the first health network outpatient care network colorado ... · stockton ca 95201 accident fund...

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PAYOR NAME COLORADO Comprehensive Client List Billing / Claims Submission Eligibility/ Benefits/ Compensability UM/Pre-Certification and/or Referral Management Billing/Claims The First Health® Network Outpatient Care Network SELECT BENEFIT ADMINISTRATORS, INC. (800) 397-0427 SELECT BENEFIT ADMINISTRATORS, INC. 66 FEDERAL CREDIT UNION Affiliated With: SELECT BENEFIT ADMINISTRATORS, INC. Fund No: PlanType: Group Health SELECT BENEFIT ADMINISTRATORS, INC. (800) 397-0427 SELECT BENEFIT ADMINISTRATORS, INC. 3001 Westown Pkwy. WEST DES MOINES IA 50266 BUTLER BENEFIT SERVICES (563) 327-2240 CHECK BENEFIT CARD A & D MANAGEMENT CO INC Affiliated With: SISCO/Cottingham & Butler Fund No: PlanType: Group Health BUTLER BENEFIT SERVICES (563) 327-2240 BUTLER BENEFIT SERVICES PO Box 3310 Davenport IA 52808-3310 THE LOOMIS COMPANY (866) 663-2365 CHECK BENEFIT CARD A C HOUSTON LUMBER Affiliated With: THE LOOMIS COMPANY Fund No: PlanType: Group Health THE LOOMIS COMPANY (866) 663-2365 THE LOOMIS COMPANY 850 N PARK RD WYOMISSING PA 19610 THE LOOMIS COMPANY (800) 346-1223 UM NOT APPLICABLE A C HOUSTON LUMBER Affiliated With: THE LOOMIS COMPANY Fund No: PlanType: Group Health THE LOOMIS COMPANY (800) 346-1223 THE LOOMIS COMPANY PO Box 7011 WYOMISSING PA 19610- 6011 CHECK BENEFIT CARD CHECK BENEFIT CARD A G ADMINISTRATORS Affiliated With: A G ADMINISTRATORS Fund No: PlanType: Group Health CHECK BENEFIT CARD CHECK BENEFIT CARD Info as of 12/27/2007 www.firsthealth.com For further information, contact Provider Relations at (800) 937-6824 Page CCL CO-1 Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. * Indicates payor information has been revised since the last reporting period. Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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Page 1: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SELECT BENEFIT ADMINISTRATORS, INC.(800) 397-0427

SELECT BENEFIT ADMINISTRATORS, INC.

66 FEDERAL CREDIT UNIONAffiliated With: SELECT BENEFIT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SELECT BENEFIT ADMINISTRATORS, INC.(800) 397-0427

SELECT BENEFIT ADMINISTRATORS, INC.3001 Westown Pkwy.WEST DES MOINES IA 50266

BUTLER BENEFIT SERVICES(563) 327-2240

CHECK BENEFIT CARDA & D MANAGEMENT CO INCAffiliated With: SISCO/Cottingham & Butler

Fund No:PlanType: Group Health

BUTLER BENEFIT SERVICES(563) 327-2240

BUTLER BENEFIT SERVICESPO Box 3310Davenport IA 52808-3310

THE LOOMIS COMPANY(866) 663-2365

CHECK BENEFIT CARDA C HOUSTON LUMBERAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(866) 663-2365

THE LOOMIS COMPANY850 N PARK RDWYOMISSING PA 19610

THE LOOMIS COMPANY(800) 346-1223

UM NOT APPLICABLEA C HOUSTON LUMBERAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(800) 346-1223

THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011

CHECK BENEFIT CARD CHECK BENEFIT CARDA G ADMINISTRATORSAffiliated With: A G ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-1• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 2: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

DELTA HEALTH SYSTEMS(209) 939-3403

DELTA TEAM CARE(800) 336-0123

A L GILBERT COMPANYAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(209) 939-3403

DELTA HEALTH SYSTEMS1234 W OAK STSTOCKTON CA 95201

American Administrative Group Inc.(800) 221-4582

CHECK BENEFIT CARDA1 COPELAND INVESTMENTSAffiliated With: AMERICAN ADMINISTRATIVE GROUP

Fund No:PlanType: Group Health

American Administrative Group Inc.(800) 221-4582

American Administrative Group Inc.PO Box 93670LUBBOCK TX 79493-3670

CHECK BENEFIT CARD CHECK BENEFIT CARDABACUS PROJECT MANAGEMENT INC

Affiliated With: ADVANCED BENEFIT SOLUTIONS LLC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

EBMC(614) 766-5800

CHECK BENEFIT CARDABETIC CORPORATIONAffiliated With: EMPLOYEE BENEFIT MANAGEMENT CORP

Fund No:PlanType: Group Health

EBMC(614) 766-5800

EBMC4789 Rings RdDublin OH 43017-1599

GROUP INSURANCE SERVICE CENTER(800) 242-4472

GISC TOTALCARE(866) 598-3973

ABFB CORPORATION DBA THE WHITE MARKET

Affiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

GROUP INSURANCE SERVICE CENTER(800) 242-4472

GROUP INSURANCE SERVICE CENTER20 WINTER STPEMBROKE MA 02359

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-2• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 3: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDABRAHAM BALDWIN AGRICULTURAL COLLEGE AIH0057867

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDABRAHAM BALDWIN AGRICULTURAL COLLEGE AIH0057877

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEABRAHAM BALDWIN AGRICULTURAL COLLEGE UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

ASSURECARE(800) 968-6616

CARELINE(763) 383-4800

ABTREX INDUSTRIESAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-3• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 4: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDACADEMY OF ART COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

NHBC(888) 621-7900

CHECK BENEFIT CARDACCESS ADMINISTRATORS , INCAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

DELTA HEALTH SYSTEMS(800) 807-0820

DELTA TEAM CARE(800) 356-2395

ACCESS NURSES INCAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(800) 807-0820

DELTA HEALTH SYSTEMSPO Box 80Stockton CA 95201

Accident Fund Insurance Company of America(517) 367-1771

Accident Fund Insurance Company of America(517) 367-1771

Accident Fund Insurance Company of America

Affiliated With: ACCIDENT FUND OF AMERICA

Fund No:PlanType: Workers' Compensation

Accident Fund Insurance Company of America(517) 367-1771

Accident Fund Insurance Company of America232 S Capitol AveLansing MI 48901-7990

American Administrative Group(800) 877-7474

First Health(800) 346-3220

ACCO ManagementAffiliated With: American Administrative Group

Fund No:PlanType: Group Health

American Administrative Group(800) 877-7474

American Administrative GroupPO Box 93670LUBBOCK TX 79493-3670

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-4• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 5: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

P5 E HEALTH SERVICES, INC.(800) 397-3685

P5 PROVIDER REVIEW(200) 633-1988

ACCOR NORTH AMERICA, INC.Affiliated With: P5 E HEALTH SVCS, INC. (MOTEL 6 & RED ROOF INNS)

Fund No:PlanType: Group Health

P5 E HEALTH SERVICES, INC.(800) 397-3685

P5 E HEALTH SERVICES, INC.2455 E. Parleys Way #300Salt Lake City UT 84109

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

ACE DISPOSAL COMPANYAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDACE INTERNATIONAL UNIVERSITY OF NORTH TEXAS

Affiliated With: ACADEMIC RISK MANAGEMENT

Term Effective: 8/31/2007Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDACKERMAN MCQUEENAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

GLOBALCARE, INC. GLOBALCARE, INC.ACMGAffiliated With: GLOBALCARE, INC.

Fund No:PlanType: Group Health

GLOBALCARE, INC. GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-5• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 6: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURECARE(800) 422-2026

ASSURECARE(763) 383-4800

ACROM PUBLISHINGAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

CHECK BENEFIT CARD CHECK BENEFIT CARDACS BENEFIT SERVICES INCAffiliated With: NATIONAL HEALTH BENEFITS COUNCIL

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD8002779476

CHECK BENEFIT CARDACTARISAffiliated With: CORPORATE BENEFITS SERVICE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8002779476

CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDActerna Corp Administrators, Inc.Affiliated With: Gallagher Benefit Administrators, Inc.

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

FCE BENEFIT ADMINISTRATORS(800) 899-9355

CHECK BENEFIT CARDADA S MCKINLEYAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-6• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 7: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURECARE(800) 968-6616

CARELINE(763) 383-4800

ADAMS-REMCOAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823

FMH BENEFIT SERVICES INC(800) 990-9058

HCM(800) 990-9058

ADKNOWLEDGE, INCAffiliated With: FMH BENEFIT SERVICES, A DIVISION OF CORESOURCE

Fund No:PlanType: Group Health

FMH BENEFIT SERVICES INC(800) 990-9058

FMH BENEFIT SERVICES INCPO Box 25946OVERLAND PARK KS 66225-5946

MARSH ADVANTAGE AMERICA(800) 426-9786

CHECK BENEFIT CARDADVANCE AMERICA CASH ADVANCE

Affiliated With: MARSH ADVANTAGE AMERICA

Term Effective: 9/30/2007Fund No:PlanType: Group Health

MARSH ADVANTAGE AMERICA(800) 949-5945

MARSH ADVANTAGE AMERICAONE W. THIRD ST #900TULSA OK 74103

EBPA(800) 525-8788

CHECK BENEFIT CARDADVANCE MANUFACTURING COMPANY WRAP JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDADVANCED FINANCIAL TECHNOLOGY

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-7• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 8: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDADVANCED SYSTEMS TECHNOLOGY

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

ADVANSTAFFAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

ADVANSTAFF TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

CONTACT EMPLOYER CONTACT EMPLOYERAdvantageAffiliated With: ADVANTAGE

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(800) 293-3131

CONTACT EMPLOYER

Attn:

CHECK BENEFIT CARD CHECK BENEFIT CARDAdvantage Consulting ServicesAffiliated With: ADVANTAGE CONSULTING SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-8• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 9: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH PLAN INC(508) 752-2480

CARE MANAGEMENT SERVICES(866) 325-1550

ADVANTAGE GASES AND TOOLSAffiliated With: HEALTH PLANS, INC.

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INCPO Box 5199WESTBOROUGH MA 01581

ADVENTIST HEALTH SYSTEM WEST

CHECK BENEFIT CARDADVENTIST HEALTH SYSTEM / WEST-CORPORATE OFFICE

Affiliated With: ADVENTIST HEALTH SYSTEM/WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM WEST

ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002

Advocate Case Management(405) 601-2498

CHECK BENEFIT CARDAdvocate Case ManagementAffiliated With: CompIQ

Fund No:PlanType: Workers' Compensation

Advocate Case Management(405) 601-2498

Advocate Case Management809 S Agnew Ste HOklahoma City OK 73108

PARAGON BENEFITS, INC.(703) 279-9218

AMERICAN HEALTH HOLDINGS(703) 279-9218

AEROTRON AIRPOWERAffiliated With: PARAGON BENEFITS INC

Fund No:PlanType: Group Health

PARAGON BENEFITS, INC.(703) 279-9218

PARAGON BENEFITS, INC.PO Box 12288COLUMBUS GA 31917

AFFILIATED HEALTHCARE INC

CHECK BENEFIT CARDAFFILIATED HEALTH CARE INC - DIRECT PEPM BUSINESS

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-9• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 10: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AFFILIATED HEALTHCARE INC

CHECK BENEFIT CARDAFFILIATED HEALTHCARE INC - TRAVEL PEPM BUSINESS

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

AFS Insurance Services, Inc(801) 978-8337

Western Grocers Employee Benefit Trust(801) 978-8337

AFS Insurance Services, Inc.Affiliated With: AFS Insurance Services, Inc.

Fund No:PlanType: Group Health

AFS Insurance Services, Inc(801) 978-8337

AFS Insurance Services, IncPO Box 10895Scottsdale AZ 85271-0895

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

AG SUPPLYAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

CHECK BENEFIT CARD8004427247

CHECK BENEFIT CARDAGIA INCAffiliated With: HEALTHCOMP ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8004427247

CHECK BENEFIT CARD

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)(714) 668-8920

HINES & ASSOCIATES(800) 528-2498

AGRI-CEL INCAffiliated With: EMPLOYEE BENEFITS ADMINISTRATION & MANAGEMENT

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)(714) 668-8920

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)PO Box 5079WESTLAKE VILLAGE CA 91359

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-10• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 11: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDAGUA CALIENTE BAND OF CAHUILLA INDIANS

Affiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI - BUNKIE GENERAL HOSPITALAffiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY STE 502HOUSTON TX 77046

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC(713) 914-3400

AHI - CHEM AIR INCAffiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI - CITY OF OPELOUSASAffiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY STE 502HOUSTON TX 77046

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI - DEEP SOUTHAffiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY STE 502HOUSTON TX 77046

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-11• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 12: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI - GRAY AND COMPANY, INCAffiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AFFILIATED HEALTHCARE INC

CHECK BENEFIT CARDAHI - LOST HIGHWAYAffiliated With: AFFILIATED HEALTH CARE, INC.

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI - ST MARTIN PARISH SCHOOL BOARD

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY STE 502HOUSTON TX 77046

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI - TEMBEC USAAffiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY STE 502HOUSTON TX 77046

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI ABBEVILLE GENERAL HOSPITAL

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77042

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-12• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 13: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD AFFILIATED HEALTHCARE INC

AHI ADAMS DIST CO INCAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI AIR EVAC EMSAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI AMERICAN INSURANCE CO OF TEXAS

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI ARIZONA TRAILS INCAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI ARKANSAS DENTAL ASSOCIATION

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-13• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 14: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI ASBESTOS WORKERS LOCAL NO 53 WELFARE FUND

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI BEAUREGARD MEMORIAL HOSPITAL

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AFFILIATED HEALTHCARE INC7139143400

AFFILIATED HEALTHCARE INC7139143400

AHI BOBCAT INCAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC7139143400

AFFILIATED HEALTHCARE INC11200 WESTHEIMERHOUSTON TX 77042

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI CALCASIEU PARISH POLICE JURY AND THE PORT OF ST CHARLES

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI CALVERT OIL COAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-14• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 15: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI CAMERON PARISH POLICE JURY

Affiliated With: AFFILIATED HEALTHCARE, INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY STE 502HOUSTON TX 77046

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI CASE ASSOCIATESAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI CHAMBERS LIBERTY COUNTIES NAVIGATION

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI CHUGACH DEVELOPMENTAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI CITY OF MONROEAffiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-15• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 16: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI CITY OF RUSTONAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI CITY OF WEST MONROEAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI CLETEX TRUCKINGAffiliated With: AFFILIATED HEALTHCARE, INC.

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI COACH USAAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI COLUMBIA LIGHTHOUSE FOR THE BLIND

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-16• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 17: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI COMBINED UNDERWRITERSAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI CRISTI CLEANING SERVICES LIMITED

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI DATSAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI DUSTPRO INCAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI ENERGY DYNAMICS INDUSTRIES INC

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-17• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 18: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI FCE BENEFIT ADMINISTRATORS

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI FEDERAL HOME PRODUCTSAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI FLINT OIL CO INCAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI FRANK W MURPHY MANUFACTURE

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI FREEDOM LIFE INSURANCE COMPANY

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-18• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 19: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI GREENS PRESSURE TESTINGAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI GROWERS OIL COAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI GULF COAST ENTERPRISESAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI GULF COAST ENTERPRISES MAJOR

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI HARRIS GALVESTON COASTAL SUBSIDENCE DIST

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-19• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 20: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI HITNEY SOLAR PRODUCTSAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI INDUSTRIAL INSULATION GROUP

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI INDUSTRIAL SPECIALTY CONTRACTORS

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI INTERMOUNTAIN REFININGAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI JOHN H CARTER CO INCAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-20• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 21: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI JUDD AUTO SERVICEAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AFFILIATED HEALTHCARE INC(800) 722-3372

CHECK BENEFIT CARDAHI K TEK LLCAffiliated With: AFFILIATED HEALTHCARE

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(800) 722-3372

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI LAMB SERVICESAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI LIFE OF AMERICAAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI LIFESHARE BLOOD CENTERAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-21• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 22: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC(713) 914-3400

AHI LIVINGSTON PARISH SHERIFF'S OFFICE

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI M A PATOUT & SON LTDAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI MATLOCK GAS AND EQUIPMENT CO

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI MCDONALD'S B. R. MANAGEMENT CO.

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77042

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI MCNEECE BROS OILAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-22• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 23: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AFFILIATED HEALTHCARE INC

CHECK BENEFIT CARDAHI METRO AVIATIONAffiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI MISC KILLMERAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI MMR GROUPAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI NATCHITOCHES REGIONAL MEDICAL CENTER

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY STE 502HOUSTON TX 77046

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI NATIONAL FOUNDATION LIFE INSURANCE COMPA

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-23• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 24: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI NEIL CORPORATIONAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI OUTDOOR CAP COMPANY INC

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI PARKER OIL COAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI PORT TERMINAL RAILROAD ASSOC EBPT

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI RACELAND RAW SUGAR CORP

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-24• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 25: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI REPUBLIC AMERICAN LIFE INSURANCE CO

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI SCHMELZIA OIL COMPANYAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI SECURIGUARDAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI SERVICE SOURCEAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI SHANNON HARDWARE COMPANY

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77042

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-25• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 26: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI SHAY OIL COAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI SHEARMAN COMPANY, LLCAffiliated With: AFFILIATED HEALTHCARE, INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY STE 502HOUSTON TX 77046

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI SIA MANAGEMENTAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC(713) 914-3400

AHI ST JAMES PARISH SCHOOL BOARD

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI STAR SERVICESAffiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77046

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-26• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 27: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI STEIN LLCAffiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY STE 502HOUSTON TX 77046

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI STERLING SUGARS INCAffiliated With: AFFILIATE HEALTHCARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

LIFEWISE HEALTH PLAN OF OREGON2 GREENWAY STE 502HOUSTON TX 77046

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI STULLER INCAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI SUN WEST CONTAINER COAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI SUNBELT INDUSTRIESAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-27• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 28: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI THE NEUROMEDICAL CENTER INC

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY STE 502HOUSTON TX 77046

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI TRIPLEX INCAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI VERNON PARISH POLICE JURY

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY PLAZA STE 502HOUSTON TX 77042

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI VOCATIONAL GUIDANCE SERVICES

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI VOCATIONAL TRAININGAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-28• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 29: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI WEST CALCASIEU CAMERON HOSPITAL

Affiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDAHI WILL STAFF WORLDWIDE INCAffiliated With: AFFILIATED HEALTHCARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AFFILIATED HEALTHCARE INC

CHECK BENEFIT CARDAHI-ABELL CORPORATIONAffiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC

AFFILIATED HEALTHCARE INC2 GREENWAY STE 502HOUSTON TX 77046

AFFILIATED HEALTHCARE INC(713) 914-3400

CHECK BENEFIT CARDAHI-AMITE FOUNDRY & MACHINE INC

Affiliated With: AFFILIATED HEALTH CARE INC

Fund No:PlanType: Group Health

AFFILIATED HEALTHCARE INC(713) 914-3400

AFFILIATED HEALTHCARE INC2 GREENWAY STE 502HOUSTON TX 77046

CONTACT EMPLOYER CONTACT EMPLOYERAIG Claim Services IncAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-29• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 30: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERAIG Claims ServicesAffiliated With: AIG Claims Services

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERAir Force TheAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

QUALIFIED BENEFIT SERVICES LLC(800) 853-3234

UM NOT APPLICABLEAIR TERMINAL INCAffiliated With: QUALIFIED BENEFIT SERVICES

Fund No:PlanType: Group Health

QUALIFIED BENEFIT SERVICES LLC(800) 853-3234

QUALIFIED BENEFIT SERVICES LLCPO Box 5000SPRINGVILLE UT 84663

CONTACT EMPLOYER CONTACT EMPLOYERAirforce Insurance FundAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

HINES AND ASSOCIATES(800) 866-0105

AKIMEKA, LLCAffiliated With: PREFERRED BENEFIT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INCPO Box 916188LONGWOOD FL 32791-6188

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-30• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 31: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MEDICAL CLAIMS SERVICES8882250522

INTRACORP(972) 302-2700

AL TYLER & SONS, INC.Affiliated With: MEDICAL CLAIMS SERVICE, INC.

Fund No:PlanType: Group Health

MEDICAL CLAIMS SERVICES(800) 557-1755

MEDICAL CLAIMS SERVICESONE WALL ST STE 2ARAVENSWOOD WV 26164

HEALTHCOMP(800) 442-7247

HEALTHCOMP(800) 755-7247

ALAMEDA HOSPITALAffiliated With: HEALTHCOMP TPA

Fund No:PlanType: Group Health

HEALTHCOMP(800) 442-7247

HEALTHCOMPPO Box 45018Fresno CA 93718

GROUP & PENSION ADMINISTRATORS(800) 827-7223

CHECK BENEFIT CARDAlamo Cement (TRAVEL)Affiliated With: GROUP & PENSION ADMINISTRATORS

*

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.

ALAMO NAVAJO SCHOOL BOARDAffiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.PO Box 25160SCOTTSDALE AZ 85255-0102

CONTACT EMPLOYER CONTACT EMPLOYERAlbanyAffiliated With: New York State Insurance Fund

*

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-31• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 32: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ALBANY (STRATTON) VA MEDICAL CENTER

CHECK BENEFIT CARDALBANY (STRATTON) VA MEDICAL CENTER 3520

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

ALBANY (STRATTON) VA MEDICAL CENTER

ALBANY (STRATTON) VA MEDICAL CENTER

113 HOLLAND AVEALBANY NY 12208

Attn: FEE BASIS 136E

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDALBANY STATE UNIV AIH0057887Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDALBANY STATE UNIV AIH0058897Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEALBANY STATE UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

ALBUQUERQUE VAMC CHECK BENEFIT CARDALBUQUERQUE VAMC 3170Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

ALBUQUERQUE VAMC ALBUQUERQUE VAMC

1501 SAN PEDRO SEALBUQUERQUE NM 87108

Attn: FMS-04

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-32• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 33: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

RBMS, LLC(907) 561-3740

MRC(509) 328-9700

ALEUT CORPORATIONAffiliated With: RISK AND BENEFIT MANAGEMENT SERVICES, LLC

Fund No:PlanType: Group Health

RBMS, LLC(907) 561-3740

RBMS, LLC510 L STREET, STE 650ANCHORAGE AK 99501

TRUSTEED PLANS SERVICE GROUP(800) 345-8563

QUALIS(800) 783-8606

ALEUTIAN SPRAY FISHERIESAffiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE GROUP(800) 426-9786

TRUSTEED PLANS SERVICE GROUPPO Box 1894TACOMA WA 98406-1705

CHECK BENEFIT CARD CHECK BENEFIT CARDALEXANDRIA MOULDING INCAffiliated With: MERCER ADMINISTRATION

Term Effective: 8/31/2007Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

ALEXANDRIA VAMC CHECK BENEFIT CARDALEXANDRIA VAMC 3102Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

ALEXANDRIA VAMC ALEXANDRIA VAMC

SHREVEPORT HWYALEXANDRIA LA 71306

Attn: FEE BASIS - BLDG 5, Rm 225

EBPA(802) 846-8060

CHECK BENEFIT CARDALICE PECK DAY HEALTH SYSTEMS JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-33• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 34: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDALICO INCAffiliated With: SELF INSURED PLANS LLC

Fund No:PlanType: Auto

CHECK BENEFIT CARD CHECK BENEFIT CARD

KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711

QUANTUM CARE(866) 412-8252

ALL AMERICAN BOTTLING COAffiliated With: THE KEMPTON GROUP INC

Fund No:PlanType: Group Health

KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711

KEMPTON GROUP ADMINISTRATORS INCPO Box 54889OKLAHOMA CITY OK 73154

ULTRABENEFITS INC(866) 858-7223

CHECK BENEFIT CARDALL STAR GASAffiliated With: ULTRABENEFITS, INC.

