Bremerton, WA 98337-0039 Emdeon, RelayHealth, or SSI Payor ID 91131
KPS Health Plans PO Box 339 Bremerton, WA 98337-0039 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 360-478-6796
Page 16 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
LAW ENFORCEMENT OFFICERS & FIREFIGHTERS HEALTH & WELFARE TRUST (LEOFF) Contracted with First Choice since: 1/1/2005 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-377-2388
Law Enforcement Officers and Firefighters Health & Welfare Trust c/o Rehn & Associates PO Box 5433 Spokane, WA 99205 Emdeon, RelayHealth, or SSI Payor ID 91131
Law Enforcement Officers and Firefighters Health & Welfare Trust c/o Rehn & Associates PO Box 5433 Spokane, WA 99205 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card
LOCALS 302 & 612 INTERNATIONAL UNION OF OPERATING ENGINEERS Contracted with First Choice since: 7/1/2000 Service Area Definition: Washington, Alaska (except Anchorage Borough), Idaho, and Oregon
800-735-7053
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
First Choice Health Network 800-231-6935 Referral required for:
Outpatient Surgery (some) Inpatient Chem Dep
BHCC 800-640-7682 Referral required for:
Inpatient Mental Health
LOCAL UNION 598 PLUMBING & PIPEFITTING INDUSTRY HEALTH & WELFARE FUND Contracted with First Choice since: 10/1/1999 Service Area Definition: Washington and Oregon
800-547-1314
William C Earhart Co Inc PO Box 4148 Portland, OR 97208 Emdeon, RelayHealth, or SSI Payor ID 91131
William C Earhart Co Inc PO Box 4148 Portland, OR 97208 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
Innovative Care Management 800-862-3338
Page 17 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
LOOMIS BENEFITS WEST & THE LOOMIS COMPANY Contracted with First Choice since: 9/1/1985 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-367-3721
Loomis Benefits West PO Box 13906 Reading, PA 19612 Emdeon, RelayHealth, or SSI Payor ID 91131
Loomis Benefits West PO Box 13906 Reading, PA 19612 DRG Contracted Hospitals: send claims to address below First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 800-992-2080
MASONRY SECURITY PLAN OF WASHINGTON Contracted with First Choice since: 1/1/2006 Service Area Definition: Washington, Alaska, Idaho, and Oregon
206-926-2842 866-312-4591
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
First Choice Health Network 888-328-7304
MBA OF WYOMING Contracted with First Choice since: 10/1/1998 Service Area Definition: Washington, Alaska, and Idaho
800-877-3727
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 800-877-3727
Page 18 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
MERITAIN HEALTH Contracted with First Choice since: 11/1/2007 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-925-2272
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
800-542-6355
MOUNTAIN STATES ADMINISTRATIVE SERVICES Contracted with First Choice since: 8/1/2007 Service Area Definition: Washington, Alaska, Idaho, and Oregon
520-722-0811 866-956-8488
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Varies by group; check patient’s ID card
NATIONAL HEALTH BENEFITS CORPORATION (NHBC) Contracted with First Choice since: 1/1/2007 Service Area Definition: Washington, Idaho, and Oregon
888-621-7900
NHBC 8990 E Raintree Dr Ste 100 Scottsdale, AZ 85260 Emdeon, RelayHealth, or SSI Payor ID 91131
NHBC 8990 E Raintree Dr Ste 100 Scottsdale, AZ 85260 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Varies by group; check patient’s ID card
Page 19 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
NATIONAL RURAL ELECTRIC COOPERATIVE ASSOCIATION (NRECA) Contracted with First Choice since: 10/1/1992 Service Area Definition: Washington, Alaska, Idaho, and Oregon
402-483-9200
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
SHARE 800-52-NRECA
NEZ PERCE TRIBE dba NIMIIPUU HEALTH Contracted with First Choice since: 1/1/2009 Service Area Definition: Washington, Alaska, Idaho, and Oregon
888-891-2920
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 888-891-2920
NOOKSACK RIVER CASINO Contracted with First Choice since: 1/1/07 Service Area Definition: Washington
888-690-2020
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Hines 800-944-9401
Page 20 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
NORTHWEST METAL CRAFTS TRUST FUND Contracted with First Choice since: 1/1/2006 Service Area Definition: Washington, Alaska, Idaho, and Oregon
206-926-2842 866-312-4591
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
First Choice Health Network 888-328-7304
NORTHWEST PLUMBING & PIPEFITTING Contracted with First Choice since: 1/1/1994 Service Area Definition: Washington, Alaska, and Idaho
800-735-7053
Northwest Plumbing & Pipefitting c/o Welfare & Pension Administrative Services PO Box 34203 Seattle, WA 98124-1203 Emdeon Payor ID 91136
Northwest Plumbing & Pipefitting c/o Welfare & Pension Administrative Services PO Box 34203 Seattle, WA 98124-1203 Emdeon Payor ID 91136 DRG Contracted Hospitals: send claims to address above
No pre-authorization required.