*

Term Effective: 8/31/2007Fund No:PlanType: Group Health

ULTRABENEFITS INC(508) 438-0007

ULTRABENEFITS INCPO Box 763WESTBOROUGH MA 01581

GROUP & PENSION ADMINISTRATORS(800) 827-7223

HEALTH WATCH(972) 238-7900

ALL TECH INSPECTIONS, INC. TRAVEL

Affiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

GROUP & PENSION ADMINISTRATORS INC(800) 827-7223

HEALTH WATCH(972) 238-7900

ALLEN SAMUELS AUTO GROUPAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS INC(972) 238-7900

GROUP & PENSION ADMINISTRATORS INC12770 MERIT DR STE 200DALLAS TX 75251

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-34• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 35: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADVANTAGE(800) 825-3540

ALLENS, INCAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORS3121 QUAIL SPRINGS PKWYOKLAHOMA CITY OK 73134

ALLIED NATIONAL(800) 825-7531

CHECK BENEFIT CARDALLIED NATIONAL INCAffiliated With: ALLIED NATIONAL INC

Fund No:PlanType: Group Health

GLOBALCARE, INC.(800) 825-7531

GLOBALCARE, INC.6875 SHILOH RD EALPHARETTA GA 30005

BENEFIT CONCEPTS, INC.(610) 491-4992

BENEFIT CONCEPTS, INC.(215) 773-2023

ALLSTATE POWER VACAffiliated With: BENEFIT CONCEPTS INC

Fund No:PlanType: Group Health

BENEFIT CONCEPTS, INC.(610) 491-4992

BENEFIT CONCEPTS, INC.1021 W 8TH AVEKING OF PRUSSIA PA 19406

Alpha Review Corporation(630) 305-8108

Alpha Review Corporation(630) 305-8108

Alpha Review CorporationAffiliated With: Alpha Review Corporation

Fund No:PlanType: Workers' Compensation

Alpha Review Corporation(630) 305-8108

Alpha Review Corporation1807 Diehl RdNaperville IL 60563

Alpha Review Corporation(630) 305-8108

Alpha Review Corporation(630) 305-8108

Alpha Review Corporation AutoAffiliated With: Alpha Review Corporation

Fund No:PlanType: Auto

Alpha Review Corporation(630) 305-8108

Alpha Review Corporation1807 Diehl RdNaperville IL 60563

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-35• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 36: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

REGIONAL CARE INC(308) 635-2260

HINES ASSOCIATES(308) 635-2260

ALPINE RESOURCES GROUP INCAffiliated With: REGIONAL CARE INC 19254

Fund No:PlanType: Group Health

REGIONAL CARE INC(308) 635-2260

REGIONAL CARE INC905 W 27th StScottsbluff NE 69361

AMERIBEN SOLUTIONS(800) 953-1801

CHECK BENEFIT CARDALSCOAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 953-1801

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

CHECK BENEFIT CARD CHECK BENEFIT CARDALTA BATES SUMMIT MEDICAL CENTER

Affiliated With: BENEFIT AND RISK MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

BENEFIT ADMINISTRATIVE SYSTEMS(708) 647-3433

CHECK BENEFIT CARDALTOM TRANSPORT INCAffiliated With: BENEFIT ADMINISTRATIVE SYSTEMS #10329

Fund No:PlanType: Group Health

BENEFIT ADMINISTRATIVE SYSTEMS(708) 647-3433

BENEFIT ADMINISTRATIVE SYSTEMS17475 Jovanna Dr. STE 1BHOMEWOOD IL 60430

ALTOONA VAMC CHECK BENEFIT CARDALTOONA VAMC 3122Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

ALTOONA VAMC ALTOONA VAMC

2907 PLEASANT VALLEY BLVDALTOONA PA 16602

Attn: FEE BASIS (14F)

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-36• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 37: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EMPLOYEE BENEFIT CONSULTANTS(800) 523-5789

CHECK BENEFIT CARDALTO-SHAAM INCAffiliated With: HEALTH DATA SERVICES

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT CONSULTANTS(800) 523-5789

EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839

RBMS, LLC(907) 561-3740

MEDICAL REHABILITATION CONSULTANTS(800) 827-5058

Alutiiq, LLCAffiliated With: RBMS LLC

Fund No:PlanType: Group Health

RBMS, LLC(907) 561-3740

RBMS, LLC510 L STREET, STE 650ANCHORAGE AK 99501

CHECK BENEFIT CARD CHECK BENEFIT CARDALVERNO CLINICAL LABORATORIES, INC.

Affiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDALVERNO INFORMATION SERVICES

Affiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

Amalgamated Life Insurance Co. - Clothing Fund(212) 539-5105

Amalgamated Life Insurance Co. - Clothing Fund(800) 332-5426

Amalgamated Clothing FundAffiliated With: Amalgamated Life Insurance Co.

Fund No:PlanType: Group Health

Amalgamated Life Insurance Co. - Clothing Fund(212) 539-5105

For electronic claims submission ID, refer to Benefit Card. Mail all other claims to: Amalgamated Life Insurance Co - Clothing FundPO Box 1449New York NY 10116-1449ECS Payor ID 13550

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-37• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 38: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Amalgamated Life Insurance Co. - Cotton Fund(212) 539-5100

Amalgamated Life Insurance Co. - Cotton Fund(800) 332-5426

Amalgamated Cotton FundAffiliated With: Amalgamated Life Insurance Co.

Fund No:PlanType: Group Health

Amalgamated Life Insurance Co. - Cotton Fund(212) 539-5100

For electronic claims submission ID, refer to Benefit Card. Mail all other claims to: Amalgamated Life Insurance Co - Clothing FundPO Box 1451New York NY 10116-1451ECS Payor ID 13550

ALICO(212) 539-5112

ALICO(800) 332-5426

Amalgamated Industrial Service Workers Benefit Fund

Affiliated With: Amalgamated Life Insurance Co.

Fund No:PlanType: Group Health

ALICO(212) 539-5112

For electronic claims submission ID, refer to Benefit Card. Mail all other claims to: ALICOPO Box 1432New York NY 10003ECS Payor ID 13550

Amalgamated Life Insurance Co.(800) 543-4723

Amalgamated Life Insurance Co. - Retail Fund(800) 332-5426

Amalgamated Retail FundAffiliated With: Amalgamated Life Insurance Co.

Fund No:PlanType: Group Health

Amalgamated Life Insurance Co.(800) 543-4723

Amalgamated Life Insurance Co.730 BroadwayNew York NY 10003ECS Payor ID 13550

CHECK BENEFIT CARD ADVANCED BENEFITS SOLUTIONS

AMALGAMATED RETIREE HEALTH AND WELFARE TRUST

Affiliated With: ADVANCED BENEFIT SOLUTIONS LLC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AMARILLO VAMC CHECK BENEFIT CARDAMARILLO VAMC 3171Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

AMARILLO VAMC AMARILLO VAMC

6010 AMARILLO BLVD WESTAMARILLO TX 79106

Attn: FEE 136

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-38• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 39: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

AMBECAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

ADVENTIST HEALTH SYSTEMS/WEST(800) 441-2524

UM NOT APPLICABLEAMC PPO FOR TCGH-BASED EMPLOYEES

Affiliated With: ADVENTIST HEALTH SYSTEMS / WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEMS/WEST(800) 441-2524

ADVENTIST HEALTH SYSTEMS/WEST2100 DOUGLASROSEVILLE CA 95661

CONTACT EMPLOYER CONTACT EMPLOYERAmerica First Auto COAffiliated With: RAM

Fund No:PlanType: Auto

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERAmerica First WCAffiliated With: RAM

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

American Administrative Group Inc.(800) 877-7474

First Health(800) 346-3220

American Administrative Group (AAG)

Affiliated With: American Administrative Group

Fund No:PlanType: Group Health

- Network participation is contingent upon proper member identification. The First Health® Network Logo must be on the benefit card.

American Administrative Group Inc.(800) 877-7474

American Administrative Group Inc.PO Box 34297San Antonio TX 78265ECS Payor ID 37283

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-39• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 40: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERAmerican Alternative Insurance Company

Affiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

AMERICAN ASPHALT & GRADING COMPANY

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

AMERICAN ASPHALT & GRADING COMPANY TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CHECK BENEFIT CARD CHECK BENEFIT CARDAMERICAN COMMUNITY - JMSAffiliated With: AMERICAN COMMUNITY

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AMERICAN COMMUNITY MUTUAL INSURANCE(734) 591-4695

CHECK BENEFIT CARDAMERICAN COMMUNITY MUTUAL INSURANCE COMPANY

Affiliated With: AMERICAN COMMUNITY MUTUAL INSURANCE COMPANY

Fund No:PlanType: Group Health

AMERICAN COMMUNITY MUTUAL INSURANCE(734) 591-4695

AMERICAN COMMUNITY MUTUAL INSURANCE39201 Seven Mile RdLivonia MI 48152

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-40• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 41: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDAMERICAN EDUCATION CENTERSAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

EMPLOYEE BENEFIT MANAGEMENT SERVICES, INC.8007773575

CHECK BENEFIT CARDAMERICAN EMPLOYERS BENEFIT TRUST

Affiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES, INC.

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT MANAGEMENT SERVICES, INC.8007773575

EMPLOYEE BENEFIT MANAGEMENT SERVICES, INC.PO Box 21367BILLINGS MT 59104-1367

CHECK BENEFIT CARD CHECK BENEFIT CARDAMERICAN EMPLOYMENT GROUPAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

C.L. FRATES AND COMPANY(405) 290-5696

CHECK BENEFIT CARDAMERICAN FARMERS AND RANCHERS MUTUAL INSURANCE COMPANY

Affiliated With: C L FRATES & COMPANY

Fund No:PlanType: Group Health

C.L. FRATES AND COMPANY(405) 290-5696

C.L. FRATES AND COMPANYPO Box 26967OKLAHOMA CITY OK 73126-0967

HEALTHSCOPE BENEFITS INC(866) 885-4944

HEALTHSCOPE BENEFITS INC(501) 218-7691

AMERICAN GREETINGSAffiliated With: HEALTHSCOPE BENEFITS, INC

Fund No:PlanType: Group Health

HEALTHSCOPE BENEFITS INC(800) 560-4664

HEALTHSCOPE BENEFITS INC27 CORPORATE HILL DRLITTLE ROCK AR 72205

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-41• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 42: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

WAUSAU BENEFITS, INC.(715) 841-7802

CHECK BENEFIT CARDAMERICAN HEALTH CENTERS AFFILIATED COMPANIES

Affiliated With: WAUSAU BENEFITS INC

Fund No:PlanType: Group Health

(800) 826-9781 WAUSAU BENEFITS, INC.

PO Box 8046WAUSAU WI 54401-8046

Attn: LeAnn Fichtner

AMERICAN HEALTHCARE ALLIANCE(800) 870-6252

CHECK BENEFIT CARDAMERICAN HEALTHCARE ALLIANCE

Affiliated With: AMERICAN HEALTHCARE ALLIANCE

Fund No:PlanType: Group Health

AMERICAN HEALTHCARE ALLIANCE(800) 870-6252

AMERICAN HEALTHCARE ALLIANCEPO Box 8530KANSAS CITY MO 64114-0530

AMERICAN HEALTHCARE ALLIANCE(800) 870-6252

CHECK BENEFIT CARDAMERICAN HEALTHCARE ALLIANCE - OUT OF AREA

Affiliated With: AMERICAN HEALTHCARE ALLIANCE 13780

Fund No:PlanType: Group Health

AMERICAN HEALTHCARE ALLIANCE(800) 870-6252

AMERICAN HEALTHCARE ALLIANCEPO Box 8530KANSAS CITY MO 64114-0530

AMO MEDICAL PLAN CHECK BENEFIT CARDAMERICAN MARITIME OFFICERSAffiliated With: AMERICAN HEALTHCARE ALLIANCE

Fund No:PlanType: Group Health

AMO MEDICAL PLAN AMO MEDICAL PLANPO Box 35Dania FL 33004

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-42• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 43: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAMERICAN MISSIONARY FELLOWSHIP

Affiliated With: BROKERAGE CONCEPTS BENEFIT CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

ADVANCED BENEFITS SOLUTIONS, INC.8884191094

ARIZONA FOUNDATION FOR MEDICAL CARE(602) 417-2337

AMERICAN REFRIGERATION SUPPLIES INC

Affiliated With: ADVANCED BENEFIT SOLUTIONS

Fund No:PlanType: Group Health

ADVANCED BENEFITS SOLUTIONS, INC.8884191094

ADVANCED BENEFITS SOLUTIONS, INC.PO Box 71490PHOENIX AZ 85050

AMERICAN REPUBLIC INSURANCE COMPANY(800) 247-2190

CHECK BENEFIT CARDAMERICAN REPUBLIC INDIVIDUALS

Affiliated With: AMERICAN REPUBLIC INSURANCE COMPANY

Fund No:PlanType: Group Health

AMERICAN REPUBLIC INSURANCE COMPANY(800) 247-2190

AMERICAN REPUBLIC INSURANCE COMPANYPO Box 2975CLINTON IA 52733

CHECK BENEFIT CARD CHECK BENEFIT CARDAmerican Republic Insurance Company

Affiliated With: American Republic Insurance Company

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-43• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 44: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDAMERICAN SEAFOODS COMPANYAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PREFERRED CARE, INC.(800) 222-3085

CHECK BENEFIT CARDAMERICAN SENTINEL SPORTS & ATHLETIC SERIES 600

Affiliated With: PREFERRED CARE, INC.

Fund No:PlanType: Group Health

PREFERRED CARE, INC.(800) 222-3085

PREFERRED CARE, INC.6 Neshaminy Interplex #205TREVOSE PA 19053

PREFERRED CARE, INC.(800) 222-3085

CHECK BENEFIT CARDAMERICAN SENTINEL SPORTS & ATHLETIC SERIES 800

Affiliated With: PREFERRED CARE, INC.

Fund No:PlanType: Group Health

PREFERRED CARE, INC.(800) 222-3085

SAMBA6 Neshaminy Interplex #205TREVOSE PA 19053

FISERV HEALTH TENNESSEE(800) 255-8109

INTRACORP(800) 866-8899

AMERICAN SERVICES TECHNOLOGY

Affiliated With: CAROLINA BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

FISERV HEALTH TENNESSEE(800) 255-8109

FISERV HEALTH TENNESSEEPO Box 530PUEBLO CO 81002-0530

JSL ADMINISTRATORS, INC.(910) 480-3100

DOCTORS DIRECT HEALTHCARE(910) 485-0510

AMERICAN TRUETSCHLERAffiliated With: JSL ADMINISTRATORS INC

Fund No:PlanType: Group Health

JSL ADMINISTRATORS, INC.(910) 480-3100

JSL ADMINISTRATORS, INC.201 HAY STREET, STE 302FAYETTEVILLE NC 28301

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-44• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 45: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

JSL ADMINISTRATORS, INC.(910) 480-3100

MEDCOST(800) 443-9178

AMERICAN TRUETZSCHLERAffiliated With: JSL ADMINISTRATORS INC

Fund No:PlanType: Group Health

JSL ADMINISTRATORS, INC.(910) 480-3100

JSL ADMINISTRATORS, INC.201 HAY STREET, STE 302FAYETTEVILLE NC 28301

CHECK BENEFIT CARD CHECK BENEFIT CARDAMERICAN TRUST ADMINISTRATORS

Affiliated With: AMERICAN TRUST ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

AMERICAN WEST DEVELOPMENTAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Benesight(800) 464-5488

CHECK BENEFIT CARDAmerican Youth HostelsAffiliated With: Benesight

Fund No:PlanType: Group Health

Benesight(407) 661-4242

BenesightPO Box 360Pueblo CO 81002-0360

WAUSAU BENEFITS, INC.(715) 841-7802

CHECK BENEFIT CARDAMERIMAX FABRICATED PRODUCTS

Affiliated With: WAUSAU BENEFITS INC

Fund No:PlanType: Group Health

WAUSAU BENEFITS, INC.(715) 841-7802

WAUSAU BENEFITS, INC.

PO Box 8046WAUSAU WI 54401-8046

Attn: LeAnn Fichtner

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-45• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 46: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EQUITABLE PLAN SERVICES(405) 755-2929

CHECK BENEFIT CARDAMERIRESOURCE GROUPAffiliated With: EQUITABLE PLAN SERVICES

Fund No:PlanType: Group Health

EQUITABLE PLAN SERVICES(405) 755-2929

EQUITABLE PLAN SERVICESPO Box 720460OKLAHOMA CITY OK 73172

CONTACT EMPLOYER CONTACT EMPLOYERAMERISUREAffiliated With: SOLUTIONS4

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

Solutions4(888) 350-1150 Ext 228

Solutions4701 TECHNOLOGY DR STE 201CANONSBURG PA 15317

CONTACT EMPLOYER CONTACT EMPLOYERAMFAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

BUSINESS ADMINISTRATORS & CONSULTANTS INC(614) 863-8780

BAC(801) 954-8010

AMG INCAffiliated With: BUSINESS ADMINISTRATORS AND CONSULTANTS

Fund No:PlanType: Group Health

BUSINESS ADMINISTRATORS & CONSULTANTS INC(614) 863-8780

BUSINESS ADMINISTRATORS & CONSULTANTS INC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068

T R PAUL INC.7139143400

HINES & ASSOCIATES(727) 530-3444

AMGRAPH PACKAGINGAffiliated With: TR PAUL GROUP SERVICES INC

Fund No:PlanType: Group Health

T R PAUL INC.(800) 678-8161

T R PAUL INC.PO Box 5508NEWTOWN CT 06470

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-46• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 47: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PIONEER MANAGEMENT SYSTEMS(877) 868-9060

CHECK BENEFIT CARDAMHERST COLLEGEAffiliated With: PIONEER MANAGEMENT SYSTEMS

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(877) 868-9060

PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01090

HEALTH PLAN INC(508) 752-2480

CMS(866) 325-1550

AMOSKEAG BEVERAGES, INCAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

FairPay Solutions(972) 715-8000

FairPay Solutions(972) 715-8000

AmTrustAffiliated With: FairPay Solutions

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

FairPay Solutions(972) 715-8000

FairPay Solutions

14295 Midway Rd Ste 300Addison TX 75001

Attn: Jon Peebles

CHECK BENEFIT CARD CHECK BENEFIT CARDAMX INTERNATIONAL INCAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARDAN DERINGER INC WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-47• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 48: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDANA MARIA COLLEGE SPORTSAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

MERITAIN HEALTH(812) 455-1938

CHECK BENEFIT CARDANCHOR INDUSTRIESAffiliated With: MERITIAN HEALTH

Fund No:PlanType: Group Health

MERITAIN HEALTH(812) 455-1938

MERITAIN HEALTH111 SE THIRD ST STE 404EVANSVILLE IN 47708

STUDENT RESOURCES(800) 237-0903 Ext 6352

CHECK BENEFIT CARDANDOVER NEWTON THEOLOGICAL SCHOOL

Affiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT RESOURCES(800) 237-0903 Ext 6352

STUDENT RESOURCES2301 W. PLANO PKWY #300PLANO TX 75075

TRUE CHOICE(800) 251-9665

UM NOT APPLICABLEANGELO STATE UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 251-9665

TRUE CHOICEPO Box 700307DALLAS TX 75370

ADVANCED BENEFIT SOLUTIONS LLC(888) 419-1094

ARIZONA FOUNDATION FOR MEDICAL CARE(602) 417-2337

ANGELS BASEBALLAffiliated With: ADVANCED BENEFIT SOLUTIONS LLC

Fund No:PlanType: Group Health

ADVANCED BENEFIT SOLUTIONS LLC(888) 419-1094

ADVANCED BENEFIT SOLUTIONS LLCPO Box 71490PHOENIX AZ 85050

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-48• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 49: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ANN ARBOR VA MEDICAL CENTER

CHECK BENEFIT CARDANN ARBOR VA MEDICAL CENTER 3152

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

ANN ARBOR VA MEDICAL CENTER

ANN ARBOR VA MEDICAL CENTER

2215 FULLERANN ARBOR MI 48105

Attn: FEE BASIS CHIEF RESOURCE OFFICER (20)

PIONEER MANAGEMENT SYSTEMS INC8004234586

PIONEER MANAGEMENT SYSTEMS INC8004234586

ANNA MARIA COLLEGEAffiliated With: PIONEER MANAGEMENT SYSTEMS

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS INC8004234586

PIONEER MANAGEMENT SYSTEMS INC330 WHITNEY AVEHOLYOKE MA 01041

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

ANNIE E CASEY FOUNDATION, THE

Affiliated With: NORTH AMERICAN ADMINISTRATORS - NY

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226

BENESIGHT INC(888) 339-7280

VALUECHECK(214) 920-9076

ANRITSU COMPANYAffiliated With: BENESIGHT INC

Fund No:PlanType: Group Health

BENESIGHT INC(888) 339-7280

BENESIGHT INCPO Box 399PUEBLO CO 81002

CHECK BENEFIT CARD CHECK BENEFIT CARDAPACHE CORPORATIONAffiliated With: BENEFIT PLANNERS LTD

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-49• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 50: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TRUSTEED PLANS SERVICE GROUP(800) 426-9786

AMERICAN HEALTH HOLDING(888) 877-7994

APA-THE ENGINEERED WOOD ASSOCIATION

Affiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE GROUP(800) 426-9786

TRUSTEED PLANS SERVICE GROUPPO Box 1894TACOMA WA 98401-1894

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

APCO EQUIPMENTAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

RBMS, LLC(907) 561-3740

MEDICAL REHABILITATION CONSULTANTS(800) 827-5058

APEA AFT HEALTH & WELFARE TRUST

Affiliated With: RBMS, LLC

Fund No:PlanType: Group Health

RBMS, LLC(907) 561-3740

RBMS, LLC510 L STREET, STE 650ANCHORAGE AK 99501

GLOBALCARE, INC.8008601111

MedWatch(800) 432-8421

APPALACHIAN BENEFIT ADMINSTRATORS

Affiliated With: GLOBALCARE, INC.

Fund No:PlanType: Group Health

GLOBALCARE, INC.6783411722

GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005

CHECK BENEFIT CARD CHECK BENEFIT CARDAPPLETON MCGILL ELECTRIC SWITCH

Affiliated With: MCGILL ELECTRIC SWITCH PRODUCT GROUP

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-50• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 51: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Applied Underwriters(402) 827-3424

Applied Underwriters(402) 827-3424

Applied UnderwritersAffiliated With: Applied Underwriters

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(800) 293-3131

Applied UnderwritersPO Box 3804Omaha NE 68103

CHECK BENEFIT CARD8007159414

CHECK BENEFIT CARDAQUANTIVE INCAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8007159414

CHECK BENEFIT CARD

THE LOOMIS COMPANY(800) 782-0392

CHECK BENEFIT CARDARAMARKAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(800) 782-0392

THE LOOMIS COMPANY850 N PARK RDWYOMISSING PA 19610

America's TPA(866) 478-6268

CHECK BENEFIT CARDARAZAffiliated With: AMERICAS TPA

Fund No:PlanType: Group Health

America's TPA(866) 478-6268

America's TPAPO Box 398220Bloomington MN 55439

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)(805) 497-4581

HINES & ASSOCIATES(800) 528-2498

ARC IMPERIAL VALLEYAffiliated With: EMPLOYEE BENEFITS ADMINISTRATION & MGMT (EBA&M)

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)(805) 497-4581

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-51• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 52: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8004269786

CHECK BENEFIT CARDARCA XYTEC SYSTEMS INCAffiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8004269786

CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDARDENT HEALTH SERVICESAffiliated With: HARRINGTON BENEFIT SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SUPERIEN HEALTH NETWORK(800) 266-5896

CHECK BENEFIT CARDARE ASSOCIATES LLCAffiliated With: SUPERIEN HEALTH NETWORK 18373

Fund No:PlanType: Group Health

SUPERIEN HEALTH NETWORK(800) 266-5896

SUPERIEN HEALTH NETWORK

PO Box 2388 CSTOW OH 44224

Attn: Supervisor of the Claims Dept

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDARGOSY UNIVERSITYAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

ADMINISTRATIVE CONCEPTS, INC.(610) 293-9229

CHECK BENEFIT CARDARGOSY UNIVERSITYAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS, INC.(610) 293-9229

ADMINISTRATIVE CONCEPTS, INC.

997 Old Eagle School Rd. #215WAYNE PA 19087-1706

Attn: Customer Service Dept

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-52• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 53: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

ARISTOCRATS TRAVEL PLANAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

GLOBALCARE(678) 341-1811

HINES & ASSOCIATES(800) 670-7718

ARIZONA STRUCTUREAffiliated With: GLOBALCARE, INC.

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005

ECOM PPO ADVISORS, INC(479) 785-6178

CHECK BENEFIT CARDARKANSAS BEST CORPORATIONAffiliated With: ECOM PPO ADVISORS INC

Fund No:PlanType: Group Health

ECOM PPO ADVISORS, INC(479) 785-6178

ECOM PPO ADVISORS, INC

8350 N. CENTRAL EXPWY, STE 600DALLAS TX 75206

Attn: ACCOUNTING

ADMINONE CORPORATION(800) 967-2077

MEDCAREONE CORP(800) 816-1206

ARKANSAS MILL SUPPLY COAffiliated With: ADMINONE CORPORATION

Fund No:PlanType: Group Health

ADMINONE CORPORATION(800) 967-2077

RESOURCEONE ADMINSTRATORS

PO Box 489BUCKEYSTOWN MD 21717

Attn: Mary Shepherd

ARM, LTD.(503) 968-6831

CHECK BENEFIT CARDARM, LTD.Affiliated With: ALTERNATIVE RISK MANAGEMENT LTD NORTHWEST

Fund No:PlanType: Group Health

ARM, LTD.(877) 544-1770

ARM, LTD.10200 S.W. Nimbus Ave. Ste G-5PORTLAND OR 97223

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-53• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 54: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

ARMFIELD HARRISON & THOMASAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDARMSTRONG ATLANTIC STATE UNIVERSITY AIH0057907

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDARMSTRONG ATLANTIC STATE UNIVERSITY AIH0057917

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEARMSTRONG ATLANTIC STATE UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

GLOBALCARE, INC.8008601111

Arnett Health Plans(765) 448-7725

ARNETT HEALTH PLANSAffiliated With: GLOBALCARE, INC.

Fund No:PlanType: Group Health

GLOBALCARE, INC.6783411722

GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-54• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 55: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)(805) 497-4581

HINES & ASSOCIATES(800) 528-2498

ARNOLD MAGNETICSAffiliated With: EMPLOYEE BENEFITS ADMINISTRATION & MGMT (EBA&M)

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)(805) 497-4581

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)PO Box 5079WESTLAKE VILLAGE CA 91359

CHECK BENEFIT CARD CHECK BENEFIT CARDArrowpoint Capital Corp.Affiliated With: Royal Indemnity Company

Fund No:PlanType: Workers' Compensation

CHECK BENEFIT CARD CHECK BENEFIT CARD

Royal & SunAlliance(800) 524-4505

Royal & SunAlliance(800) 524-4505

Arrowpoint Capital Corp. AutoAffiliated With: Royal Indemnity Company

Fund No:PlanType: Auto

RCRC - Royal & SunAlliance(800) 266-8598

RCRC - Royal & SunAlliance1210 Ward Ave Ste 300West Chester PA 19380

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 226-5116

CHECK BENEFIT CARDART CENTER COLLEGE OF DESIGN

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 226-5116

PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376

ADMINISTRATIVE CONCEPTS, INC.(610) 293-9229

CHECK BENEFIT CARDART INSTITUTE OF AMERICAAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS, INC.(610) 293-9229

ADMINISTRATIVE CONCEPTS, INC.

997 Old Eagle School Rd. #215WAYNE PA 19087-1706

Attn: Customer Service Dept

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-55• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 56: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDART INSTITUTE OF AMERICAAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

BENEFIT MANAGEMENT INC.(800) 824-5034

CHECK BENEFIT CARDARVEST BANK GROUP INCAffiliated With: BENEFIT MANAGEMENT INC

Fund No:PlanType: Group Health

BENEFIT MANAGEMENT INC.(800) 824-5034

BENEFIT MANAGEMENT INC.PO BOX 3767BARTLESVILLE OK 74006

NORTH AMERICAN ADMINISTRATORS(800) 397-2122

NORTH AMERICAN ADMINISTRATORS(800) 397-2122

ASARCO AZAffiliated With: MARITAIN HEALTH

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS(800) 397-2122

NORTH AMERICAN ADMINISTRATORS

PO Box 853921Richardson TX 75085-3921

Attn: Claims Dept

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

NORTH AMERICAN ADMINISTRATORS(800) 828-6922

ASH BROKERAGEAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

NORTH AMERICAN ADMINISTRATORS-NYPO Box 730AMHERST NY 14226

ASHVILLE VAMC CHECK BENEFIT CARDASHEVILLE VAMC 3134Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

ASHVILLE VAMC ASHVILLE VAMC

1100 TUNNEL RDASHVILLE NC 28805

Attn: FEE BASIS 136

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-56• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 57: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURECARE(800) 968-6616

CARELINE(763) 383-4800

ASHLEYAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823

GALLAGHER BENEFIT ADMINISTRATORS INC(630) 493-3849

GALLAGHER BENEFIT ADMINISTRATORS INC(630) 493-3842

ASIA FOUNDATIONAffiliated With: GALLAGHER BENEFIT ADMINISTRATORS INC

Fund No:PlanType: Group Health

GALLAGHER BENEFIT ADMINISTRATORS INC(800) 877-7474

GALLAGHER BENEFIT ADMINISTRATORS INCPO Box 34297San Antonio TX 78265

Mountain States Administrative Services(520) 722-7133

Hines and Associates(847) 214-2780

ASMLAffiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

Mountain States Administrative Services(520) 722-7133

Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710

HEALTHSCOPE BENEFITS INC(866) 885-4944

HEALTHSCOPE BENEFITS INC(501) 218-7691

ASMO MANUFACTURINGAffiliated With: HEALTHSCOPE BENEFITS, INC

Fund No:PlanType: Group Health

HEALTHSCOPE BENEFITS INC(800) 560-4664

HEALTHSCOPE BENEFITS INC27 CORPORATE HILL DRLITTLE ROCK AR 72205

CHECK BENEFIT CARD CHECK BENEFIT CARDASPEN EDUCATIONAffiliated With: BENEFIT PLANNERS LTD

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-57• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 58: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GLOBALCARE(888) 285-4864

AEGIS CARE MANAGEMENT(800) 868-1660

ASR TRIALONAffiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(888) 285-4864

GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

CHECK BENEFIT CARDAssemblies of God (AG10000036598)

Affiliated With: International Medical Group, Inc.

Fund No:PlanType: Group Health

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

ASSETS, INCAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

AFS Insurance(800) 464-7425 or (801) 978-8336

AFS Insurance(801) 978-8337

Associated Food Stores, Inc.Affiliated With: Associated Food Stores, Inc.

Fund No:PlanType: Group Health

AFS Insurance(800) 464-7425 or (801) 978-8336

AFS Insurance1850 W 2100 SSalt Lake City UT 84119

CHECK BENEFIT CARD6783411722

CHECK BENEFIT CARDASSOCIATED PLAN ADMINISTRATORS

Affiliated With: GLOBALCARE

Fund No:PlanType: Group Health

CHECK BENEFIT CARD6783411722

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-58• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 59: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDASSUMPTION COLLEGE SPORTSAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

MED-CERT(800) 356-7126

ASSUMPTION GRAIN COOPERATIVE GRAIN COMPANY

Affiliated With: NORTH AMERICA ADMINISTRATORS LP TENNESSEE

Fund No:PlanType: Group Health

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

KEY BENEFIT ADMINISTRATORS(866) 387-0489

FORTIS BENEFITS INSURANCE COMPANY(866) 387-3407

ASSURANT HEALTH PREFERRED PLAN

Affiliated With: FORTIS BENEFITS INSURANCE COMPANY

Fund No:PlanType: Group Health

KEY BENEFIT ADMINISTRATORS(317) 284-7649

KEY BENEFIT ADMINISTRATORS8330 ALLISON POINT TRAILINDIANAPOLIS IL 46250

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

ASSURECAREAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

ACCOUNT EXECUTIVE(800) 242-4472

GISC OPTIMUM CARE / AMERICAN HEALTH(800) 290-4698

ASSURED SOURCEAffiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

ACCOUNT EXECUTIVE(800) 242-4472

ACCOUNT EXECUTIVE20 WINTER STPEMBROKE MA 02359

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-59• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 60: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PPC(800) 446-5439

PRIMARY PHYSICIANCARE, INC.7045232758

ASTEN JOHNSONAffiliated With: PRIMARY PHYSICIAN CARE INC

Fund No:PlanType: Group Health

PPC(800) 446-5439

PPCPO Box 11088CHARLOTTE NC 28220

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDATASCADERO UNIFIED SCHOOL DISTRICT

Affiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

GROUP & PENSION ADMINISTRATORS(800) 827-7223

CHECK BENEFIT CARDAtascosa County (TRAVEL)Affiliated With: GROUP & PENSION ADMINISTRATORS

*

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

GROUP & PENSION ADMINISTRATORS INC(800) 827-7223

GPA/HEALTH WATCH(972) 587-1402

ATCO RUBBER PRODUCTS INCAffiliated With: GROUP & PENSION ADMINISTRATORS INC

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS INC(972) 587-2311

GROUP & PENSION ADMINISTRATORS INCPO Box 749075DALLAS TX 75374-9075

CompIQ Corporation(800) 293-3131

CompIQ CorporationAthens AdministratorsAffiliated With: CompIQ

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(800) 293-3131

CompIQ Corporation35 Tesla Way #100Irvine CA 92618

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-60• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 61: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDATLANTA METRO AIH0057927Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEATLANTA METRO COLLEGE UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

ATLANTA VAMC CHECK BENEFIT CARDATLANTA VAMC 3545Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

ATLANTA VAMC ATLANTA VAMC

1670 CLAIRMONT RDDECATUR GA 30033

Attn: FEE BASIS 508/16

INSURANCE ADMINISTRATORS OF AMERICA INC8885991515

HEALTHCARE STRATEGIES INC8885991515

ATLANTIC BROADBANDAffiliated With: INSURANCE ADMINISTRATOR OF AMERICA, INC. (IAA)

Fund No:PlanType: Group Health

INSURANCE ADMINISTRATORS OF AMERICA INC8885991515

INSURANCE ADMINISTRATORS OF AMERICA INC1934 OLNEY AVE STE 200CHERRY HILL NJ 08003

CONTACT EMPLOYER CONTACT EMPLOYERAtlantic Charter Insurance CoAffiliated With: GENEX Services, Inc

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-61• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 62: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Atlantic Medical Insurance Company LTD(242) 326-8191

First Health(800) 356-0810

Atlantic Medical Insurance Company LTD

Affiliated With: Colonial Group International LTD

Fund No: V8254PlanType: Group Health

Atlantic Medical Insurance Company LTD(242) 326-8191

Atlantic Medical Insurance Company LTDAtlantic House 2nd Ter and Collins AvePO Box SS-5915Nassau, Bahamas, NP

CONTACT EMPLOYER CONTACT EMPLOYERAtlantic MutualAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

CHECK BENEFIT CARDATLANTIC UNION COLLEGEAffiliated With: PIONEER MANAGEMENT SERVICES

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090

CORESOURCE(800) 354-5233

UM NOT APPLICABLEATLAS AMERICAAffiliated With: CORESOURCE

Fund No:PlanType: Group Health

CORESOURCE(800) 354-5233

CORESOURCEPO Box 2920CLINTON OH 52733-2920

Attenta(800) 580-1642

Attenta(800) 580-2273

AttentaAffiliated With: Attenta

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

Attenta(800) 580-1642

CONTACT EMPLOYER

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-62• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 63: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

INSURANCE MANAGEMENT SERVICES(800) 687-5944

CHECK BENEFIT CARDATWOOD DISTRIBUTINGAffiliated With: INSURANCE MANAGEMENT SERVICES

Fund No:PlanType: Group Health

INSURANCE MANAGEMENT SERVICES(800) 687-5944

INSURANCE MANAGEMENT SERVICESPO Box 15688AMARILLO TX 79105

CHECK BENEFIT CARD8005211555

UM NOT APPLICABLEATWOOD MOBILE PRODUCTS INC

Affiliated With: NGS AMERICAN INC

Fund No:PlanType: Group Health

NGS AMERICAN, INC.8005211555

NGS AMERICAN, INC.PO Box 7676DETROIT MI 48080

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDAUBURN UNIVERSITYAffiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

AUGUSTA - EXTERNAL AFFAIRS

CHECK BENEFIT CARDAUGUSTA - EXTERNAL AFFAIRS 3715

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

AUGUSTA - EXTERNAL AFFAIRS

AUGUSTA - EXTERNAL AFFAIRS

950 15TH ST Rm 1D-103AUGUSTA GA 30901

Attn: EXTERNAL AFFAIRS (112E)

AUGUSTA - FEE BASIS CHECK BENEFIT CARDAUGUSTA - FEE BASIS 3542Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

AUGUSTA - FEE BASIS AUGUSTA - FEE BASIS

950 15TH STAUGUSTA GA 30901

Attn: FEE BASIS 116

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-63• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 64: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDAUGUSTA STATE UNIV AIH0057947

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDAUGUSTA STATE UNIV AIH0057957

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEAUGUSTA STATE UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

TRUE CHOICE(800) 251-9665

UM NOT APPLICABLEAUSTIN COLLEGEAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 251-9665

TRUE CHOICEPO Box 700307DALLAS TX 75370

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDAUTOMOBILES OF ITALY INCAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-64• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 65: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

NHBC(888) 621-7900

CHECK BENEFIT CARDAVALON BENEFIT SERVICESAffiliated With: NATIONAL HEALTH BENEFIT CORPORATION NHBC #12717

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

HEALTH NETWORK AMERICA(732) 676-2637

HEALTH NETWORK AMERICA(732) 676-2637

AVALON HEALTHCARE - INSURANCE COMPANY

Affiliated With: HEALTH NETWORK AMERICA

Fund No:PlanType: Group Health

HEALTH NETWORK AMERICA(732) 676-2637

HEALTH NETWORK AMERICA246 INDUSTRIAL WAY WESTEATONTOWN NJ 07724

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

AVI RESORT & CASINOAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

ALLIED BENEFIT SYSTEMS, INC3129068080

CHECK BENEFIT CARDAWANA CLUBS INTERNATIONAL, INC

Affiliated With: ALLIED BENEFIT SYSTEMS INC

Fund No:PlanType: Group Health

ALLIED BENEFIT SYSTEMS, INC3129068080

ALLIED BENEFIT SYSTEMS, INC208 S. LASALLE STREETCHICAGO IL 60604

TRANSWESTERN INSURANCE ADMINISTRATORS, INC.8002218942

CHECK BENEFIT CARDAZCONA HARVESTING LLCAffiliated With: TRANSWESTERN INSURANCE ADMINISTRATORS INC

Fund No:PlanType: Group Health

TRANSWESTERN INSURANCE ADMINISTRATORS, INC.8002218942

TRANSWESTERN INSURANCE ADMINISTRATORS, INC.PO Box 45019Fresno CA 93718

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-65• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 66: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

AZUSA PACIFIC UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

BABB, INC INTRACORPBABB, INC

Fund No:PlanType: Group Health

Refer to Intercorp

BABB, INC BABB, INC850 RIDGE AVEPITTSBURGH PA 15212

HEALTHCARE MANAGEMENT ADMINISTRATORS INC(800) 869-7093

CHECK BENEFIT CARDBADEN SPORTAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS, INC

Fund No:PlanType: Group Health

HEALTHCARE MANAGEMENT ADMINISTRATORS INC(800) 869-7093

HEALTHCARE MANAGEMENT ADMINISTRATORS INCPO Box 85016Bellevue WA 98015-8516

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDBAINBRIDGE COLLEGE AIH0057967

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEBAINBRIDGE COLLEGE UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-66• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 67: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PATIENT ADVOCATES LLC CHECK BENEFIT CARDBAKER COMPANYAffiliated With: PATIENT ADVOCATE LLC

Fund No:PlanType: Group Health

PATIENT ADVOCATES LLC PATIENT ADVOCATES LLCPO Box 1959Gray ME 04039

CONTACT EMPLOYER CONTACT EMPLOYERBaldwin and LyonsAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

SMITH ADMINISTRATORS(801) 261-5511

SERVICE ADVOCATES(877) 261-5511

BALL ENTERPRISES, INC.Affiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

SMITH ADMINISTRATORS(801) 261-5511

SMITH ADMINISTRATORS428 E WINCHESTER ST, STE 200SALT LAKE CITY UT 84107

PROFESSIONAL BENEFIT ADMINISTRATORS(630) 655-3755

UM NOT APPLICABLEBall HorticulturealAffiliated With: PROFESSIONAL BENEFIT ADMINISTRATORS INC

*

Fund No:PlanType: Group Health

PROFESSIONAL BENEFIT ADMINISTRATORS(630) 655-3755

PROFESSIONAL BENEFIT ADMINISTRATORS900 Jorie Blvd Ste 250Oakbrook IL 60523

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

BALLY TECHNOLOGY - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-67• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 68: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8007867930

CHECK BENEFIT CARDBANK OF COMMERCEAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8007867930

CHECK BENEFIT CARD

PATIENT ADVOCATES LLC CHECK BENEFIT CARDBARBER FOODSAffiliated With: PATIENT ADVOCATE LLC

Fund No:PlanType: Group Health

PATIENT ADVOCATES LLC PATIENT ADVOCATES LLCPO Box 1959Gray ME 04039

CHECK BENEFIT CARD CHECK BENEFIT CARDBARGREEN ELLINGSON INCAffiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CENBEN USA(614) 797-5204

CHECK BENEFIT CARDBARONA BAND OF MISSION INDIANS

Affiliated With: CENBEN USA INC

Fund No:PlanType: Group Health

CENBEN USA(614) 797-5204

CENBEN USA

4079 Executive PkwyWesterville OH 43081

Attn: Melissa Joseph

WINTERBROOK/CCN(405) 843-9551 Ext 106

CHECK BENEFIT CARDBARTLETT-COLLINSAffiliated With: MEDBEN

Fund No:PlanType: Group Health

WINTERBROOK/CCN(405) 843-9551 Ext 106

WINTERBROOK/CCNPO Box 568800OKLAHOMA CITY OK 73156-8800

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-68• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 69: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AMERIBEN SOLUTIONS(800) 953-1801

AUM(800) 388-3193

BASIC AMERICAN FOODSAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 953-1801

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

CompIQ Corporation(800) 293-3131

CONTACT EMPLOYERBass and BabbAffiliated With: CompIQ

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(800) 293-3131

CompIQ Corporation2 South PointeLake Forest CA 92630

CompIQ Corporation(800) 293-3131

CHECK BENEFIT CARDBass and Babb AutoAffiliated With: CompIQ

Fund No:PlanType: Auto

CompIQ Corporation(800) 293-3131

CompIQ Corporation2 South PointeLake Forest CA 92630

HEALTH NET FEDERAL SERVICES(972) 550-2836

UM NOT APPLICABLEBATAVIA VAMC 4001Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(972) 550-2836

ALBANY (STRATTON) VA MEDICAL CENTER

113 HOLLAND AVEALBANY NY 12208

Attn: FEE BASIS 136E

CONSOLIDATED HEALTH PLANS(800) 633-7867

UM NOT APPLICABLEBates CollegeAffiliated With: CONSOLIDATED HEALTH PLANS

Fund No:PlanType: Group Health

CONSOLIDATED HEALTH PLANS(800) 633-7867

CONSOLIDATED HEALTH PLANS195 STAFFORD STSPRINGFIELD MA 01104

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-69• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 70: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH NET FEDERAL SERVICES(972) 550-2836

UM NOT APPLICABLEBATH VAMC 4002Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(972) 550-2836

ALBANY (STRATTON) VA MEDICAL CENTER

113 HOLLAND AVEALBANY NY 12208

Attn: FEE BASIS 136E

BATTLE CREEK VAMC CHECK BENEFIT CARDBATTLE CREET VAMC 3153Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

BATTLE CREEK VAMC BATTLE CREEK VAMC

5500 ARMSTRONG RDBATTLE CREEK MI 49015

Attn: FEE BASIS (136)

SISCO(800) 547-4726

CHECK BENEFIT CARDBAY INDUSTRIES INCAffiliated With: SISCO/Cottingham & Butler

Fund No:PlanType: Group Health

SISCO(800) 547-4726

SISCOPO Box 389DUBUQUE IA 52004-0389

CHECK BENEFIT CARD CHECK BENEFIT CARDBAY MEDICAL CENTERAffiliated With: CADENT ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PIONEER MANAGEMENT SYSTEMS(413) 534-8658

UM NOT APPLICABLEBay Path CollegeAffiliated With: PIONEER MANAGEMENT SYSTEMS

*

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(413) 534-8658

PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01089

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-70• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 71: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BAY PINES RD CHECK BENEFIT CARDBAY PINES VA MEDICAL CENTER 3144

Affiliated With: HEALTH NET FEDERALSERVICES

Fund No:PlanType: Group Health

BAY PINES RD BAY PINES RD

10000 BAY PINES RDBAY PINES FL 33744

Attn: FEE BASIS 136A

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDBAYLOR UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

Zenith Administrators(602) 336-2244

CHECK BENEFIT CARDBBP CONCRETES CONSTRUCTION

Affiliated With: ELDORADO CLAIMS SERVICES, INC.