NORTHWEST ROOFERS & EMPLOYERS HEALTH & SECURITY TRUST FUND Contracted with First Choice since: 6/1/2000 Service Area Definition: Washington, Alaska, and Idaho
800-735-7053
Northwest Roofers Trust c/o Welfare & Pension Administrative Services PO Box 34498 Seattle, WA 98124-1498 Emdeon Payor ID 91136
Northwest Roofers Trust c/o Welfare & Pension Administrative Services PO Box 34498 Seattle, WA 98124-1498 Emdeon Payor ID 91136 DRG Contracted Hospitals: send claims to address above
Qualis Health 800-783-8606
Page 21 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
NORTHWEST SHEET METAL WORKERS HEALTH CARE PLANS Contracted with First Choice since: 8/1/1992 Service Area Definition: Washington, Alaska, Idaho, and Oregon
509-534-0600 800-872-8979
Northwest Sheet Metal Workers c/o Rehn & Associates PO Box 5433 Spokane, WA 99205 Emdeon, RelayHealth, or SSI Payor ID 91131
Northwest Sheet Metal Workers c/o Rehn & Associates PO Box 5433 Spokane, WA 99205 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network 206-292-8255 800-231-6935 Referral required for:
Outpatient Surgery (some) Inpatient Mental Health Inpatient Chem Dep
NORTHWEST TEXTILE PROCESSORS TRUST Contracted with First Choice since: 4/1/1999 Service Area Definition: Washington, Alaska, Idaho, and Oregon
206-441-7574 800-735-7053
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Qualis 800-783-8606
ODS HEALTH PLAN Contracted with First Choice since: 11/1/1992 Service Area Definition: Washington (excluding Clark County) and Idaho
503-243-3968 877-337-0650
ODS Health Plan PO Box 40384 Portland, OR 97240 Emdeon Payor ID 13350
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 877-337-0650
Page 22 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
P5 HEALTH PLAN SOLUTIONS Contracted with First Choice since: 5/1/2004 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-348-6898
P5 Health Plan Solutions PO Box 9554 Salt Lake City, UT 84109-9554 Emdeon Payor ID 87068
P5 Health Plan Solutions PO Box 9554 Salt Lake City, UT 84109-9554 Emdeon Payor ID 87068
Varies by group; check patient’s ID card
PACIFIC UNDERWRITERS Contracted with First Choice since: 1/1/2000 Service Area Definition: Washington, Alaska, and Idaho
800-562-5226
Pacific Underwriters PO Box 68787 Seattle, WA 98168 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
No pre-authorization required
PERFORMANCE HEALTH TECHNOLOGY Contracted with First Choice since: 6/1/2004 Service Area Definition: Washington, Alaska, Idaho, and Oregon
503-584-2168 800-893-9230
Performance Health Technology PO Box 5308 Salem, OR 97304 Emdeon, RelayHealth, or SSI Payor ID 91131
Performance Health Technology PO Box 5308 Salem, OR 97304 DRG Contracted Hospitals: send claims to address above
Innovative Care Management 800-862-3338
Page 23 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
PHILLIPS ADMINISTRATIVE SERVICE INC Contracted with First Choice since: 1/1/1993 Service Area Definition: Washington, Alaska, and Idaho
541-928-1717 800-356-9822
Phillips Administrative Services PO Box 218 Albany, OR 97321 Emdeon, RelayHealth, or SSI Payor ID 91131
Phillips Administrative Services PO Box 218 Albany, OR 97321 DRG Contracted Hospitals: send claims to address below First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
800-356-9822
PHYSICIAN HEALTH PARTNERS Contracted with First Choice since: 7/1/2009 Service Area Definition: Washington, Idaho, and Oregon
877-888-0062
Correctional Health Partners 1515 Arapahoe St, Bldg 1, Ste 300 Denver, CO 80202 Emdeon, RelayHealth, or SSI Payor ID 91131
Correctional Health Partners 1515 Arapahoe St, Bldg 1, Ste 300 Denver, CO 80202 DRG Contracted Hospitals: send claims to address below First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
Page 24 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
PONDERAY NEWSPRINT CO Contracted with First Choice since: 1/1/2003 Service Area Definition: Washington and Idaho
800-562-4023
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
First Choice Health Network 206-292-8255 800-231-6935 Referral required for:
Outpatient Surgery Inpatient Mental Health Inpatient Chem Dep
PRAIRIE STATES ENTERPRISES Contracted with First Choice since: 1/1/2009 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-615-7020
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 800-615-7020