Fund No:PlanType: Group Health

Zenith Administrators(602) 336-2244

Zenith Administrators2001 CAMELBACKPHOENIX AZ 85014

ADMINISTRATIVE SOLUTIONS INC(678) 339-0211

CHECK BENEFIT CARDBCLG CORPORATIONAffiliated With: ADMINISTRATIVE SOLUTIONS, INC.

Fund No:PlanType: Group Health

ADMINISTRATIVE SOLUTIONS INC(678) 339-0211

ADMINISTRATIVE SOLUTIONS INCPO Box 2490ALPHARETTA GA 30023

WAUSAU BENEFITS, INC.(715) 841-7802

WAUSAU BENEFITS, INC.(800) 808-4424

BDS MARKETING, INC.Affiliated With: WAUSAU BENEFITS

Fund No:PlanType: Group Health

WAUSAU BENEFITS, INC.(715) 841-7802

WAUSAU BENEFITS, INC.

PO Box 8046WAUSAU WI 54401-8046

Attn: LeAnn Fichtner

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-71• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 72: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

BEACH MOLD & TOOLAffiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

BEACON GROUPAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

Bear Cat Inc.Affiliated With: QVI Risk Solutions Inc

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

ASSURECARE1011 SW EMKAY DR STE 209BEND OR 97702

S AND S HEALTHCARE STRATEGIES(800) 717-2872

CHECK BENEFIT CARDBEAULIEU OF AMERICA HOLLYTEX

Affiliated With: S AND S HEALTHCARE STRATEGIES LTD

Fund No:PlanType: Group Health

S AND S HEALTHCARE STRATEGIES(800) 717-2872

S AND S HEALTHCARE STRATEGIESPO Box 141097CINCINNATI OH 45250

CHECK BENEFIT CARD CHECK BENEFIT CARDBECHTEL NEVADAAffiliated With: BENEFIT PLANNERS LTD

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-72• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 73: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

CHECK BENEFIT CARDBECKER COLLEGEAffiliated With: PIONEER MANAGEMENT SERVICES

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

CHECK BENEFIT CARDBECKER COLLEGE - SPORTSAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706

MERCER ADMINISTRATION(314) 982-5622

UM NOT APPLICABLEBECKETT MEDIAAffiliated With: MERCER ADMINISTRATION

Fund No:PlanType: Group Health

MERCER ADMINISTRATION(314) 982-5622

MERCER ADMINISTRATION701 Market St Ste 1350St Louis MO 63101

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

BECKLEY SINGLETON TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

BECKLEY VAMC CHECK BENEFIT CARDBECKLEY VAMC 3547Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

BECKLEY VAMC BECKLEY VAMC200 VETERANS AVEBECKLEY WV 23667

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-73• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 74: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BEDFORD VA MEDICAL CENTER

CHECK BENEFIT CARDBEDFORD VA MEDICAL CENTER 3111

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

BEDFORD VA MEDICAL CENTER

BEDFORD VA MEDICAL CENTER

200 SPRINGS RDBEDFORD MA 01730

Attn: FEE BASIS - (518-136B)

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

BEEHIVE CREDIT UNIONAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

Western Health(605) 719-4600 or (888) 341-1766

Western Health(605) 719-4640 or (800) 229-0892

Behavior ManagementAffiliated With: Rapid City Regional Hospital DBA Western Health

Fund No:PlanType: Group Health

Western Health(605) 719-4600 or (888) 341-1766

Western Health529 Kansas City St Ste 200Rapid City SD 57701

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDBELDEN WIRE AND CABLEAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

DELTA HEALTH SYSTEMS(209) 474-5647

CHECK BENEFIT CARDBELL CARTER FOODS INCAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(209) 474-5647

DELTA HEALTH SYSTEMSPO Box 1147STOCKTON CA 95201

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-74• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 75: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD(800) 292-5386

CHECK BENEFIT CARDBELLA VISTA VILLAGEAffiliated With: BENEFIT PLANNERS LTD

Fund No:PlanType: Group Health

CHECK BENEFIT CARD(800) 292-5386

CHECK BENEFIT CARD

MAKSIN MANAGEMENT CORP(800) 220-1123

UM NOT APPLICABLEBELLARMINE UNIVERSITYAffiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

MAKSIN MANAGEMENT CORP(800) 220-1123

MAKSIN MANAGEMENT CORP2500 McClellan AvePennsauken NJ 08109

FISERV HEALTH KANSAS(800) 235-7160

TRUSTMARK LIFE INSURANCE CO.(800) 725-6566

BELMAR INTERNATIONALAffiliated With: FISERV HEALTH - KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798

CHECK BENEFIT CARDBELMARK, INCAffiliated With: EMPLOYEE BENEFIT CONSULTANTS

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798

EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839

BRMS(888) 326-2555

BRMS(800) 368-0767

BENEFIT AND RISK MANAGEMENT SERVICES WRAP

Affiliated With: BENEFIT AND RISK MANAGEMENT SERVICES

Fund No:PlanType: Group Health

BRMS(888) 326-2555

BRMSPO Box 2650RANCHO CORDOVA CA 98401

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-75• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 76: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

NHBC(888) 621-7900

CHECK BENEFIT CARDBENEFIT MANAGEMENT SYSTEMS

Affiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

NHBC(888) 621-7900

CHECK BENEFIT CARDBENEFIT PLAN SERVICES INCAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

NHBC(888) 621-7900

CHECK BENEFIT CARDBENEFITSOURCE, INCAffiliated With: NATIONAL HEALTH BENEFIT CORPORATION NHBC #12717

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

GLOBALCARE(888) 285-4864

AEGIS CARE MANAGEMENT(800) 868-1660

BENESYSAffiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(888) 285-4864

GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005

Benicorp Insurance Company(317) 290-1205

CHECK BENEFIT CARDBENICORP INSURANCE COMPANY

Affiliated With: BENICORP INSURANCE COMPANY

Fund No:PlanType: Group Health

Benicorp Insurance Company(317) 290-1205

Benicorp Insurance CompanyPO Box 68917Indianapolis IN 46268-0917

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-76• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 77: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Benicorp Insurance Company(800) 837-1205

Individualized Care Management(888) 448-1864

Benicorp Insurance CompanyAffiliated With: Benicorp Insurance Company

Fund No:PlanType: Group Health

-Network participation is contingent upon proper member identification. The First Health® Network Logo must be on the benefit card.

Benicorp Insurance Company(800) 837-1205

Benicorp Insurance CompanyPO Box 68917Indianapolis IN 46268-0917

Benicorp Insurance Company(800) 837-1205

Benicorp Insurance Company(888) 448-1864

Benicorp Travel AccessAffiliated With: Benicorp Insurance Company

Fund No:PlanType: Group Health

Benicorp Insurance Company(800) 837-1205

Benicorp Insurance CompanyPO Box 68917Indianapolis IN 46268-0917

CHECK BENEFIT CARD8009607247

CHECK BENEFIT CARDBENTLY PRESSURIZED BEARING COMPANY

Affiliated With: HEALTHCOMP ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8009607247

CHECK BENEFIT CARD

ARM, LTD.(877) 544-1770

HINES & ASSOCIATES(888) 437-9927

BERING SEA ECCOTECH, INCAffiliated With: ALTERNATIVE RISK MANAGEMENT LTD NORTHWEST

Fund No:PlanType: Group Health

ARM, LTD.(877) 544-1770

ARM, LTD.10200 S.W. Nimbus Ave. Ste G-5PORTLAND OR 97223

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-77• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 78: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

BERKLEY RISK ADMINISTRATORSAffiliated With: PREFERREDONE ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICESPO Box 59212MINNEAPOLIS MN 55459

GROUP INSURANCE SERVICE CENTER INC(800) 242-4472

GISC TOTALCARE(800) 242-4472

BERKSHIRE CORPORATIONAffiliated With: GROUP INSURANCE SERVICE CENTER INC

Fund No:PlanType: Group Health

GROUP INSURANCE SERVICE CENTER INC(800) 242-4472

GROUP INSURANCE SERVICE CENTER INC20 INDUSTRIAL PARK DRPEMBROKE MA 02359

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

BERLIN-GORHAM OPERATIONSAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226

DELTA HEALTH SYSTEMS(866) 547-1714

DELTA TEAM CARE3129068080

BERRY HINCKLEY INDUSTRIESAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(866) 547-1714

DELTA HEALTH SYSTEMS

PO Box 692590STOCKTON CA 95269

Attn: Tish Asuncion

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

BEST CHAIRS, INC.Affiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-78• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 79: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BEST LIFE AND HEALTH(800) 433-0088

CHECK BENEFIT CARDBEST LIFE AND HEALTHAffiliated With: BEST LIFE AND HEALTH

Fund No:PlanType: Group Health

BEST LIFE AND HEALTH(800) 433-0088

BEST LIFE AND HEALTHPO Box 19721Irvine CA 92623-9721

Insurers Administrative Corp(800) 964-4948

Med-Valu(800) 522-2161

Best Life and Health Insurance (IAC)Affiliated With: INSURERS ADMINISTRATIVE CORP

Fund No:PlanType: Group Health

Insurers Administrative Corp(800) 964-4948

Insurers Administrative CorpPO Box 828Park Ridge IL 60068-0828

PPC(800) 446-5439

PPC(704) 523-2758

BETCO, INCAffiliated With: PRIMARY PHYSICIAN CARE

Fund No:PlanType: Group Health

PPC(800) 446-5439

PPCPO Box 11088CHARLOTTE NC 28220

CHECK BENEFIT CARD9419674139

CHECK BENEFIT CARDBETHEL FARMS LTDAffiliated With: HERITAGE CONSULTANTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD9419674139

CHECK BENEFIT CARD

CHECK BENEFIT CARD8002666311

CHECK BENEFIT CARDBETTERAVIA FARMSAffiliated With: HEALTHCOMP ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8002666311

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-79• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 80: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(800) 877-3727

CRITIQUE(800) 666-5551

BH INC. & A & D HACKING INC.Affiliated With: MANAGED BENEFIT ADMINISTRATORS & INSURANCE

Fund No:PlanType: Group Health

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(800) 877-3727

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTSPO Box 651109SALT LAKE CITY UT 84165-1109

GALLAGHER BENEFIT ADMINISTRATORS INC

CHECK BENEFIT CARDBIANCHI INTERNATIONALAffiliated With: TRIDENT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

BIG SPRING VAMC CHECK BENEFIT CARDBIG SPRINGS VAMC 3172Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

BIG SPRING VAMC BIG SPRING VAMC

300 VETERANS BLVDBIG SPRING TX 79720

Attn: FEE BASIS

GROUP & PENSION ADMINISTRATORS(800) 827-7223

HEALTH WATCH(972) 238-7900

BIG TEX TRAILERS PRIMARYAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

GROUP & PENSION ADMINISTRATORS(800) 827-7223

HEALTH WATCH(972) 238-7900

BIG TEX TRAILERS TRAVELAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-80• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 81: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8002218942

CHECK BENEFIT CARDBINGHAM EQUIPMENT COMPANYAffiliated With: TRANSWESTERN INSURANCE ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8002218942

CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERBinghamptonAffiliated With: New York State Insurance Fund

*

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

BINIONSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

BIRMINGHAM VAMC CHECK BENEFIT CARDBIRMINGHAM VAMC 3538Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

BIRMINGHAM VAMC BIRMINGHAM VAMC

700 S 19TH STBIRMINGHAM AL 35233

Attn: FEE BASIS - 136E

CONSOCIATE, INC.(800) 798-2422

NATIONAL HEALTH SERVICES(800) 558-4353

BLACK AND COMPANYAffiliated With: CONSOCIATE INC

Fund No:PlanType: Group Health

CONSOCIATE, INC.(800) 798-2422

CONSOCIATE, INC.PO Box 1068DECATUR IL 62525

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-81• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 82: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH NET FEDERAL SERVICES(916) 985-1259

CHECK BENEFIT CARDBLACK HILLS HCS 3710Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

VA BLACK HILLS HCS (3710)

VA BLACK HILLS HCS (3710)500 NORTH 5TH STREET, FEE BUS13HOT SPRINGS SD 57747

Western Health(605) 719-4600 or (888) 341-1766

Western Health(605) 719-4640 or (800) 229-0892

Black Hills Workshop and Training Center Inc

Affiliated With: Rapid City Regional Hospital DBA Western Health

Fund No:PlanType: Group Health

Western Health(605) 719-4600 or (888) 341-1766

Western Health529 Kansas City St Ste 200Rapid City SD 57701

CHECK BENEFIT CARD9185867926

CHECK BENEFIT CARDBLACK MESA PIPELINEAffiliated With: MARSH ADVANTAGE AMERICA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD9185867926

CHECK BENEFIT CARD

MIDWEST SECURITY ADMINISTRATORS, INC.(800) 542-6642

Q-REVIEW(608) 783-8706

BLACKHAWK CREDIT UNIONAffiliated With: MIDWEST SECURITY ADMINISTRATORS INC.

Fund No:PlanType: Group Health

MIDWEST SECURITY ADMINISTRATORS, INC.(800) 542-6642

MIDWEST SECURITY ADMINISTRATORS, INC.2700 MIDWEST DRONALASKA WI 54650

BLUE BELL BENEFIT TRUST(979) 830-7388

CHECK BENEFIT CARDBLUE BELLCREAMERIES USAAffiliated With: BLUE BELL BENEFIT TRUST

Fund No:PlanType: Group Health

BLUE BELL BENEFIT TRUST(979) 830-7388

BLUE BELL BENEFIT TRUSTPO Box 605BRENHAM TX 77834

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-82• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 83: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH PLAN INC5087522480

CMS INC(866) 325-1550

BLUE ROCK INDUSTRIESAffiliated With: HEALTH PLANS, INC.

Fund No:PlanType: Group Health

HEALTH PLAN INC5087522480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

CHECK BENEFIT CARD CHECK BENEFIT CARDBLUEGRASS FAMILY HEALTH

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERBluegrass Health NetworkAffiliated With: Bluegrass Health Network

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

AMERIHEALTH ADMINISTRATORS(215) 793-3223

AMERIHEALTH ADMINISTRATORS(215) 793-3223

BOHLIN CYWINSKI JACKSONAffiliated With: AMERIHEALTH ADMINISTRATORS

Fund No:PlanType: Group Health

AMERIHEALTH ADMINISTRATORS(215) 793-3223

AMERIHEALTH ADMINISTRATORS720 BLAIR MILL RD.HORSHAM PA 19044

MAKSIN MANAGEMENT CORP(800) 220-1123

UM NOT APPLICABLEBOISE STATE UNIVERSITYAffiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

MAKSIN MANAGEMENT CORP(800) 220-1123

MAKSIN MANAGEMENT CORP2500 McClellan AvePennsauken NJ 08109

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-83• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 84: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BOISE VAMC CHECK BENEFIT CARDBOISE VAMC 3177Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

BOISE VAMC BOISE VAMC

500 W FORT STBOISE ID 83702

Attn: MAS 136

VA BONHAM CHECK BENEFIT CARDBONHAM VA 3168Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

VA BONHAM VA BONHAM

1201 E 9TH STBONHAM TX 75048

Attn: BRENDA MAGNASS

EBPA(802) 846-8060

CHECK BENEFIT CARDBOOTHCREEK SKI HOLDING JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

BOOTZ MANUFACTORING COAffiliated With: PREFERRED HEALTH PLAN INC 962550088

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(502) 992-4535

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

BORDER FOODS COMPANIESAffiliated With: PREFERREDONE ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICESPO Box 59212MINNEAPOLIS MN 55459

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-84• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 85: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SRT ADMINISTRATORS SRT ADMINISTRATORSBORREGO PASS SCHOOLAffiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS SRT ADMINISTRATORSPO Box 25160SCOTTSDALE AZ 85255-0102

CHECK BENEFIT CARD CHECK BENEFIT CARDBOSKOVICH FARMSAffiliated With: TRANSWESTERN INSURANCE ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Benesight8009928354

Benesight8009928354

BOSSARD METRICS INCAffiliated With: BENESIGHT INC

Fund No:PlanType: Group Health

Benesight8009928354

BenesightPO Box 310PUEBLO CO 81002

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

CHECK BENEFIT CARDBOSTON BAPTIST COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706

CHECK BENEFIT CARD CHECK BENEFIT CARDBOSTON COLLEGEAffiliated With: KLAIS AND COMPANY

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-85• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 86: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

KLAIS & COMPANY INC(330) 867-8443

CHECK BENEFIT CARDBOSTON COLLEGEAffiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(330) 867-8443

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

MEDICAL CLAIMS SERVICES, INC.(888) 225-0522

AMERICAN HEALTH HOLDINGS INC(886) 614-4244

BOSTON HIGASHI SCHOOLAffiliated With: MEDICAL CLAIMS SERVICES, INC.

Fund No:PlanType: Group Health

MEDICAL CLAIMS SERVICES, INC.(888) 225-0522

MEDICAL CLAIMS SERVICES, INC.ONE WALL ST STE 2ARAVENSWOOD WV 26164

HEALTH NET FEDERAL SERVICES(214) 387-3232

CHECK BENEFIT CARDBOSTON VA MEDICAL CENTER 3118

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(214) 387-3232

HEALTH NET FEDERAL SERVICES

150 S HUNTINGTON AVEBOSTON MA 02130

Attn: FEE BASIS 136F

GILSBAR(888) 215-9841

MED COM CARE MGT(985) 898-1505

BOTHWELL SAXTON RESTAURANTS, LLC

Affiliated With: GILSBAR INC

Fund No:PlanType: Group Health

GILSBAR(888) 215-9841

GILSBAR2100 COVINGTON CENTRECOVINGTON LA 70433

NHBC(888) 621-7900

CHECK BENEFIT CARDBOULDER ADMINISTRATIVE SERVICES

Affiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC) 12717

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-86• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 87: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

CHECK BENEFIT CARDBOWDOIN COLLEGEAffiliated With: PIONEER MANAGEMENT SERVICES

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090

FISERV HEALTH KANSAS(800) 235-7160

TRUSTMARK LIFE INSURANCE CO.(800) 725-6566

BOYD COUNTERTOPS INCAffiliated With: FISERV HEALTH - KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

Bradley/Dixie Company(866) 360-7926

QUANTUM HEALTH(800) 257-2038

BRADLEY DIXIE COMPANIESAffiliated With: PARAGON BENEFITS, INC.

Fund No:PlanType: Group Health

Bradley/Dixie Company(866) 360-7926

Bradley/Dixie CompanyPO Box 12288COLUMBUS GA 31904

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

BRADY INDUSTRIESAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

KLAIS & COMPANY INC(800) 331-1096

CHECK BENEFIT CARDBRANDEIS UNIVERSITYAffiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(800) 331-1096

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-87• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 88: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDBRATTLEBORO MEMORIAL HOSPITAL

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CENBEN USA(614) 797-5204

CHECK BENEFIT CARDBREG, INC.Affiliated With: CENBEN USA INC

Fund No:PlanType: Group Health

CENBEN USA(614) 797-5204

CENBEN USA

4079 Executive PkwyWesterville OH 43081

Attn: Melissa Joseph

Brokerage Concepts, Inc.6104914911

Brokerage Concepts, Inc.(215) 773-3722

BRENNAN TRANSPORTATION SERVICE

Affiliated With: BROKERAGE CONCEPTS BENEFITS CONCEPTS INC

Fund No:PlanType: Group Health

Brokerage Concepts, Inc.6104914911

Brokerage Concepts, Inc.PO Box 61553KING OF PRUSSIA PA 19406

CHECK BENEFIT CARD CHECK BENEFIT CARDBRENTWOOD INDUSTRIES INCAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

BRENTWOOD VOLVOAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-88• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 89: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

BREVARD ACHIEVEMENT CENTER

Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

BREWER YACHT YARD GROUPAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

BRIDGES WTC, INC.Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

BRIDGESTONEAffiliated With: ASSURECAREE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

British Caymanian Insurance(441) 296-3200

First Health(800) 423-9130

British Caymanian InsuranceAffiliated With: Colonial Group International LTD

Fund No: V8256PlanType: Group Health

British Caymanian Insurance(441) 296-3200

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-89• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 90: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDBRITZ COMPANIES ET ALAffiliated With: HEALTHCOMP ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERBroadspire, A Crawford CompanyAffiliated With: Broadspire, A Crawford Company

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER Crawford & Company5620 Glenridge Dr NEAtlanta GA 30342

MUTUAL ASSURANCE ADMINISTRATORS(405) 607-2694

CHECK BENEFIT CARDBRONCO DRILLINGAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(405) 607-2694

MUTUAL ASSURANCE ADMINISTRATORS3121 QUAIL SPRINGS PKWYOKLAHOMA CITY OK 73134

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDBRONCO DRILLING COMPANY INCAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS, INC.(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

BRONX VA MEDICAL CENTER

CHECK BENEFIT CARDBRONX VA MEDICAL CENTER 3121

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

BRONX VA MEDICAL CENTER

BRONX VA MEDICAL CENTER

130 W KINGSBRIDGE RDBRONX NY 10468

Attn: FEE BASIS 00AM

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-90• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 91: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BROOKLYN VA MEDICAL CENTER

CHECK BENEFIT CARDBROOKLYN VA MEDICAL CENTER 3521

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

BROOKLYN VA MEDICAL CENTER

BROOKLYN VA MEDICAL CENTER

800 POLY PLACEBROOKLYN NY 11209

Attn: FEE BASIS 136

UNDERWRITERS SAFETY & CLAIMS(800) 678-1536

HEALTH SERVICE REVIEW(800) 334-6468

BROTHERS TRADING CO INC AND INVENTORY HANDLERS INC

Affiliated With: UNDERWRITERS SAFETY & CLAIMS

Fund No:PlanType: Group Health

UNDERWRITERS SAFETY & CLAIMS(800) 678-1536

UNDERWRITERS SAFETY & CLAIMSPO Box 23507Louisville KY 40223-0507

CHECK BENEFIT CARD CHECK BENEFIT CARDBROULIMS SUPERMARKETSAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

ADMINISTRATIVE CONCEPTS, INC.(610) 293-9229

CHECK BENEFIT CARDBROWN MACKIE COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS, INC.(610) 293-9229

ADMINISTRATIVE CONCEPTS, INC.