PREMIER CLAIMS ADMINISTRATION, formerly known as FirsTier Administrators Contracted with First Choice since: 1/1/1997 Service Area Definition: Washington, Alaska, Idaho, and Oregon
866-565-7557
Premier Claims Administration PO Box 19338 Reno, NV 89511 Emdeon, RelayHealth, or SSI Payor ID 91131
Premier Claims Administration PO Box 19338 Reno, NV 89511 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 206-527-9580
Page 25 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
PRINCIPAL FINANCIAL GROUP Contracted with First Choice since: 6/1/1989 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-247-4695 800-533-5044 Christian Brothers: 800-807-0400
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Varies by group; check patient’s ID card
PRINTING SPECIALTIES & PAPER PRODUCTS JOINT EMPLOYER & UNION HEALTH & WELFARE FUND Contracted with First Choice since: 8/1/1997 Service Area Definition: Washington
206-726-3291 800-525-1817
Printing Specialties c/o Northwest Administrators 2323 Eastlake Ave E Seattle, WA 98102-3393 Emdeon, RelayHealth, or SSI Payor ID 91131
Printing Specialties c/o Northwest Administrators 2323 Eastlake Ave E Seattle, WA 98102-3393 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
UniCare 800-762-3029 Managed Health Network 800-327-4103 Referral required for:
Chemical dependency treatment
Mental health treatment
Page 26 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
PROVIDENCE HEALTH PLAN Contracted with First Choice since: 3/1/2003 Service Area Definition: Washington (excluding Clark, Cowlitz, Klickitat, Skamania, and Wahkiakum Counties) and, effective 1/1/2010, Idaho (Benewah, Bonner, Boundary, Clearwater, Idaho, Latah, Lewis, Nez Perce, and Shoshone Counties)
800-878-4445
Check patient’s ID card Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Providence Health Plan 800-638-0449
PUGET SOUND BENEFITS TRUST Contracted with First Choice since: 1/1/1992 Service Area Definition: Washington, Alaska, and Idaho
800-735-7053
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Alicare 888-345-4239
Page 27 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
PUGET SOUND ELECTRICAL WORKERS HEALTH & WELFARE TRUST FUND Contracted with First Choice since: 11/1/1993 Service Area Definition: Washington, Alaska, Idaho, and Oregon
866-314-4239
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Qualis Health 800-783-8606
QVI RISK SOLUTIONS, INC Contracted with First Choice since: 6/1/2005 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-418-9717
QVI Risk Solutions PO Box 7199 Bend, OR 97708 Emdeon, RelayHealth, or SSI Payor ID 91131
QVI Risk Solutions PO Box 7199 Bend, OR 97708 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 800-418-9717
RETIREE’S WELFARE TRUST Contracted with First Choice since: 10/1/2000 Service Area Definition: Washington, Alaska, Idaho, and Oregon
206-726-3269 800-692-5179
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
First Choice Health Network 800-511-8997
Page 28 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
SAMARITAN HEALTH PLANS Contracted with First Choice since: 1/1/2006 Terminates: 10/31/2009 Service Area Definition: Oregon (excluding Benton, Lincoln, and Linn Counties)
800-569-4616
Samaritan Health Plans 815 NW 9th St Corvallis, OR 97330 Emdeon, RelayHealth, or SSI Payor ID 91131
Samaritan Health Plans 815 NW 9th St Corvallis, OR 97330 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 800-569-4616
SELECT BENEFIT ADMINISTRATORS, INC Contracted with First Choice since: 1/1/1999 Service Area Definition: Washington, Alaska, and Idaho
888-532-5332
Select Benefit Administrators, Inc PO Box 230519 Portland, OR 97281-0591 Emdeon, RelayHealth, or SSI Payor ID 91131
Select Benefit Administrators, Inc PO Box 230519 Portland, OR 97281-0591 DRG Contracted Hospitals: send claims to address below First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 888-532-5332
SHASTA ADMINISTRATIVE SERVICES Contracted with First Choice since: 1/1/2004 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-441-4518
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Varies by group; check patient’s ID card
Page 29 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
SISTERS OF PROVIDENCE/ MOTHER JOSEPH PROVINCE Contracted with First Choice since: 2/1/1995 Service Area Definition: Washington, Alaska, and Idaho
425-525-3236