997 Old Eagle School Rd. #215WAYNE PA 19087-1706

Attn: Customer Service Dept

ADMINISTRATIVE CONCEPTS INC(610) 293-9229

UM NOT APPLICABLEBROWN MACKIE COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS INC(610) 293-9229

ADMINISTRATIVE CONCEPTS INC

997 Old Eagle School Rd. #215WAYNE PA 19087-1706

Attn: Customer Service Dept

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-91• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 92: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONSOLIDATED HEALTH PLANS(800) 517-4791

UM NOT APPLICABLEBrown UniversityAffiliated With: CONSOLIDATED HEALTH PLANS

*

Fund No:PlanType: Group Health

CONSOLIDATED HEALTH PLANS(800) 633-7867

CONSOLIDATED HEALTH PLANS195 STAFFORD STSPRINGFIELD MA 01104

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

BRUTGER EQUITIES, INCAffiliated With: PREFERREDONE ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICESPO Box 59212MINNEAPOLIS MN 55459

CHECK BENEFIT CARD CHECK BENEFIT CARDBSI INCAffiliated With: INTEGRITY HEALTH SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

COMMERCE BENEFITS GROUP(800) 223-9941

CARDINAL UTILIZATION MANAGEMENT(877) 272-7040

BUCKINGHAM COMPANIESAffiliated With: COMMERCE BENEFITS GROUP

Fund No:PlanType: Group Health

COMMERCE BENEFITS GROUP(800) 223-9941

COMMERCE BENEFITS GROUPPO Box 8150RAPID CITY SD 57709-8150

OSF HealthPlans, Inc.(877) 677-8222

CHECK BENEFIT CARDBUEHLER HOMEAffiliated With: OSF HEALTHPLANS

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(877) 677-8222

OSF HealthPlans, Inc.PO Box 5128PEORIA IL 61601-5128

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-92• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 93: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERBuffaloAffiliated With: New York State Insurance Fund

*

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

BUFFALO CHINAAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

HEALTH NET FEDERAL SERVICES(972) 550-2836

UM NOT APPLICABLEBUFFALO VAMC 4003Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(972) 550-2836

ALBANY (STRATTON) VA MEDICAL CENTER

113 HOLLAND AVEALBANY NY 12208

Attn: FEE BASIS 136E

Builders Insurance Group(678) 309-4000

Builders Insurance Group(678) 309-4172

Builders Insurance Group

Fund No:PlanType: Workers' Compensation

Builders Insurance Group(678) 309-4172

Builders Insurance GroupPO Box 723099Atlanta GA 31139-0099

HEALTHCARE SOLUTIONS GROUP, INC.(800) 749-1422

CHECK BENEFIT CARDBUILDER'S SUPPLY INCAffiliated With: HEALTHCARE SOLUTIONS GROUP INC

Fund No:PlanType: Group Health

HEALTHCARE SOLUTIONS GROUP, INC.(800) 749-1422

HEALTHCARE SOLUTIONS GROUP, INC.PO Box 1309MUSKOGEE OK 74402

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-93• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 94: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Bunch & Associates Inc(888) 853-4735

Bunch & Associates Inc(888) 853-4735

Bunch & Associates Inc.Affiliated With: Bunch & Associates Inc.

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

Bunch & Associates Inc(888) 853-4735

Bunch & Associates IncPO Box 32045Lakeland FL 33802

CHECK BENEFIT CARD(800) 292-5386

CHECK BENEFIT CARDBURLINGTON RESOURCESAffiliated With: BENEFIT PLANNERS LTD

Fund No:PlanType: Group Health

CHECK BENEFIT CARD(800) 292-5386

CHECK BENEFIT CARD

NHBC(888) 621-7900

CHECK BENEFIT CARDBUTLER BENEFIT SERVICES INCAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

BUTLER VAMC CHECK BENEFIT CARDBUTLER VAMC 3123Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

BUTLER VAMC BUTLER VAMC

325 NEW CASTLE RDBUTLER PA 16001

Attn: FEE BASIS (70)

C.L. FRATES AND COMPANY(405) 290-5696

C.L. FRATES AND COMPANY(800) 669-1815

C L FRATES AND COMPANYAffiliated With: C L FRATES & COMPANY

Fund No:PlanType: Group Health

C.L. FRATES AND COMPANY(405) 290-5696

C.L. FRATES AND COMPANYPO Box 268967OKLAHOMA CITY OK 73126

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-94• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 95: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Mountain States Administrative Services(520) 722-7133

Hines and Associates(847) 214-2780

C T I INCAffiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

Mountain States Administrative Services(520) 722-7133

Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710

SMITH ADMINISTRATORS(817) 335-2582

SERVICE ADVOCATES(801) 261-5511

CABLE COMMUNICATIONSAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

SMITH ADMINISTRATORS(817) 335-2582

SMITH ADMINISTRATORS3800 SANDSHELL DR STE 260FT. WORTH TX 76134

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

CABRILLO COLLEGEAffiliated With: AMERIBEN SOLUTIONS

Term Effective: 8/31/2007Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

EBA&M(714) 668-8920

CHECK BENEFIT CARDCADDOCK ELECTRONICS, INC.Affiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT

Fund No:PlanType: Group Health

EBA&M(714) 668-8920

EBA&MPO Box 8572WEST LAKE VILLAGE CA 91359

ULTRABENEFITS INC(866) 858-7223

AMERICAN HEALTH HOLDINGS(614) 818-3222

CAINS FOODS LPAffiliated With: ULTRABENEFITS INC

Fund No:PlanType: Group Health

ULTRABENEFITS INC(866) 858-7223

ULTRABENEFITS INC29 EAST MOUNTAIN STWORCESTER MA 01606

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-95• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 96: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBPA(802) 846-8060

CHECK BENEFIT CARDCALAIS REGIONAL HOSPITAL WRAP JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

EBPA(802) 846-8060

CHECK BENEFIT CARDCALAIS REGIONAL HOSPITAL WRAP VST

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

J SMITH LANIER & CO(910) 480-3100

CHECK BENEFIT CARDCALDWELL FREIGHT LINESAffiliated With: JSL ADMINISTRATORS INC

Fund No:PlanType: Group Health

J SMITH LANIER & CO(910) 480-3100

J SMITH LANIER & CO201 HAY STREET, STE 302FAYETTEVILLE NC 28301

AMERIBEN SOLUTIONS(800) 654-7900 (800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

CALIFORNIA BAPTIST UNIVERSITY

Affiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-96• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 97: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDCALIFORNIA INSTITUTE OF INTEGRAL STUDIES

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

CHECK BENEFIT CARD CHECK BENEFIT CARDCALIFORNIA INSTITUTE OF TECHNOLOGY

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CALIFORNIA IRONWORKERS FIELD WELFARE PLAN

CALIFORNIA IRONWORKERS FIELD WELFARE PLAN

CALIFORNIA IRONWORKERS FIELD WELFARE PLAN

Affiliated With: CALIFORNIA IRONWORKERS FIELD WELFARE PLAN

Fund No:PlanType: Group Health

CALIFORNIA IRONWORKERS FIELD WELFARE PLAN

CALIFORNIA IRONWORKERS FIELD WELFARE PLAN131 N. El Molina Ave. #330PASADENA CA 91101

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDCALIFORNIA STATE UNIVERSITY - LOS ANGELES

Affiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 9/30/2007Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-97• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 98: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

DELTA HEALTH SYSTEMS(800) 807-0820

DELTA TEAM CARE(209) 939-3438

CALIFORNIA STEEL INDUSTRIESAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(800) 807-0820

DELTA HEALTH SYSTEMSPO Box 80Stockton CA 95201

GISC, INC(800) 242-4472

GISC TOTALCARE(800) 999-1077

CALISE AND SONSAffiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

GISC, INC(800) 242-4472

GISC, INC20 WINTER STPEMBROKE MA 02359

GILSBAR(800) 445-7227

CHECK BENEFIT CARDCALLIDUS TECHNOLOGIES INCAffiliated With: GILSBAR INC

Fund No:PlanType: Group Health

GILSBAR(800) 445-7227

GILSBARPO Box 2947COVINGTON LA 70434

TRUSTEED PLANS SERVICE GROUP(800) 426-9786

AMERICAN HEALTH HOLDING(888) 877-7994

CALLISONS INC - PEPMAffiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE GROUP(800) 426-9786

TRUSTEED PLANS SERVICE GROUPPO Box 1894TACOMA WA 98401-1894

SMITH ADMINISTRATORS(817) 335-2582

SERVICE ADVOCATES(877) 261-5511

CAMBERLEY HOTEL COAffiliated With: SMITH ADMINISTRATORS

Term Effective: 8/31/2007Fund No:PlanType: Group Health

SMITH ADMINISTRATORS(817) 335-2582

SMITH ADMINISTRATORS3800 SANDSHELL DR STE 260FT. WORTH TX 76134

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-98• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 99: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERCambridge Integrated Services/Allied Automotive Group

Affiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Health Plan Services(800) 681-0056

First Health(800) 639-9157

Cambridge Life Insurance CompanyAffiliated With: First Health Life and Health Insurance Company

Fund No: V5038PlanType: Group Health

Health Plan Services(800) 681-0056

First HealthPO Box 44199Las Vegas NV 89116

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

CAMCO, INC.Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

TRUE CHOICE(800) 251-9665

UM NOT APPLICABLECAMERON UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 251-9665

TRUE CHOICEPO Box 700307DALLAS TX 75370

Canadian Medical Network Canadian Medical NetworkCANADIAN MEDICAL NETWORKAffiliated With: CANADIAN MEDICAL NETWORK

*

Fund No:PlanType: Group Health

Canadian Medical Network Canadian Medical Network140 Renfrew Dr. Ste 103Ontario, Canada L3R 6B3

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-99• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 100: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FISERV HEALTH INC(800) 235-7160

AVIDYN HEALTH(866) 802-1328

CANADIAN PIPE & SUPPLY CO INC

Affiliated With: FISERV HEALTH KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH INC(800) 235-7160

FISERV HEALTH INCPO Box 520Pueblo CO 81002-0520

COOPERATIVE BENEFIT ADMINISTRATOR(402) 483-9200

CHECK BENEFIT CARDCANADIAN VALLEY ELECTRIC CO-OP

Affiliated With: NATIONAL RURAL ELECTRIC COOPERATIVE ASSOCIATION

Fund No:PlanType: Group Health

COOPERATIVE BENEFIT ADMINISTRATOR(402) 483-9200

COOPERATIVE BENEFIT ADMINISTRATORPO Box 6249LINCOLN NE 68506-0249

HEALTH NET FEDERAL SERVICES(972) 550-2836

UM NOT APPLICABLECANANDAIGUA VAMC 4004Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(972) 550-2836

ALBANY (STRATTON) VA MEDICAL CENTER

113 HOLLAND AVEALBANY NY 12208

Attn: FEE BASIS 136E

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDCANCER TREATMENT CENTERS OF AMERICA INC

Affiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

Cannon Cochran Management Services Inc(800) 252-5059

CONTACT EMPLOYERCannon Cochran Management Services, Inc.

Affiliated With: Stratacare

Fund No:PlanType: Workers' Compensation

StrataCare Inc(800) 277-6512

Cannon Cochran Management Services IncTown Centre Bldg 2 East Main St Ste 208Danville IL 61832

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-100• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 101: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ECOM PPO ADVISORS, INC

UM NOT APPLICABLECAPITAL INTERNATIONAL MANAGEMENT

Affiliated With: ECOM PPO ADVISORS INC

Fund No:PlanType: Group Health

ECOM PPO ADVISORS, INC ECOM PPO ADVISORS, INC

8350 N. CENTRAL EXPWY, STE 600DALLAS TX 75206

Attn: ACCOUNTING

FISERV HEALTH INC(800) 826-9781

AVIDYN HEALTH(800) 808-4424

CAPITAL LUMBER COMPANYAffiliated With: WAUSAU BENEFITS INC

Fund No:PlanType: Group Health

FISERV HEALTH INC(800) 826-9781

FISERV HEALTH INCPO Box 450Pueblo CO 81002-0450

CHECK BENEFIT CARD CHECK BENEFIT CARDCAPITOL ROOFING SERVICESAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

THE EPOCH GROUP, LC(913) 362-0040

THE EPOCH GROUP, LC(913) 362-0040

CARDIOVASCULAR CONSULTANTS PC

Affiliated With: THE EPOCH GROUP 10469

Fund No:PlanType: Group Health

THE EPOCH GROUP, LC(913) 362-0040

THE EPOCH GROUP, LCPO Box 12170OVERLAND PARK KS 66282

GROUP & PENSION ADMINISTRATORS INC(800) 827-7223

HEALTH WATCH(972) 238-7900

CARDON HEALTHCAREAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS INC(972) 238-7900

GROUP & PENSION ADMINISTRATORS INC12770 MERIT DR STE 200DALLAS TX 75251

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-101• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 102: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

KLAIS & COMPANY INC(800) 331-1096

CHECK BENEFIT CARDCAREER EDUCATION CORPORATION

Affiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(800) 331-1096

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

MCMC LLC(888) 350-1150 Ext 228

MCMC LLC(888) 350-1150 Ext 228

CARESYS AUTOAffiliated With: MCMC LLC

Fund No:PlanType: Auto

MCMC LLC(888) 350-1150 Ext 228

MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317

CareWorks(800) 627-0065

CareWorks(800) 627-0065

CareWorks

Fund No:PlanType: Group Health

CareWorks(800) 627-0065

CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERCareWorks

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

RESOURCEONE ADMINSTRATORS(800) 967-2077

MEDCAREONE CORP(800) 816-1206

CAREY JOHNSON OIL COMPANYAffiliated With: RESOURCEONE ADMINISTRATORS

Fund No:PlanType: Group Health

RESOURCEONE ADMINSTRATORS(800) 967-2077

RESOURCEONE ADMINSTRATORS

PO Box 489BUCKEYSTOWN MD 21717

Attn: Mary Shepherd

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-102• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 103: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

CARLING TECHNOLOGIES INC.Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

First Health(800) 654-5321

First Health(800) 654-5321

Carlson Restaurants Worldwide - Platinum and Gold

Affiliated With: Carlson Holdings Inc.

Fund No: H8240PlanType: Group Health

The First Health® Network is not used for Behavioral Health services.

First Health(800) 654-5321

First HealthPO Box 8400London KY 40742

First Health(800) 654-5321

First Health(800) 654-5321

Carlson Restaurants Worldwide - Silver

Affiliated With: Carlson Holdings Inc.

Fund No: H8240PlanType: Group Health

First Health(800) 654-5321

First HealthPO Box 8400London KY 40742

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

CARR PRINTING COMPANY, INC.Affiliated With: TALL TREE ADMININSTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

CHECK BENEFIT CARD CHECK BENEFIT CARDCARRIAGE INCAffiliated With: ALLIED BENEFIT SYSTEMS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-103• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 104: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CORESOURCE(800) 327-5462

CORESOURCE(866) 794-0770

CARROLL DISTRIBUTING COMPANY

Affiliated With: CORESOURSE

Fund No:PlanType: Group Health

CORESOURCE(800) 327-5462

CORESOURCE5200 77 CENTER DR STE 400CHARLOTTE NC 28217

T R PAUL INC.8006788161 Ext 244

CHECK BENEFIT CARDCARVILL AMERICA INCAffiliated With: T R PAUL INC.

Fund No:PlanType: Group Health

T R PAUL INC.8006788161 Ext 244

T R PAUL INC.PO Box 5508NEWTON CT 06470-5508

Claims Administrative Services, Inc.(800) 765-2412

Forte(800) 580-4567

CAS - Claims Administrative Services

Affiliated With: STRATACARE

Fund No:PlanType: Workers' Compensation

Claims Administrative Services, Inc.(800) 765-2412

Claims Administrative Services, Inc.501 Shelley DrTyler TX 75711

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

CASCADE AUTOMOTIVE, INC.Affiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

ASSURECARE1011 SW EMKAY DR STE 209BEND OR 97702

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

CASHMAN EQUIPMENTAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-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.

Page 105: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

CASHMAN PHOTO ENTERPRISES OF NEVADA - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

ASSURECARE(800) 968-6616

CARELINE(763) 383-4800

CATAAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823

OSF HealthPlans, Inc.(800) 673-5222

CHECK BENEFIT CARDCATHOLIC DIOCESE OF PEORIAAffiliated With: OSF HEALTHPLANS INC #20714

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(309) 677-8356

OSF HealthPlans, Inc.PO Box 5128PEORIA IL 61601-5128

AMERICAS CHOICE HEALTHPLANS(800) 633-4226

HEALTHCARE SOLUTIONS GROUP, INC.(800) 582-1535

CAVLIER TELEPHONEAffiliated With: AMERICAS CHOICE HEALTHPLAN

Fund No:PlanType: Group Health

AMERICAS CHOICE HEALTHPLANS(800) 633-4226

AMERICAS CHOICE HEALTHPLANS13111 Northwest Fwy, Ste 510Houston TX 77040

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

CHECK BENEFIT CARDCayman IslandsAffiliated With: International Medical Group, Inc.

Fund No:PlanType: Group Health

The First Health® Network is not used for Chiropractic services.

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-105• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 106: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDCAYUCOS ELEMENTARY SCHOOLAffiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

CBCA Administrators Inc(800) 831-7783

Capp Care(800) 937-2277 or (714) 251-2200

CBCA Administrators, Inc.Affiliated With: CBCA Administrators, Inc.

Fund No:PlanType: Group Health

-Network participation is contingent upon proper member identification. The First Health® Network Logo must be on the benefit card.

CBCA Administrators Inc(800) 831-7783

CBCA Administrators Inc1979 Marcus Ave Ste C101Lake Success NY 11042

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

CCASAPEAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

CCASAPE/Clark County School District - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-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.

Page 107: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDCCLC INTLAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDCCN ELECTRONIC DIRECTORY GH

Affiliated With: CCN ELECTRONIC DIRECTORY FORMERLY POW

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDCCN ELECTRONIC DIRECTORY INTERNATIONAL

Affiliated With: CCN ELECTRONIC DIRECTORY FORMERLY POW

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

CCSD SUPPORT STAFFAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CHECK BENEFIT CARD SELF INSURED PLANS LLC

CEDAR HAMMOCK FIRE CONTROL DISTRICT

Affiliated With: SELF INSURED PLANS LLC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-107• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 108: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERCedar Hill InsuranceAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CHECK BENEFIT CARD CHECK BENEFIT CARDCEGA GROUPAffiliated With: STAR HEALTHCARE NETWORK INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CREATIVE PLAN ADMINISTRATORS(301) 695-0480

AMERICAN HEALTH HOLDINGS(866) 648-5554

CENTER IMTAffiliated With: CREATIVE PLAN ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

CREATIVE PLAN ADMINISTRATORS(301) 695-0480

CREATIVE PLAN ADMINISTRATORSPO Box 734BUCKEYSTOWN MD 21717

HEALTHCOMP TPA(800) 442-7247

CHECK BENEFIT CARDCENTRAL CALIFORNIA ELECTRICAL WORKERS (CCEW)

Affiliated With: HEALTHCOMP THIRD PARTY ADMINISTRATORS

Fund No:PlanType: Group Health

HEALTHCOMP TPA(800) 442-7247

HEALTHCOMP TPAPO Box 45018Fresno CA 93718

FISERV HEALTH KANSAS(800) 235-7160

AVIDYN / VALUE CHECK(866) 802-1328

CENTRAL DETROIT DIESEL - ALLISON INC

Affiliated With: FISERV HEALTH - KANSAS

*

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-108• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 109: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CENTRAL IOWA HCS (3708)

CHECK BENEFIT CARDCENTRAL IOWA HCS 3708Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

CENTRAL IOWA HCS (3708) CENTRAL IOWA HCS (3708)

3600 30TH STREETDES MOINES IA 50310

Attn: FEE OAS-D

MAKSIN MANAGEMENT CORP(800) 220-1123

UM NOT APPLICABLECENTRAL METHODIST UNIVERSITY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

MAKSIN MANAGEMENT CORP(800) 220-1123

MAKSIN MANAGEMENT CORP2500 McClellan AvePennsauken NJ 08109

CERES HEALTH CARE INC CERES HEALTH CARE INC

CENTRAL RESERVE LIFE INSURANCE COMPANY

Affiliated With: AMERICAN REPUBLIC INSURANCE CO.

Fund No:PlanType: Group Health

CERES HEALTH CARE INC CERES HEALTH CARE INC17800 ROYALTON RDSTONGSVILLE OH 44136

HCH ADMINISTRATION INC(877) 876-5969

CHECK BENEFIT CARDCENTRAL STATES INDUSTRIAL EQUIPMENT & SERVICE, INC

Affiliated With: HEALTH DATA SERVICE

Fund No:PlanType: Group Health

HCH ADMINISTRATION INC(877) 876-5969

HCH ADMINISTRATION INCPO Box 1986PEORIA IL 61656

ADVENTIST HEALTH SYSTEM WEST

CHECK BENEFIT CARDCENTRAL VALLEY GENERAL HOSPITAL

Affiliated With: ADVENTIST HEALTH SYSTEM/WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM WEST

ADVENTIST HEALTH SYSTEM/WEST C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-109• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 110: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD5594992450

CHECK BENEFIT CARDCENTRAL VALLEY TRUSTAffiliated With: HEALTHCOMP ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD5594992450

CHECK BENEFIT CARD

SISCO(800) 547-4726

CHECK BENEFIT CARDCENTURY FOODSAffiliated With: SISCO/Cottingham & Butler

Fund No:PlanType: Group Health

SISCO(800) 547-4726

SISCOPO Box 389DUBUQUE IA 52004-0389

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

CHECK BENEFIT CARDCENTURY WESTPORTAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226

CERES c/o World Insurance(800) 786-7557

CHECK BENEFIT CARDCERES GROUP - CRS100 FHAffiliated With: AMERICAN REPUBLIC INSURANCE CO.

Fund No:PlanType: Group Health

CERES c/o World Insurance(800) 786-7557

CERES c/o World InsurancePO Box 2804Clinton IA 52733

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

CERSOSIMO INDUSTRIES, INCAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-110• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 111: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

CERSOSIMO LUMBER COMPANY, INC

Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

CERES c/o World Insurance(800) 253-4641

CHECK BENEFIT CARDCGI MAJOR MEDICAL CRS100 CCN

Affiliated With: AMERICAN REPUBLIC INSURANCE CO.

Fund No:PlanType: Group Health

CERES c/o World Insurance(800) 253-4641

CERES c/o World InsurancePO Box 2804Clinton IA 52733

ULTRABENEFITS INC(866) 858-7223

CHECK BENEFIT CARDCHADWICK MEDICAL ASSOCIATES, P.C.

Affiliated With: ULTRABENEFITS, INC.

Fund No:PlanType: Group Health

ULTRABENEFITS INC(866) 858-7223

ULTRABENEFITS INCPO Box 763WESTBORO MA 01581

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

CHALLENGE ENTERPRISES OF NORTH FLORIDA

Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-111• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 112: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

CHARLESTON AUTO PARTSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CHECK BENEFIT CARD CHECK BENEFIT CARDCHARLESTON SOUTHERN UNIVERSITY

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHARLESTON VAMC (RALPH H JOHNSON)

CHECK BENEFIT CARDCHARLESTON VAMC (RALPH H JOHNSON VA) 3539

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

CHARLESTON VAMC (RALPH H JOHNSON)

CHARLESTON VAMC (RALPH H JOHNSON)

109 BEE STCHARLESTON SC 29401

Attn: FEE BASIS 136F

ACORDIA NATIONAL C/O CCN(888) 685-7774

CHECK BENEFIT CARDCHATHAM STEEL CORPAffiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR

*

Fund No:PlanType: Group Health

ACORDIA NATIONAL C/O CCN(888) 685-7774

ACORDIA NATIONAL C/O CCNPO Box 3262CHARLESTON WV 25332

MBA(800) 877-3727

CRITIQUE(800) 666-5551

CHECK CITYAffiliated With: MANAGED BENEFIT ADMINISTRATORS & INSURANCE

Fund No:PlanType: Group Health

MBA(801) 268-3334

MBAPO Box 651109SALT LAKE CITY UT 84165-1109

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-112• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 113: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MCMC LLC(888) 350-1150 Ext 228

MCMC LLC(888) 350-1150 Ext 228

CHELMSFORD AUTOAffiliated With: MCMC LLC

Fund No:PlanType: Auto

MCMC LLC(888) 350-1150 Ext 228

MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317

CHECK BENEFIT CARD6514397098

CHECK BENEFIT CARDCHEMEKETA COMMUNITY COLLEGE

Affiliated With: STUDENT ASSURANCE SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD6514397098

CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERCherokee InsuranceAffiliated With: Cherokee Insurance

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

CONTACT EMPLOYER CONTACT EMPLOYER

HEALTHSCOPE BENEFITS INC(800) 560-4664

CHECK BENEFIT CARDCHESAPEAKE ENERGY CORPORATION

Affiliated With: HEALTHSCOPE BENEFITS

*

Term Effective: 12/31/2007Fund No:PlanType: Group Health

HEALTHSCOPE BENEFITS INC(800) 560-4664

HEALTHSCOPE BENEFITS INC27 CORPORATE HILL DRLITTLE ROCK AR 72205

CHECK BENEFIT CARD CHECK BENEFIT CARDChevron CorporationAffiliated With: Chevron Corporation

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

Chevron Chevron6001 Bollinger Canyon Rd Ste ESan Ramon CA 94583-2324

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-113• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 114: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHEYENNE VAMC CHECK BENEFIT CARDCHEYENNE VAMC 3531Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

CHEYENNE VAMC CHEYENNE VAMC

WILLIAM ST off HWY 12 WESTFORT HARRISON MT 59636

Attn: FEE BASIS

JESSE BROWN VAMC CHECK BENEFIT CARDCHICAGO (JESSE BROWN VAMC) 3160

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

JESSE BROWN VAMC JESSE BROWN VAMC

820 S DAMEN AVE 5210CHICAGO IL 60612

Attn: FEE 136E

CHECK BENEFIT CARD CHECK BENEFIT CARDCHICAGO MCGILL ELECTRIC SWITCH

Affiliated With: MCGILL ELECTRIC SWITCH PRODUCT GROUP

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PREMIER CLAIMS ADMINISTRATORS7753245644

UNIVERSAL HEALTH NETWORK(702) 356-1159

CHICAGO-VEGAS HOLDING COMPANY, INC

Affiliated With: PREMIER CLAIMS ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

PREMIER CLAIMS ADMINISTRATORS7753245644

PREMIER CLAIMS ADMINISTRATORSPO Box 19338RENO NV 89511

CHECK BENEFIT CARD CHECK BENEFIT CARDCHICK PACKAGINGAffiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-114• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 115: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDCHICKSAW HOLDING COMPANYAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

CHILDRENS HEART CENTER LV - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CHECK BENEFIT CARD CHECK BENEFIT CARDCHILES RESTAURANT GROUPAffiliated With: SELF INSURED PLANS LLC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHILLICOTHE VA MEDICAL CENTER

CHECK BENEFIT CARDCHILLICOTHE VA MEDICAL CENTER 3524

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

CHILLICOTHE VA MEDICAL CENTER

CHILLICOTHE VA MEDICAL CENTER

17273 STATE RT 104CHILLICOTHE OH 45601

Attn: 136 BLD 27 RM 17

EBPA(802) 846-8060

CHECK BENEFIT CARDCHITTENDEN CORPORATION JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-115• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 116: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDCHOCTAW ELECTRIC COOPERATIVE INC

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

UPSTATE ADMINISTRATIVE SERVICES C O CHOICE PLUS OF VERMONT

CHECK BENEFIT CARDCHOICE PLUS OF VERMONTAffiliated With: UPSTATE ADMINISTRATIVE SERVICES C O

Fund No:PlanType: Group Health

UPSTATE ADMINISTRATIVE SERVICES C O CHOICE PLUS OF VERMONT

UPSTATE ADMINISTRATIVE SERVICES C O CHOICE PLUS OF VERMONTPO Box 6589SYR NY 13217-6589

BENEFIT MANAGEMENT INC.(800) 290-1368

MedWatch(800) 432-8421

CHOICE SOLUTIONS, INCAffiliated With: BENEFIT MANAGEMENT INC

Fund No:PlanType: Group Health

BENEFIT MANAGEMENT INC.(800) 290-1368

BENEFIT MANAGEMENT INC.PO Box 1090GREAT BEND KS 67530

SRT ADMINISTRATORS, INC.(888) 690-2020

SRT ADMINISTRATORS, INC C/O CCN

CH'OOSHGAI COMMUNITY SCHOOL

Affiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS, INC C/O CCN(888) 690-2020

SRT ADMINISTRATORS, INC.PO Box 25160SCOTTSDALE AZ 85255-0102

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

CHRISTENSEN & GRIFFITH CONSTRUCTION

Affiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-116• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 117: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PRINCIPAL FINANCIAL GROUP(800) 522-2161

CHECK BENEFIT CARDCHRISTIAN BROTHERS EMPLOYEE BENEFIT TRUST

Affiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARDCHROMA TECH WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARDCHROMA TECH WRAP VSTAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

CDS Group Health(775) 352-6951

UNIVERSAL HEALTH REVIEW(775) 355-0921

CHROMALLOYAffiliated With: CDS GROUP HEALTH

Fund No:PlanType: Group Health

CDS Group Health(775) 352-6951

CDS Group Health1625 E PRATER WAY BLDG C STE 101SPARKS NV 89461

CHECK BENEFIT CARD CHECK BENEFIT CARDChurch of Jesus Christ of Latter-Day Saints The

Fund No:PlanType: Group Health

Deseret Mutual Benefit Administrators(800) 777-1647

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-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.

Page 118: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

American Administrative Group(800) 658-9777

American Administrative Group(877) 202-6379 Ext 2530

CIMARRON ELECTRIC COOPERATIVE

Affiliated With: AMERICAN ADMINISTRATIVE GROUP

Fund No:PlanType: Group Health

American Administrative Group(800) 658-9777

American Administrative GroupPO Box 53070LUBBOCK TX 79453

Underwriters Safety & Claims, Inc.(800) 678-1536

Bluegrass Health Network(800) 264-7502

Cincinnati RedsAffiliated With: Underwriters Safety & Claims Inc.

Fund No:PlanType: Group Health

Underwriters Safety & Claims, Inc.(800) 678-1536

Underwriters Safety & Claims, Inc.PO Box 23507Louisville KY 40223-0507

CINCINNATI VA MEDICAL CENTER

CHECK BENEFIT CARDCINCINNATI VA MEDICAL CENTER 3197

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

CINCINNATI VA MEDICAL CENTER

CINCINNATI VA MEDICAL CENTER

3200 VINE STCINCINNATI OH 45220

Attn: FEE BASIS 136E

SUPERIEN HEALTH NETWORK(800) 266-5896

CHECK BENEFIT CARDCINCOM SYSTEMS, INCAffiliated With: SUPERIEN HEALTH NETWORK #18373

Fund No:PlanType: Group Health

SUPERIEN HEALTH NETWORK(800) 266-5896

SUPERIEN HEALTH NETWORK

PO Box 2388 CSTOW OH 44224

Attn: Supervisor of the Claims Dept

HEALTH PLAN INC(508) 752-2480

CARE MANAGEMENT SERVICES(886) 325-1550

CITIZEN PUBLISHING - PEPMAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INCPO Box 5199WESTBOROUGH MA 01581

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-118• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 119: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FISERV HEALTH INC(800) 235-7160

AVIDYN HEALTH(214) 647-6194

CITIZENS BANK AND TRUST OF ARDMORE

Affiliated With: FISERV HEALTH

Fund No:PlanType: Group Health

FISERV HEALTH INC(800) 235-7160

FISERV HEALTH INCPO Box 530PUEBLO CO 81002-0530

CHECK BENEFIT CARD CHECK BENEFIT CARDCITY OF CALEXICOAffiliated With: PINNACLE CLAIMS MANAGEMENT INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

EQUITABLE PLAN SERVICES(405) 755-2929

CHECK BENEFIT CARDCITY OF CHICKASHAAffiliated With: EQUITABLE PLAN SERVICES

Fund No:PlanType: Group Health

EQUITABLE PLAN SERVICES(405) 755-2929

EQUITABLE PLAN SERVICESPO Box 720460OKLAHOMA CITY OK 73172

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INC

CITY OF CLERMONTAffiliated With: PREFERRED BENEFIT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INCPO Box 916188LONGWOOD FL 32791-6188

PROFESSIONAL CLAIMS MGMT(630) 655-1001

CHECK BENEFIT CARDCITY OF GARYAffiliated With: PROFESSIONAL CLAIMS MANAGEMENT

Fund No:PlanType: Group Health

PROFESSIONAL CLAIMS MGMT(630) 655-1001

PROFESSIONAL CLAIMS MGMT16 W 455 S FRONTGATE RD STE 216BURR RIDGE IL 60527

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-119• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 120: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GROUP & PENSION ADMINISTRATORS INC(800) 827-7223

HEALTH WATCH(972) 238-7900

CITY OF GRANBURY TRAVELAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS INC(972) 238-7900

GROUP & PENSION ADMINISTRATORS INC12770 MERIT DR STE 200DALLAS TX 75251

PARAGON BENEFITS, INC.(706) 327-9218

AMERICAN HEALTH HOLDINGS(706) 327-9218

CITY OF HAZLEHURSTAffiliated With: PARAGON BENEFITS INC

Fund No:PlanType: Group Health

PARAGON BENEFITS, INC.(706) 327-9218

PARAGON BENEFITS, INC.PO Box 12288COLUMBUS GA 31917

EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002

UM NOT APPLICABLE(800) 367-9939

CITY OF HOBARTAffiliated With: EMPLOYEE BENEFIT CONSULTANTS INC

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002

EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839

JSL ADMINISTRATORS, INC.(910) 480-3100

DOCTORS DIRECT HEALTHCARE(910) 485-0510

CITY OF JACKSONVILLEAffiliated With: JSL ADMINISTRATORS

Fund No:PlanType: Group Health

JSL ADMINISTRATORS, INC.(910) 480-3100

JSL ADMINISTRATORS, INC.201 HAY STREET, STE 302FAYETTEVILLE NC 28301

CONTACT EMPLOYER CONTACT EMPLOYERCity of Long BeachAffiliated With: Tristar

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

CONTACT EMPLOYER CONTACT EMPLOYER

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-120• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 121: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CITY OF LOS ANGELES(213) 847-9712

CITY OF LOS ANGELES(213) 847-9712

City of Los AngelesAffiliated With: Fair Isaac Corp / Diversified HealthCare Services

Fund No:PlanType: Workers' Compensation

CITY OF LOS ANGELES(213) 847-9712

CITY OF LOS ANGELES700 E. Temple St Rm 210Los Angeles CA 90012

ASSURECARE(800) 968-6616

CARELINE(763) 383-4800

CITY OF MICHIGAN CITYAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823

GROUP ADMINISTRATORS, LTD.(800) 749-1422

CHECK BENEFIT CARDCITY OF MIDWEST CITYAffiliated With: GROUP ADMINISTRATORS LTD

Fund No:PlanType: Group Health

GROUP ADMINISTRATORS, LTD.(800) 749-1422

GROUP ADMINISTRATORS, LTD.PO Box 95600HOFFMAN ESTATES IL 60195

C.L. FRATES AND COMPANY(405) 290-5696

C.L. FRATES AND COMPANY(800) 669-1815

CITY OF MOOREAffiliated With: C L FRATES & COMPANY

Fund No:PlanType: Group Health

C.L. FRATES AND COMPANY(405) 290-5696

C.L. FRATES AND COMPANYPO Box 26967OKLAHOMA CITY OK 73126-0967

Benefit Planners(800) 292-5386

CHECK BENEFIT CARDCITY OF NORMANAffiliated With: BENEFIT PLANNERS

Fund No:PlanType: Group Health

Benefit Planners(800) 292-5386

Benefit PlannersPO Box 690450SAN ANTONIO TX 78269

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-121• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 122: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

CITY OF OKLAHOMA FALLSAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DRBEND OR 97702

ADMINISTRATIVE SOLUTIONS INC(678) 339-0211

CHECK BENEFIT CARDCITY OF PERRYAffiliated With: ADMINISTRATIVE SOLUTIONS, INC.

Fund No:PlanType: Group Health

ADMINISTRATIVE SOLUTIONS INC(678) 339-0211

ADMINISTRATIVE SOLUTIONS INCPO Box 2490ALPHARETTA GA 30023

AHC CHOICE HEALTH PLANS(800) 559-1322

CHECK BENEFIT CARDCITY OF PONCA CITYAffiliated With: AMERICAS CHOICE HEALTHPLANS

Fund No:PlanType: Group Health

(800) 559-1322 AHC CHOICE HEALTH PLANSPO Box 922009HOUSTON TX 77292-2009

THE EPOCH GROUP, LC(800) 365-9036

CHECK BENEFIT CARDCITY OF POPLER BLUFFAffiliated With: THE EPOCH GROUP, INC

Fund No:PlanType: Group Health

THE EPOCH GROUP, LC(800) 365-9036

THE EPOCH GROUP, LC10795 Watson RdSt. Louis MO 63129

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 700-7153

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.2094992000

CITY OF PUYALLUPAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS, INC

Fund No:PlanType: Group Health

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 700-7153

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.220 120TH Ave NE Bldg DBellevue WA 98005

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-122• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 123: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDCITY OF SAN RAMONAffiliated With: COASTAL TPA INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDCITY OF SCOTTSDALEAffiliated With: MAYO MANAGEMENT SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

THIRD PARTY ADMINISTRATIVE SERVICES(520) 670-0227

THIRD PARTY ADMINISTRATIVE SERVICES(520) 670-0227

CITY OF SIERRA VISTAAffiliated With: THIRD PARTY ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

THIRD PARTY ADMINISTRATIVE SERVICES(520) 670-0227

THIRD PARTY ADMINISTRATIVE SERVICES7493 N Oracle Rd Ste 200Tucson AZ 85704

EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002

UM NOT APPLICABLE(800) 367-9939

CITY OF VALPARAISOAffiliated With: EMPLOYEE BENEFIT CONSULTANTS INC

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002

EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

CIVIL TOWN OF CLARKSVILLEAffiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-123• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 124: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERClaims ControlAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERClaims Indemnity Services IncAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CHECK BENEFIT CARD6783411722

CHECK BENEFIT CARDCLAIMS TECHNOLOGY INCAffiliated With: GLOBALCARE

Fund No:PlanType: Group Health

CHECK BENEFIT CARD6783411722

CHECK BENEFIT CARD

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

UM NOT APPLICABLECLARCOR, INCAffiliated With: ALLIED BENEFIT SYSTEMS INC

Fund No:PlanType: Group Health

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

ALLIED BENEFIT SYSTEMS, INC208 S LASALLE ST STE 1300CHICAGO IL 60604

HEALTH PLAN INC(508) 752-2480

CMS(866) 325-1550

CLAREMONT FLOCK CORPORATION

Affiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-124• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 125: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

KHS, A KMG AMERICA COMPANY(800) 822-1274

CHECK BENEFIT CARDCLAREMONT RESTAURANT GROUP, LLC

Affiliated With: KHS A KMG AMERICA COMPANY

Fund No:PlanType: Group Health

KHS, A KMG AMERICA COMPANY(800) 822-1274

KHS, A KMG AMERICA COMPANY210 S WHITE STLANCASTER SC 29720

THE LOOMIS COMPANY(800) 346-1223

CHECK BENEFIT CARDCLARK COUNTYAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(800) 346-1223

THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011

GROUP BENEFIT SERVICES, INC.(517) 631-3469

HEALTHLINK(314) 989-6115

CLARK COUNTY MISSOURIAffiliated With: GROUP BENEFIT SERVICES

Fund No:PlanType: Group Health

GROUP BENEFIT SERVICES, INC.(800) 995-3569

GROUP BENEFIT SERVICES, INC.1736 E. Sunshine Ste 200Springfield MO 65804

Underwriters Safety & Claims, Inc.(800) 678-1536

Bluegrass Health Network(800) 264-7502

Clark District Co. of VersaillesAffiliated With: Underwriters Safety & Claims Inc.

Fund No:PlanType: Group Health

Underwriters Safety & Claims, Inc.(800) 678-1536

Underwriters Safety & Claims, Inc.PO Box 23507Louisville KY 40223-0507

HEALTH NET FEDERAL SERVICES(214) 387-3232

CHECK BENEFIT CARDCLARKSBURG VA MEDICAL CENTER 3663

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(214) 387-3232

HEALTH NET FEDERAL SERVICES5504 HILL HEAVEN CTFRISCO TX 75035

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-125• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 126: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDCLAYTON COLLEGE & STATE UNIV AIH0057987

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDCLAYTON COLLEGE & STATE UNIV AIH0057997

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLECLAYTON COLLEGE & STATE UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

CHECK BENEFIT CARD CHECK BENEFIT CARDCLAYTON COUNTY GORGIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDCLAYTON STATE UNIVERSITY ICS AII61217

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-126• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 127: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

CHECK BENEFIT CARDClements and Company - USAIDAffiliated With: International Medical Group, Inc.

Fund No:PlanType: Group Health

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDCLEMENTS FOOD COMPANYAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDCLEMSON UNIVERSITYAffiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437

CLEVELAND VA MEDICAL CENTER

CHECK BENEFIT CARDCLEVELAND VA MEDICAL CENTER 3196

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

CLEVELAND VA MEDICAL CENTER

CLEVELAND VA MEDICAL CENTER

10000 BRECKSVILLE RDBRECKSVILLE OH 44141

Attn: FEE BASIS 136BF

DELTA HEALTH SYSTEMS(209) 474-5421

UNIVERSAL HEALTH NETWORK(800) 776-6959

CLICK BOND, INCAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(209) 474-5421

DELTA HEALTH SYSTEMSPO Box 80Stockton CA 95201

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-127• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 128: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(810) 269-8723

CLINICA DE SALUD DEL PUEBLOAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

NORTH AMERICA ADMINISTRATORS, L.P.6152563561 Ext 147

CHECK BENEFIT CARDCLINICAL RADIOLOGISTSAffiliated With: NORTH AMERICA ADMINISTRATORS L P

Fund No:PlanType: Group Health

NORTH AMERICA ADMINISTRATORS, L.P.6152563561 Ext 147

NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

EMPLOYEE BENEFIT ADMINISTRATORS(626) 294-2800

CHECK BENEFIT CARD(818) 842-0147

CLINICAS DEL CAMINO REALAffiliated With: EMPLOYEE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT ADMINISTRATORS(626) 294-2800

EMPLOYEE BENEFIT ADMINISTRATORS424 N. First Ave.ARCADIA CA 91006-2804

CHECK BENEFIT CARD8002218942

CHECK BENEFIT CARDCLOUGHERTY PACKING COMPANY

Affiliated With: TRANSWESTERN INSURANCE ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8002218942

CHECK BENEFIT CARD

PINNACLE CLAIMS MANAGEMENT(800) 649-9121

CHECK BENEFIT CARDCLOVIS UNIFIED SCHOOL DISTRICT

Affiliated With: PINNACLE CLAIMS MANAGEMENT

Fund No:PlanType: Group Health

PINNACLE CLAIMS MANAGEMENT(800) 649-9121

PINNACLE CLAIMS MANAGEMENTPO Box 2220NEWPORT BEACH CA 92658

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-128• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 129: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH PLAN INC(508) 752-2480

CHECK BENEFIT CARDCM ALMY AND SONS - %Affiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

AMERICAN HEALTH HOLDING(312) 906-8080 Ext 259

CM PRODUCTSAffiliated With: ALLIED BENEFIT SYSTEMS, INC.