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
No pre-authorization required
SOUTHWEST OREGON IPA Contracted with First Choice since: 6/1/2007 Service Area Definition: Washington, Alaska, Idaho, and Oregon (excluding Coos and Curry Counties)
877-269-2739
Southwest Oregon IPA PO Box 1246 Coos Bay, OR 97246 Emdeon, RelayHealth, or SSI Payor ID 91131
Southwest Oregon IPA PO Box 1246 Coos Bay, OR 97246 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 877-269-2739
STEIN DISTRIBUTING Contracted with First Choice since: 7/1/2008 Terminated: 9/30/2009 Service Area Definition: Washington and Oregon (plus access to Alaska and Idaho for WA- and OR-domiciled lives)
800-546-9338
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
CareAllies 800-533-1314
Page 30 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
SUMMIT ADMINISTRATION SERVICES Contracted with First Choice since: 2/1/2008 Service Area Definition: Washington
888-690-2020
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Hines 800-944-9401
TC3 HEALTH, INC Contracted with First Choice since: 1/1/2009 Service Area Definition: Washington
408-367-8398
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card
TONGASS TIMBER TRUST Contracted with First Choice since: 1/1/2001 Service Area Definition: Washington, Alaska, Idaho, and Oregon
907-225-6114
Tongass Timber Trust 111 Stedman St, Ste 200 Ketchikan, AK 99901 Emdeon, RelayHealth, or SSI Payor ID 91131
Tongass Timber Trust 111 Stedman St, Ste 200 Ketchikan, AK 99901 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network 800-231-6935 Referral required for:
In/Outpatient Mental Hlth In/Outpatient Chem Dep
Page 31 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
TRUSTEED PLANS SERVICE CORPORATION (TPSC) Contracted with First Choice since: 5/1/1992 Service Area Definition: Washington, Alaska, Idaho, and Oregon
253-564-5611 800-426-9786
Trusteed Plans Service Corporation PO Box 2950 Tacoma, WA 98401 Emdeon Payor ID 91078
Trusteed Plans Service Corporation PO Box 2950 Tacoma, WA 98401 DRG Contracted Hospitals: send claims to address above Emdeon Payor ID 91078
Check patient’s ID card or call 800-426-9786
TRUSTMARK LIFE INSURANCE CO (aka CORESOURCE) Contracted with First Choice since: 1/1/1988 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-396-2960 CoreSource: 866-280-4120 FMH: 800-990-9058 NGS American: 800-521-1555 Starmark: 800-522-1246
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Varies by group; check patient’s ID card
TUALITY HEALTHCARE Contracted with First Choice since: 1/1/2008 Service Area Definition: Washington, Alaska, Idaho, and Oregon
503-681-1743
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 503-681-1743
Page 32 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
UMR, formerly known as FISERV HEALTH Contracted with First Choice since: 2/1/1992 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-826-9781
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 800-826-9781
UNICARE Contracted with First Choice since: 1/1/90 Service Area Definition: Washington and Oregon
800-333-3304
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
UniCare 800-333-3304
UNITED EMPLOYEES BENEFIT TRUST (UEBT) Contracted with First Choice since: 1/1/1987 Service Area Definition: Washington, Alaska, Idaho, and Oregon
253-474-1214 800-223-2449
United Employee Benefits Trust PO Box 8130 Tacoma, WA 98419 Emdeon, RelayHealth, or SSI Payor ID 91131
United Employee Benefits Trust PO Box 8130 Tacoma, WA 98419 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network 800-231-6935 Referral required for:
Outpatient Surgery Inpatient Mental Health Inpatient Chem Dep
Page 33 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
UNITED FOOD & COMMERCIAL WORKERS WELFARE TRUST Contracted with First Choice since: 1/1/2006 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-872-8979
United Food & Commercial Workers Welfare Trust c/o Rehn & Associates PO Box 5433 Spokane, WA 99205 Emdeon, RelayHealth, or SSI Payor ID 91131
United Food & Commercial Workers Welfare Trust c/o Rehn & Associates PO Box 5433 Spokane, WA 99205 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network 206-292-8255 800-231-6935 Referral required for:
Outpatient Surgery (some)
USAccess Contracted with First Choice since: 2/1/2008 Service Area Definition: Washington, Alaska, Idaho, and Oregon