Fund No:PlanType: Group Health

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

ALLIED BENEFIT SYSTEMS, INC208 S LASALLE ST STE 1300CHICAGO IL 60604

CHECK BENEFIT CARD CHECK BENEFIT CARDCMH FLOORING PRODUCTS INCAffiliated With: KHS A KMG AMERICA COMPANY

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERCNA Commerical InsuranceAffiliated With: Crawford and Company

Fund No:PlanType: Workers' Compensation

Accessed through Crawford and Company

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CHECK BENEFIT CARD CHECK BENEFIT CARDCOAST COMMUNITY COLLEGE DISTRICT

Affiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-129• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 130: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FCE BENEFIT ADMINISTRATORS(800) 899-9355

CHECK BENEFIT CARDCOAST JANITORIALAffiliated With: FCE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS(800) 899-9355

FCE BENEFIT ADMINISTRATORS4615 WALZEN RD STE 300SAN ANTONIO TX 78218

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDCOAST UNIFIED SCHOOL DISTRICT

Affiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDCOASTAL CAROLINA UNIVERSITYAffiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437

PARAGON BENEFITS(706) 327-9218

AMERICAN HEALTH HOLDING(877) 417-3363

COASTAL GEORGIA COMMUNITY ACTION AUTHORITY

Affiliated With: PARAGON BENEFITS INC

Fund No:PlanType: Group Health

PARAGON BENEFITS(706) 327-9218

PARAGON BENEFITSPO Box 12288COLUMBUS GA 31917

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDCOASTAL GEORGIA COMMUNITY COLLEGE AIH0058007

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-130• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 131: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDCOASTAL GEORGIA COMMUNITY COLLEGE AIH0058017

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLECOASTAL GEORGIA COMMUNITY COLLEGE UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

FCE BENEFIT ADMINISTRATORS(800) 899-9355

UM NOT APPLICABLECoastal International SecurityAffiliated With: FCE BENEFIT ADMINISTRATORS INC

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS(800) 899-9355

FCE BENEFIT ADMINISTRATORS4615 WALZEN RD STE 300SAN ANTONIO TX 78218

EQUITABLE PLAN SERVICES(405) 755-2929

CHECK BENEFIT CARDCOATES FIELD SERVICEAffiliated With: EQUITABLE PLAN SERVICES

Fund No:PlanType: Group Health

EQUITABLE PLAN SERVICES(405) 755-2929

EQUITABLE PLAN SERVICESPO Box 720460OKLAHOMA CITY OK 73172

COATESVILLE VAMC CHECK BENEFIT CARDCOATESVILLE VAMC 3124Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

COATESVILLE VAMC COATESVILLE VAMC

1400 BLACKHORSE HILL RDCOATSVILLE PA 19320

Attn: FEE BASIS - 115E

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-131• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 132: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Western Health(605) 719-4600 or (888) 341-1766

Western Health(605) 719-4640 or (800) 229-0892

Coca ColaAffiliated With: Rapid City Regional Hospital DBA Western Health

Fund No:PlanType: Group Health

Western Health(605) 719-4600 or (888) 341-1766

Western Health529 Kansas City St Ste 200Rapid City SD 57701

CHECK BENEFIT CARD CHECK BENEFIT CARDCODALE ELECTRIC SUPPLY INCAffiliated With: P5 HEALTH PLAN SOLUTIONS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDCOGBURN HEALTH SERVICESAffiliated With: CAROLINA BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDCOHEN BROTHERS, INC.Affiliated With: BENEFIT SREVICES INC.

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

GROUP & PENSION ADMINISTRATORS INC(800) 827-7223

HEALTH WATCH(972) 238-7900

COLDWELL BANKER UNITED, REALTORS

Affiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS INC(972) 238-7900

GROUP & PENSION ADMINISTRATORS INC12770 MERIT DR STE 200DALLAS TX 75251

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-132• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 133: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDCOLLEGE OF CHARLESTONAffiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437

Collegiate Health Care(203) 851-2400

Collegiate Health Care(203) 851-2400

Collegiate Health Care

Fund No:PlanType: Group Health

CHECK BENEFIT CARD Collegiate Health Care800 Connecticut Ave Box 5033Norwalk CT 06856-5033

EBPA(800) 578-3272

CHECK BENEFIT CARDCOLLEY MCCOY MANAGEMENT GROUP WRAP JMS

Affiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

CHECK BENEFIT CARD CHECK BENEFIT CARDCOLLINS PRODUCTS LLCAffiliated With: QVI RISK SOLUTIONS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PRIMARY PHYSICIAN CARE(704) 527-8102

PRIMARY PHYSICIAN CARE(704) 523-2758

COLONIAL GROUPAffiliated With: PRIMARY PHYSICIANCARE INC

Fund No:PlanType: Group Health

PRIMARY PHYSICIAN CARE(704) 527-8102

PRIMARY PHYSICIAN CAREPO Box 11088CHARLOTTE NC 28220

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-133• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 134: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Colonial Group International LTD(441) 296-3200

First Health(800) 423-9130

Colonial Medical Insurance CompanyAffiliated With: Colonial Group International LTD

Fund No: V8255�V8257PlanType: Group Health

Colonial Group International LTD(441) 296-3200

CHECK BENEFIT CARD

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

COLONY RESORT TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CONTACT EMPLOYER CONTACT EMPLOYERColorado Casualty WCAffiliated With: RAM

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

SUMMIT AMERICA INSURANCE SERVICES(877) 246-6997

CHECK BENEFIT CARDCOLORADO STATE UNIVERSITYAffiliated With: SUMMIT AMERICA INSURANCE SERVICES LC

Fund No:PlanType: Group Health

SUMMIT AMERICA INSURANCE SERVICES(877) 246-6997

SUMMIT AMERICA INSURANCE SERVICES

7400 COLLEGE BLVD STE 100OVERLAND PARK KS 66220

Attn: VIVIAN PAUL

COLUMBIA - DORN VAMC CHECK BENEFIT CARDCOLUMBIA (DORN VAMC) 3540Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

COLUMBIA - DORN VAMC COLUMBIA - DORN VAMC

6439 GARNERS FERRY RDCOLUMBIA SC 29209

Attn: FEE BASIS - 136F

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-134• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 135: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HARRY S TRUMAN VAMC CHECK BENEFIT CARDCOLUMBIA (HARRY S TRUMAN VAMC) 3525

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HARRY S TRUMAN VAMC HARRY S TRUMAN VAMC

800 HOSPITAL DRCOLUMBIA MO 65201

Attn: BUSSINESS OFFICE ADMN FEE

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDCOLUMBIA COLLEGE AMH9038017

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDCOLUMBIA COLLEGE JOHO482842

Affiliated With: MAKSIN MANAGEMENT CORPORATION

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLECOLUMBIA LIGHTHOUSE FOR THE BLIND

Affiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-135• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 136: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PARAGON BENEFITS, INC. PARAGON BENEFITS, INC.

COLUMBUS HOUSING AUTHORITY

Affiliated With: PARAGON BENEFITS, INC.

Fund No:PlanType: Group Health

PARAGON BENEFITS, INC. PARAGON BENEFITS, INC.2221 Manchester ExpresswayCOLUMBUS GA 31904

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDCOLUMBUS STATE UNIV AIH0058027

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDCOLUMBUS STATE UNIV AIH0058037

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLECOLUMBUS STATE UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

COLUMBUS VA OPC CHECK BENEFIT CARDCOLUMBUS VA OPC 3195Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

COLUMBUS VA OPC COLUMBUS VA OPC

543 TAYLOR AVECOLUMBUS OH 43203

Attn: FEE BASIS 136B2

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-136• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 137: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

CHECK BENEFIT CARDCOMANCHE COUNTY MEMORIAL HOSPITAL

Affiliated With: WATERSTONE BENEFITS ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

CHECK BENEFIT CARD CHECK BENEFIT CARDCOMMENCEMENT BAY CORRUGATED

Affiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

COMMERCE BENEFITS GROUP(440) 930-7500

COMMERCE BENEFITS GROUP(440) 930-7500

COMMERCE BENEFITS GROUP - PEPM

Affiliated With: COMMERCE BENEFITS GROUP

Fund No:PlanType: Group Health

COMMERCE BENEFITS GROUP(440) 930-7500

COMMERCE BENEFITS GROUPPO Box 900ELYRIA OH 44036

COMMERCE BENEFITS GROUP(800) 223-9941

COMMERCE BENEFITS GROUP

COMMERCE BENEFITS GROUP/BUCKEYE PREFERRED

Affiliated With: COMMERCE BENEFITS GROUP

Fund No:PlanType: Group Health

COMMERCE BENEFITS GROUP(800) 223-9941

COMMERCE BENEFITS GROUPPO Box 900ELYRIA OH 44036

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-137• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 138: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDCOMMERCIAL ENVIRONMENT SYSTEMS

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

CORPORATE MANAGEMENT HEALTH SERVICES(800) 423-5597

COMMERCIAL SEWING INCAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INC

COMMUNICATIONS INTERNATIONAL, INC.

Affiliated With: PREFERRED BENEFIT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INCPO Box 916188LONGWOOD FL 32791-6188

COMMUNITY ADMINISTRATORS

COMMUNITY ADMINISTRATORS

COMMUNITY ADMINISTRATORSAffiliated With: THE COMMUNITY HEALTH GROUP

Fund No:PlanType: Group Health

COMMUNITY ADMINISTRATORS

COMMUNITY ADMINISTRATORSPO Box 1177CHULA VISTA CA 91912

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

COMMUNITY BANK OF NEVADAAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

*

Term Effective: 9/30/2007Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-138• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 139: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AMERIBEN SOLUTIONS(800) 953-1801

CHECK BENEFIT CARDCOMMUNITY COLLEGE OF DENVER

Affiliated With: AMERIBEN SOLUTIONS #15255

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 953-1801

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

COMMUNITY ADMINISTRATORS

CHECK BENEFIT CARDCOMMUNITY DENTALAffiliated With: COMMUNITY HEALTH GROUP

Fund No:PlanType: Group Health

COMMUNITY ADMINISTRATORS

COMMUNITY ADMINISTRATORSPO Box 1177CHULA VISTA CA 91912

COMMUNITY ADMINISTRATORS(800) 838-2869

CHECK BENEFIT CARDCOMMUNITY HEALTH GROUP HMO

Affiliated With: THE COMMUNITY HEALTH GROUP

Fund No:PlanType: Group Health

COMMUNITY ADMINISTRATORS(800) 838-2869

COMMUNITY ADMINISTRATORSPO Box 1177CHULA VISTA CA 91912

NHBC(888) 621-7900

CHECK BENEFIT CARDCOMMUNITY HEALTH SERVICESAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

EASTERN BENEFIT SYSTEMS, INC.8990 East Raintree DrScottsdale AZ 85751

COMMUNITY HEALTH SOLUTIONS OF AMERICA, LLC(904) 737-1240

STRATEGIC HEALTH DEVELOPMENT(800) 874-2371

COMMUNITY HEALTH SOLUTIONS OF AMERICA, LLC

Affiliated With: CADENT ADMINISTRATORS

Fund No:PlanType: Group Health

COMMUNITY HEALTH SOLUTIONS OF AMERICA, LLC(904) 737-1240

COMMUNITY HEALTH SOLUTIONS OF AMERICA, LLC8130 BAY MEADOWS WAY W. STE202JACKSONVILLE FL 33256

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-139• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 140: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

COASTAL TPA, INC.(800) 564-7475

CHECK BENEFIT CARDCOMMUNITY HOSPITAL OF THE MONTEREY PENINSULA

Affiliated With: COASTAL TPA INC

Fund No:PlanType: Group Health

COASTAL TPA, INC.(800) 564-7475

COASTAL TPA, INC.PO Box 80308SALINAS CA 93912

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

Community One Federal Credit Union - Travel

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CompChoice(405) 302-3176

CompChoice(405) 302-3176

Comp Choice OKAffiliated With: Comp Choice OK

Fund No:PlanType: Workers' Compensation

CompChoice(405) 302-3176

CompChoice4005 NW Express WayOklahoma City OK 73116

CompIQ Corporation(800) 293-3131

UM NOT APPLICABLEComp IQ - ASPAffiliated With: CompIQ

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(800) 293-3131

CompIQ Corporation35 Tesla Way #100Irvine CA 92618

CompIQ Corporation(800) 293-3131

UM NOT APPLICABLEComp IQ - ASP AUTOAffiliated With: CompIQ

Fund No:PlanType: Auto

CompIQ Corporation(800) 293-3131

CompIQ Corporation35 Tesla Way #100Irvine CA 92618

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-140• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 141: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Insurers Administrative Corporation (IAC)(800) 843-3106

Med-Valu(800) 522-2161

COMPANION LIFE INSURANCE COMPANY

Affiliated With: INSURERS ADMINISTRATIVE CORPORATION #11337

Fund No:PlanType: Group Health

Insurers Administrative Corporation (IAC)(800) 843-3106

Insurers Administrative Corporation (IAC)PO Box 828Park Ridge IL 60068-0828

Insurers Administrative Corp(800) 964-4948

Med-Valu(800) 522-2161

Companion Life Insurance CompanyAffiliated With: Insurers Administrative Corporation

Fund No:PlanType: Group Health

Insurers Administrative Corp(602) 906-6263

Insurers Administrative CorpPO Box 828Park Ridge IL 60068-0828

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUP(800) 533-5044

COMPASS GROUP INCAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(888) 421-2926

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

CHECK BENEFIT CARD CHECK BENEFIT CARDCompass Rose Benefit GroupAffiliated With: Compass Rose Benefit Group

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CompIQ Corporation(800) 293-3131

UM NOT APPLICABLECompIQAffiliated With: CompIQ #13910

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(800) 293-3131

CompIQ Corporation35 Tesla Way #100Irvine CA 92618

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-141• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 142: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

NHBC(888) 621-7900

CHECK BENEFIT CARDCOMPLETE BENEFITS SOLUTIONS LLC

Affiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 East Raintree DrScottsdale AZ 85751

Network Adjusters(516) 750-1319

CONTACT EMPLOYERCompMed Advantage / City of Peekskill

Affiliated With: CompMed Advantage

Fund No:PlanType: Workers' Compensation

Network Adjusters(516) 750-1319

Network AdjustersPO Box 6008Garden City NY 11530

KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711

CHECK BENEFIT CARDCOMPONE SERVICES LTDAffiliated With: THE KEMPTON GROUP

Fund No:PlanType: Group Health

KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711

KEMPTON GROUP ADMINISTRATORS INCPO Box 54889OKLAHOMA CITY OK 73154

EBPA(802) 846-8060

CHECK BENEFIT CARDCOMPREHENSIVE BENEFIT ADMINISTRATOR INC JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-142• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 143: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBPA(802) 846-8060

CHECK BENEFIT CARDCONCEPTS NREC INC VSTAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

ACORDIA NATIONAL(888) 685-7774

CHECK BENEFIT CARDCONCORD HOSPITALITY ENTERPRISES COMPANY

Affiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR

Fund No:PlanType: Group Health

ACORDIA NATIONAL(888) 685-7774

ACORDIA NATIONALPO Box 3262CHARLESTON WV 25332

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

CONCORDIA HOMES OF NEVADAAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

CHECK BENEFIT CARDCONNECTICUT COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706

EBPA(800) 525-8788

CHECK BENEFIT CARDCONNECTICUT STEEL WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-143• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 144: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONNECTICUT VA HEALTHCARE SYSTEM

CHECK BENEFIT CARDCONNECTICUT VA HEALTHCARE SYSTEM 3113

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

CONNECTICUT VA HEALTHCARE SYSTEM

CONNECTICUT VA HEALTHCARE SYSTEM

555 WILLIARD AVENEWINGTON CT 06111

Attn: FEE BASIS (04F)

Brokerage Concepts, Inc. BENEFIT CONCEPTS, INC.(800) 883-2000

CONNOLLY BOVE LODGE & HUTZ LLP

Affiliated With: BROKERAGE CONCEPTS BENEFIT CONCEPTS, INC.

Fund No:PlanType: Group Health

BENEFIT CONCEPTS, INC. BENEFIT CONCEPTS, INC.1021 W 8TH AVEKING OF PRUSSIA PA 19406

GROUP & PENSION ADMINISTRATORS(800) 827-7223

HEALTH WATCH(972) 238-7900

CONSOLIDATED CASTING TRAVEL

Affiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223 Ext 2325

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

CHECK BENEFIT CARD CHECK BENEFIT CARDCONSOLIDATED GRAPHICSAffiliated With: BENEFIT PLANNERS LTD

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

ADMINONE CORPORATION(800) 967-2077

MEDCAREONE CORP(800) 816-1206

CONSOLIDATED HEALTH PLANAffiliated With: ADMINONE CORPORATION

Fund No:PlanType: Group Health

ADMINONE CORPORATION(800) 967-2077

RESOURCEONE ADMINSTRATORS

PO Box 489BUCKEYSTOWN MD 21717

Attn: Mary Shepherd

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-144• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 145: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

HEALTHCHOICE(407) 481-7125

CONSOLIDATED MINERALS INCAffiliated With: PREFERRED BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INCPO Box 916188LONGWOOD FL 32791-6188

MERCER ADMINISTRATION8005624023

CARE ALLIES(972) 307-2700

CONSOLIDATED RESOURCES INCAffiliated With: MERCER ADMINISTRATION #10442

Fund No:PlanType: Group Health

MERCER ADMINISTRATION8005624023

MERCER ADMINISTRATIONPO Box 1520IOWA CITY IA 52244

ULTRABENEFITS INC(800) 323-4890

INTRACORP(800) 875-5315

CONSTRUCTION DATA COMPANYAffiliated With: UNITED BENEFITS DIVISION

Fund No:PlanType: Group Health

ULTRABENEFITS INC(800) 323-4890

ULTRABENEFITS INCPO Box 2480DAYTONA BEACH FL 32115-2480

TRANSWESTERN INSURANCE ADMINISTRATORS, INC.5594992000 8002218942

CHECK BENEFIT CARDCONSTRUCTION PROTECTIVE SERVICES INC

Affiliated With: TRANSWESTERN INSURANCE ADMINISTRATORS INC

Fund No:PlanType: Group Health

TRANSWESTERN INSURANCE ADMINISTRATORS, INC.8002218942

TRANSWESTERN INSURANCE ADMINISTRATORS, INC.PO Box 45019Fresno CA 93718

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

Consumer Credit Services Inc TravelAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

*

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-145• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 146: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Insurers Administrative Corporation (IAC)(602) 906-6263

Insurers Administrative Corporation (IAC)(602) 395-7096

CONSUMER'S CHOICE/USAAffiliated With: AMERICAS HEALTH CARE BENEFIT PLAN

Fund No:PlanType: Group Health

Insurers Administrative Corporation (IAC)(602) 906-6263

Insurers Administrative Corporation (IAC)PO Box 39119Phoenix AZ 85069-9119

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

CONSUMERS INTERSTATE CORPORATION

Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

SCHALER ANDERSON HEALTHCARE(602) 659-1403

CHECK BENEFIT CARDCONTACT-RURAL METROAffiliated With: SCHALLER ANDERSON HEALTHCARE

Fund No:PlanType: Group Health

SCHALER ANDERSON HEALTHCARE(602) 659-1403

SCHALER ANDERSON HEALTHCARE4645 E. COTTON CENTER BLVD BLDG 1 #200PHOENIX AZ 85040

CONTINENTAL GENERAL INSURANCE COMPANY

CERES HEALTH CARE INC

CONTINENTAL GENERAL INSURANCE COMPANY

Affiliated With: AMERICAN REPUBLIC INSURANCE CO.