413-363-0600
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 413-363-0600
VENTURENET HEALTHCARE Contracted with First Choice since: 1/1/2008 Service Area Definition: Washington, Alaska, Idaho, and Oregon
877-453-4201
VentureNet Healthcare PO Box 2909 Phoenix, AZ 85062-2909 Emdeon, RelayHealth, or SSI Payor ID 91131
VentureNet Healthcare PO Box 2909 Phoenix, AZ 85062-2909 DRG Contracted Hospitals: send claims to address below First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
American Health 866-353-0957
Page 34 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
WASHINGTON & IDAHO CARPENTERS HEALTH & SECURITY TRUST Contracted with First Choice since: 10/1/1992 Service Area Definition: Washington (through Beech Street) and Idaho
800-716-0300
Washington & Idaho Carpenters Health & Security Trust c/o Zenith Administrators PO Box 5434 Spokane, WA 99205-0434 Emdeon, RelayHealth, or SSI Payor ID 91131
Washington & Idaho Carpenters Health & Security Trust c/o Zenith Administrators PO Box 5434 Spokane, WA 99205-0434 DRG Contracted Hospitals: send claims to address above Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card or call 800-716-0300
WASHINGTON STATE HEALTH INSURANCE POOL (WSHIP) Contracted with First Choice since: 11/1/1999 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-877-5187
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Qualis Health 800-549-7549
WASHINGTON TEAMSTERS WELFARE TRUST Contracted with First Choice since: 10/1/1999 Service Area Definition: Washington, Alaska, Idaho, and Oregon
206-726-3277 800-458-3053
First Choice Health Network PO Box 21003 Seattle, WA 98111 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 21003 Seattle, WA 98111 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Qualis Health 877-372-7861 Managed Health Network 800-256-9888 Referral required for:
Chemical dependency treatment
Mental health treatment
Page 35 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
WEBTPA Contracted with First Choice since: 5/1/2009 Service Area Definition: Washington, Alaska, Idaho, and Oregon
866-259-5540
WEBTPA PO Box 99906 Grapevine, TX 76099-9706 Emdeon, RelayHealth, or SSI Payor ID 75261
WEBTPA PO Box 99906 Grapevine, TX 76099-9706 Emdeon, RelayHealth, or SSI Payor ID 75261 DRG Contracted Hospitals: send claims to address above
WEBTPA 866-259-5540
WENATCHEE VALLEY CLINIC Contracted with First Choice since: 1/1/1999 Service Area Definition: Washington, Alaska, and Idaho
509-664-4868 800-726-8808
Wenatchee Valley Clinic PO Box 810 Wenatchee, WA 98801 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 800-726-8808
WESTERN BENEFITS INC Contracted with First Choice since: 7/1/2000 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-777-3603
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
Check patient’s ID card or call 800-777-3603
Page 36 of 36 LIST OF PAYORS
10/1/2009
Payor/Employer Comments
For benefits & eligibility or claims payment status, call: Submit Physician claims to: Submit Hospital claims to:
To determine if pre-authorization or certification is required, contact:
WESTPORT SHIPYARDS, INC Contracted with First Choice since: 8/1/2003 Service Area Definition: Washington, Alaska, Idaho, and Oregon
866-239-0415
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
First Choice Health Network 888-328-7304
YAKAMA NATION Contracted with First Choice since: 12/1/1999 Service Area Definition: Washington, Alaska, Idaho, and Oregon
509-865-5121 x374
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address above
First Choice Health Network 206-292-8255 or 800-231-6935
Non-Native members
Check patient’s ID card or call 509-865-5121 x374
Native members
ZENITH ADMINISTRATORS Contracted with First Choice since: 5/1/1998 Service Area Definition: Washington, Alaska, Idaho, and Oregon
800-426-5980
Check patient’s ID card Emdeon, RelayHealth, or SSI Payor ID 91131
Check patient’s ID card Emdeon, RelayHealth, or SSI Payor ID 91131 DRG Contracted Hospitals: send claims to address below First Choice Health Network PO Box 2289 Seattle, WA 98111-2289 Emdeon, RelayHealth, or SSI Payor ID 91131
First Choice Health Network 206-292-8255 or 800-231-6935
Seattle Area Plumbers & Pipefitters
Sound Health & Wellness Trust
Check patient’s ID card or call 800-422-3038
all other groups
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