Fund No:PlanType: Group Health

CONTINENTAL GENERAL INSURANCE COMPANY

CONTINENTAL GENERAL INSURANCE COMPANYPO Box 247007OMAHA NE 68124

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDCONTINENTAL RESOURCESAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-146• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 147: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERContinental Western GroupAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

BAC(614) 863-8780

BAC(614) 863-8780

CONTRACT LUMBERAffiliated With: BUSINESS ADMNISTRATORS & CONSULTANTS INC

Fund No:PlanType: Group Health

BAC(614) 863-8780

BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARDCONTRACTORS BONDING AND INSURANCE COMPANY

Affiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARD

HEALTH PLAN INC(508) 752-2480

CARE MANAGEMENT SERVICES(866) 325-1550

CONTROL DEVICES INC DBA FIRST TECHNOLOGY

Affiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

EBPA(802) 846-8060

CHECK BENEFIT CARDCONTROL TECHNOLOGIES JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-147• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 148: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARDCONTROL TECHNOLOGIES WRAP JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

Benefit Planners(800) 292-5386

CHECK BENEFIT CARDCOOPER CAMERON CORPORATION

Affiliated With: BENEFIT PLANNERS

*

Fund No:PlanType: Group Health

Benefit Planners(800) 292-5386

Benefit PlannersPO Box 690450SAN ANTONIO TX 78269

Health Design Plus(877) 286-3559

Health Design Plus(800) 385-7085

COOPER STANDARD AUTOMOTIVE INC

Affiliated With: HEALTH DESIGN PLUS

Fund No:PlanType: Group Health

Health Design Plus(877) 286-3559

Health Design Plus1755 GEORGETOWN ROADHUDSON OH 44236

Health Design Plus(877) 286-3559

Health Design Plus(800) 385-7085

COOPER TIRE & RUBBER COMPANY

Affiliated With: HEALTH DESIGN PLUS

Fund No:PlanType: Group Health

Health Design Plus(877) 286-3559

Health Design Plus1755 GEORGETOWN ROADHUDSON OH 44236

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-148• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 149: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Employee Benefit Management Corp (EBMC)(614) 766-5800

ACMS(800) 831-6677

COOPERATIVE GROUP BENEFITS PLAN

Affiliated With: EMPLOYEE BENEFIT MANAGEMENT CORP

Fund No:PlanType: Group Health

Employee Benefit Management Corp (EBMC)(614) 766-5800

Employee Benefit Management Corp (EBMC)4789 Rings RdDublin OH 43017-1599

BENEFIT ADMINISTRATIVE SYSTEMS(800) 737-0878

CHECK BENEFIT CARDCOPE PLASTICSAffiliated With: BENEFIT ADMINISTRATIVE SYSTEMS INC

Fund No:PlanType: Group Health

BENEFIT ADMINISTRATIVE SYSTEMS(800) 737-0878

BENEFIT ADMINISTRATIVE SYSTEMS6 EXECUTIVE DR, SUITE ONEFAIRVIEW HEIGHTS IL 62208

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARDCORBIS CORPORATIONAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARD

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

MED-CERT(800) 356-7126

CORE CARRIER CORPORATIONAffiliated With: NORTH AMERICA ADMINISTRATORS LP

Fund No:PlanType: Group Health

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

QUALIFIED BENEFIT SERVICES LLC(801) 853-1300

CHECK BENEFIT CARDCORE INNOVATIVE SOLUTIONS, LLC

Affiliated With: QUALIFIED BENEFIT SERVICES, INC

Fund No:PlanType: Group Health

QUALIFIED BENEFIT SERVICES LLC(801) 853-1300

QUALIFIED BENEFIT SERVICES LLC691 W 1200 N, Suite 200SPRINGVILLE UT 84663

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-149• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 150: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

THE LOOMIS COMPANY(877) 634-9814

HINES & ASSOCIATES(888) 826-5769

CORESLAB STRUCTURESAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(877) 634-9814

THE LOOMIS COMPANYPO Box 7045Wyomissing PA 19610

CHECK BENEFIT CARD CHECK BENEFIT CARDCORNISH COLLEGE OF THE ARTSAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDCORONET MANUFACTURING CO INC

Affiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDCORPORATE BENEFIT SERVICES OF AMERICA (CBSA)

Affiliated With: CORPORATE BENEFIT SERVICES OF AMERICA (CBSA)

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AMERICAN STERLIN(877) 292-6037

CHECK BENEFIT CARDCORPORATE RESOURCE MANAGEMENT INC

Affiliated With: AMERICAN STERLIN

Fund No:PlanType: Group Health

AMERICAN STERLIN(877) 292-6037

AMERICAN STERLINPO Box 26103OVERLAND PARK KS 66225

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-150• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 151: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ACORDIA NATIONAL(888) 685-7774

ACORDIA NATIONAL(304) 353-8743

CORPORATE WINGSAffiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR

Fund No:PlanType: Group Health

ACORDIA NATIONAL(888) 685-7774

ACORDIA NATIONALPO Box 3262CHARLESTON WV 25332

ENTRUST INC(281) 368-7878

MEDICAL HELPLINE(877) 463-3435

CORRPRO COMPANIESAffiliated With: ENTRUST INC

Fund No:PlanType: Group Health

ENTRUST INC(281) 368-7878

ENTRUST INC14701 ST MARY'S LN STE 150HOUSTON TX 77079

SISCO(563) 587-5175

SISCO(563) 587-5175

Cottingham and Butler SISCOAffiliated With: Fair Isaac Corporation

Fund No:PlanType: Workers' Compensation

SISCO(563) 587-5175

SISCOPO Box 28Dubuque IA 52004

KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711

CHECK BENEFIT CARDCOTTON ELECTRIC COOPERATIVE

Affiliated With: THE KEMPTON GROUP INC

Fund No:PlanType: Group Health

KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711

KEMPTON GROUP ADMINISTRATORS INCPO Box 54889OKLAHOMA CITY OK 73154

International Medical Group, Inc.(317) 636-4721

Check Benefit CardCUNA Mutual Insurance SocietyPO Box 1648Madison WI 52701 or

Council on International Educational Exchange (CIEE)

Affiliated With: International Medical Group, Inc.

Fund No:PlanType: Group Health

International Medical Group, Inc.(317) 636-4721

International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-151• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 152: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GALLAGHER BENEFIT ADMINISTRATORS INC(888) 478-2650

GALLAGHER BENEFIT ADMINISTRATORS INC(630) 493-3925

COUNTY OF KERN POS PLANAffiliated With: GALLAGHER BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

GALLAGHER BENEFIT ADMINISTRATORS INC(888) 478-2650

GALLAGHER BENEFIT ADMINISTRATORS INCPO Box 5227LISLE IL 60532

GALLAGHER BENEFIT ADMINISTRATORS INC(888) 478-2650

GALLAGHER BENEFIT ADMINISTRATORS INC(630) 493-3925

COUNTY OF KERN PPO PLANAffiliated With: GALLAGHER BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

GALLAGHER BENEFIT ADMINISTRATORS INC(888) 478-2650

GALLAGHER BENEFIT ADMINISTRATORS INCPO Box 5227LISLE IL 60532

DELTA HEALTH SYSTEMS(800) 556-5918

DELTA TEAMCARE(877) 464-1441

COUNTY OF KINGSAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(800) 556-5918

DELTA HEALTH SYSTEMSPO Box 1147STOCKTON CA 95201

COUNTY OF LOS ANGELES(213) 637-0822

COUNTY OF LOS ANGELES(213) 637-0822

County Of Los AngelesAffiliated With: Diversified HealthCare Services

Fund No:PlanType: Workers' Compensation

COUNTY OF LOS ANGELES(213) 637-0822

COUNTY OF LOS ANGELES3333 Wilshire Blvd Ste 1000Los Angeles CA 90010

DELTA HEALTH SYSTEMS(209) 474-5647

HEALTH CARE EVALUATION(209) 951-6711

COUNTY OF MENDOCINOAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(209) 474-5647

DELTA HEALTH SYSTEMSPO Box 1147STOCKTON CA 95201

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-152• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 153: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERCounty of Santa BarbaraAffiliated With: Stratacare

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

VALLEY HEALTH PLAN(408) 885-4582

VALLEY HEALTH PLAN(888) 421-8444

COUNTY OF SANTA CLARA - DEPT OF CORRECTIONS

Affiliated With: COUNTY OF SANTA CLARA

Fund No:PlanType: Group Health

VALLEY HEALTH PLAN(408) 885-4582

VALLEY HEALTH PLAN2325 Enborg Lane #290San Jose CA 95128

VALLEY HEALTH PLAN(408) 885-4582

VALLEY HEALTH PLAN(888) 421-8444

COUNTY OF SANTA CLARA - UNSPONSORED PROGRAMS

Affiliated With: COUNTY OF SANTA CLARA

Fund No:PlanType: Group Health

VALLEY HEALTH PLAN(408) 885-4582

VALLEY HEALTH PLAN2325 Enborg Lane #290San Jose CA 95128

VALLEY HEALTH PLAN(888) 421-8444

VALLEY HEALTH PLAN(888) 421-8444

COUNTY OF SANTA CLARA DBA: SANTA CLARA VALLEY HEALTH & HOSPITAL SYSTEM

Affiliated With: COUNTY OF SANTA CLARA

Fund No:PlanType: Group Health

VALLEY HEALTH PLAN(888) 421-8444

VALLEY HEALTH PLAN2325 Enborg Lane #290San Jose CA 95128

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(877) 782-6828

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

COURTESY AUTOMOTIVE GROUP TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-153• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 154: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295

CHECK BENEFIT CARDCOURTNEY & PHARRAffiliated With: CAROLINA BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295

CAROLINA BENEFIT ADMINISTRATORS333 SOUTH PINE STSPARTANBURG SC 29302

Coventry HealthCare of Louisiana, Inc.(800) 708-9355

Coventry HealthCare of Louisiana, Inc.(800) 708-9355

Coventry Health CareAffiliated With: Coventry Health Care

Fund No:PlanType: Group Health

Coventry HealthCare of Louisiana, Inc.(800) 341-6613

Coventry HealthCare of Louisiana, Inc.PO Box 7707London KY 40742

CHECK BENEFIT CARD CHECK BENEFIT CARDCOVENTRY OF KANSAS CITYAffiliated With: COVENTRY HEALTH CARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

GROUP & PENSION ADMINISTRATORS INC(800) 827-7223

HEALTH WATCH(972) 238-7900

CPR HEARTPLACEAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS INC(972) 238-7900

GROUP & PENSION ADMINISTRATORS INC12770 MERIT DR STE 200DALLAS TX 75251

CONTACT EMPLOYER CONTACT EMPLOYERCracker BarrelAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-154• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 155: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7345

CRAFTSMEN INDUSTRIES INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Crawford & Company(888) 382-0039

Crawford & Company(800) 241-2541

Crawford & Company

Fund No:PlanType: Auto

Crawford & Company(888) 382-0039

CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERCrawford and CompanyAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CHECK BENEFIT CARD CHECK BENEFIT CARDCREATIVE MANAGEMENT TECHNOLOGY INC

Affiliated With: CAROLINA BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

BENEFIT PLAN MANAGEMENT(781) 753-7559

CONTACT EMPLOYERCREATIVE OFFICE PAVILLIONAffiliated With: BENEFIT PLAN MANAGEMENT

Fund No:PlanType: Group Health

BENEFIT PLAN MANAGEMENT(781) 753-7559

BENEFIT PLAN MANAGEMENTPO Box 536ROCKLAND MA 02370

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-155• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

CREDIT ONE TRAVEL PLANAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

CREEL PRINTINGAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SELF INSURED SERVICES COMPANY (SISCO)(800) 457-4726

HEALTHCORP(800) 457-4726

CRESCENT ELECTRIC SUPPLY CO

Affiliated With: SELF INSURED SERVICES COMPANY

Fund No:PlanType: Group Health

SELF INSURED SERVICES COMPANY (SISCO)(800) 457-4726

SELF INSURED SERVICES COMPANY (SISCO)PO Box 28Dubuque IA 52004

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLECRISTI CLEANINGAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

CERES c/o World Insurance(800) 247-2190

CHECK BENEFIT CARDCRL MAJOR MEDICAL CRS100 POK

Affiliated With: AMERICAN REPUBLIC INSURANCE CO.

Fund No:PlanType: Group Health

CERES c/o World Insurance(800) 247-2190

CERES c/o World InsurancePO Box 2804Clinton IA 52733

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-156• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 157: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDCROCODILES NOT WATERLILIESAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

DIRECT CARE AMERICA(800) 266-5896

CHECK BENEFIT CARDCROWN EQUIPMENTAffiliated With: THE CHANDLRE GROUP

Fund No:PlanType: Group Health

DIRECT CARE AMERICA(800) 266-5896

DIRECT CARE AMERICAPO Box 2090 CSTOW OH 44224

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

CROWN POINT CABINETRYAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

CHECK BENEFIT CARD CHECK BENEFIT CARDCSU LOS ANGELES INTL STUDENT SRVCS

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

NHBC(888) 621-7900

CHECK BENEFIT CARDCUMBERLAND HEALTHCAREAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-157• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 158: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDCUMMINS CONSTRUCTION COMPANY

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

CUMMINS CUMBERLANDAffiliated With: PREFERRED HEALTH PLAN INC 962550088

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(502) 992-4535

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

CONTACT EMPLOYER CONTACT EMPLOYERCURA Group TheAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

GLOBALCARE, INC.(678) 341-1922

UM NOT APPLICABLECUSTOM DESIGN BENEFITS - CINCOM

Affiliated With: GLOBALCARE INC

Fund No:PlanType: Group Health

GLOBALCARE, INC.(678) 341-1922

GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005

GLOBALCARE, INC.(678) 341-1922

UM NOT APPLICABLECUSTOM DESIGN BENEFITS - NEFF PACKAGING

Affiliated With: GLOBALCARE INC

Fund No:PlanType: Group Health

GLOBALCARE, INC.(678) 341-1922

GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-158• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 159: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURECARE(800) 968-6616

CARELINE(763) 383-4800

CUSTOMATIONAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823

GLOBALCARE(678) 341-1811

CHECK BENEFIT CARDCYPRESS-CREATIVE FORMINGAffiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

CHECK BENEFIT CARDDAHL - CHASE PATHOLOGY ASSOCIATES

Affiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

CHECK BENEFIT CARDDAHL-CHASE DIAGNOSTIC SERVICES

Affiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226

CHECK BENEFIT CARD8002779476

CHECK BENEFIT CARDDAK AMERICAS LLCAffiliated With: CORPORATE BENEFITS SERVICE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8002779476

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-159• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDDALLAS BAPTISTAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

GENEX SERVICES, INC. GENEX SERVICES, INC.DALLAS NATIONALAffiliated With: GENEX SERVICES, INC.

Fund No:PlanType: Workers' Compensation

GENEX SERVICES, INC. GENEX SERVICES, INC.440 E. SWEDESFORD RD STE 3050WAYNE PA 19087

CompIQ Corporation(949) 923-4021

CHECK BENEFIT CARDDallas National Insurance CompanyAffiliated With: CompIQ #13910

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(949) 923-4021

CompIQ Corporation35 Tesla Way #100Irvine CA 92618

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDDALLAS THEOLOGICAL SEMINARY

Affiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 426-9786

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

DALLAS VA MEDICAL CENTER

CHECK BENEFIT CARDDALLAS VA MEDICAL CENTER 3168

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

DALLAS VA MEDICAL CENTER

DALLAS VA MEDICAL CENTER

4500 S LANCASTERDALLAS TX 75216

Attn: FEE BASIS 136E

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-160• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 161: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEDALTON STATE COLLEGE UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDDALTON STATE UNIV AIH0058047Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDDALTON STATE UNIV AIH0058057Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

AMERICAN HEALTH GROUP

AMERICAN HEALTH GROUP

DANA CORPORATIONAffiliated With: AMERICAN HEALTH GROUP

Fund No:PlanType: Group Health

AMERICAN HEALTH GROUP

AMERICAN HEALTH GROUP570 LongbowMAUMEE OH 43537

INTERPLAN HEALTH GROUP(800) 266-5896

INTERPLAN HEALTH GROUP(888) 610-0082

DANA NON UNION RETIREE VEBA TRUST

Affiliated With: INTERPLAN HEALTH GROUP

Fund No:PlanType: Group Health

INTERPLAN HEALTH GROUP(800) 266-5896

INTERPLAN HEALTH GROUP

PO Box 2388 CSTOW OH 44224

Attn: Supervisor of the Claims Dept

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-161• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 162: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

DANVILLE VA MEDICAL CENTER

CHECK BENEFIT CARDDANVILLE VA MEDICAL CENTER 3154

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

DANVILLE VA MEDICAL CENTER

DANVILLE VA MEDICAL CENTER

1900 E MAIN STDANVILLE IL 61832

Attn: FEE BASIS (136A7)

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEDARTON COLLEGE UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

CHECK BENEFIT CARD CHECK BENEFIT CARDDAVE KINGSTON PRODUCE AFFILIATED COMPANIES

Affiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDDAVIDSON HOTEL COMPANIESAffiliated With: BENEFIT PLANNERS LTD

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

FISERV HEALTH INC(800) 235-7160

AVIDYN HEALTH(214) 647-6194

DAYTON SUPERIORAffiliated With: FISERV HEALTH KANSAS - 11297

Fund No:PlanType: Group Health

FISERV HEALTH INC(800) 235-7160

FISERV HEALTH INCPO Box 520Pueblo CO 81002-0520

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-162• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BENEFIT CONCEPTS, INC.(800) 220-2600

CHECK BENEFIT CARDDayton Superior CorporationAffiliated With: Brokerage Concepts Inc/Benefit Concepts Inc

Fund No:PlanType: Group Health

BENEFIT CONCEPTS, INC.(800) 220-2600

BENEFIT CONCEPTS, INC.1021 W. 8TH AVE STE 200KING OF PRUSSIA PA 19406

DAYTON VA MEDICAL CENTER

CHECK BENEFIT CARDDAYTON VA MEDICAL CENTER 3194

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

DAYTON VA MEDICAL CENTER

DAYTON VA MEDICAL CENTER

4100 W 3RD STDAYTON OH 45428

Attn: FEE BASIS 136

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

DAYWEST HEALTHCARE SERVICES

Affiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

EBMS EBMS CARELINK(406) 245-3575

DBSI REALTY CORPORATIONAffiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

EBMS EBMSPO Box 21367BILLINGS MT 59104-1367

MERITAIN HEALTH(877) 777-6076

GUIDED2HEALTH(952) 593-6447

DCI BIOLOGICALS, INCAffiliated With: CORPORATE BENEFIT SERVICE OF AMERICA

Fund No:PlanType: Group Health

MERITAIN HEALTH(877) 777-6076

MERITAIN HEALTHPO Box 1065AMHERST NY 14226

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-163• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

JSL ADMINISTRATORS, INC.(770) 683-1024

CHECK BENEFIT CARDDCR Services Inc.Affiliated With: JSL ADMINISTRATORS INC

*

Fund No:PlanType: Group Health

JSL ADMINISTRATORS, INC.(770) 683-1024

JSL ADMINISTRATORS, INC.PO BOX 71489Newnan GA 30271

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 587-3272

HEALTH CARE STRATEGIES8005821535

DEAD RIVER COMPANYAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 587-3272

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05407

EBPA(802) 846-8060

CHECK BENEFIT CARDDEAD RIVER COMPANY JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

GROUP & PENSION ADMINISTRATORS INC

CHECK BENEFIT CARDDEALERS ELECTRICAL SUPPLY COMPANY

Affiliated With: BENEFIT PLANNERS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS INC

GROUP & PENSION ADMINISTRATORS INCPO Box 749075DALLAS TX 75374-9075

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDDEAN A MCGEE EYE INSTITUTEAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-164• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.(800) 990-9058

HCM(800) 990-9058

DEBRUCE GRAINAffiliated With: FMH BENEFIT SERVICES INC A DIVISION OF CORESOURCE

Fund No:PlanType: Group Health

FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.(800) 990-9058

FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.PO Box 25946OVERLAND PARK KS 66225-5946

AMERICA'S CHOICE HEALTHPLANS, LLC(877) 224-3627

AMERICAN HEALTH HOLDINGS INC(888) 578-1812

DECATHLON USA FORMALLY MVP SPORTS

Affiliated With: AMERICA'S CHOICE HEALTHPLANS LLC

Fund No:PlanType: Group Health

AMERICA'S CHOICE HEALTHPLANS, LLC(877) 224-3627

AMERICA'S CHOICE HEALTHPLANS, LLC13111 Northwest Fwy, Ste 510Houston TX 77040

CHECK BENEFIT CARD CHECK BENEFIT CARDDECATUR PARK DISTRICTAffiliated With: CONSOCIATE GROUP

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

DECO PAPER PRODUCTSAffiliated With: PREFERRED HEALTH PLAN INC 962550088

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(502) 992-4535

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

Definiti(415) 973-8017

UM NOT APPLICABLEDefiniti / P G & EAffiliated With: COMP IQ

Fund No:PlanType: Workers' Compensation

Definiti(415) 973-8017

Definiti77 Beale StSan Francisco CA 94105

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-165• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 166: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBA&M(800) 776-1545

HINES & ASSOCIATES(800) 528-2498

DEFT, INCAffiliated With: EBA&M

Fund No:PlanType: Group Health

EBA&M(800) 776-1545

EBA&MPO Box 5079WESTLAKE VILLAGE CA 91359

ADMINISTRATIVE CONCEPTS INC(888) 293-9229

UM NOT APPLICABLEDELAWARE VALLEY COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS, INC.

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS INC(888) 293-9229

ADMINISTRATIVE CONCEPTS INC

997 Old Eagle School Rd. #215WAYNE PA 19087-1706

Attn: Customer Service Dept

Underwriters Safety & Claims, Inc.(800) 678-1536

Bluegrass Health Network(800) 264-7502

Desa InternationalAffiliated With: Underwriters Safety & Claims Inc.

Fund No:PlanType: Group Health

Underwriters Safety & Claims, Inc.(800) 678-1536

Underwriters Safety & Claims, Inc.PO Box 23507Louisville KY 40223-0507

Deseret Mutual Benefit Administrators(800) 777-3622

Deseret Mutual Benefit Administrators(800) 777-3622

Deseret Mutual Benefit Administrators

Affiliated With: Deseret Mutual Benefit Administrators

Fund No:PlanType: Group Health

Deseret Mutual Benefit Administrators(801) 578-5652

Deseret Mutual Benefit AdministratorsPO Box 45530Salt Lake City UT 84145-0530

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

DESERT LUMBERAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-166• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

DESERT ORTHOPAEDIC TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

DESERT RADIOLOGIST - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

STAR HEALTHCARE NETWORK(212) 581-8228

UM NOT APPLICABLEDESJARDINAffiliated With: STAR HEALTHCARE NETWORK INC

*

Fund No:PlanType: Group Health

STAR HEALTHCARE NETWORK(212) 581-8228

STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019

HERITAGE CONSULTANTS INC8639674139

HERITAGE CONSULTANTS INC8639674139

DESOTO COUNTY DBA SORRELLS BROTHERS PACKING CO.

Affiliated With: HERITAGE CONSULTANTS INC

*

Fund No:PlanType: Group Health

HERITAGE CONSULTANTS INC8639674139

HERITAGE CONSULTANTS INCPO Box 1730AUBURNDALE FL 33823

DETROIT VA MEDICAL CENTER

CHECK BENEFIT CARDDETROIT VA MEDICAL CENTER 3155

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

DETROIT VA MEDICAL CENTER

DETROIT VA MEDICAL CENTER

4646 JOHN RDETROIT MI 48201

Attn: FEE BASIS 001B-SS

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-167• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 168: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Benefit Planners(800) 292-5386

CHECK BENEFIT CARDDEVON ENERGYAffiliated With: BENEFIT PLANNERS

Fund No:PlanType: Group Health

Benefit Planners(800) 292-5386

Benefit PlannersPO Box 690450SAN ANTONIO TX 78269

CHECK BENEFIT CARD CHECK BENEFIT CARDDEVON ENERGY CORPORATIONAffiliated With: BENEFIT PLANNERS LTD

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDDHS INCAffiliated With: CAROLINA BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER CHECK BENEFIT CARDDHSI - California Pacific Medical Center (CPMC)

Affiliated With: Fair Isaac Corp / Diversified Healthcare Systems

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

CONTACT EMPLOYER CHECK BENEFIT CARDDHSI - Creative Risk FundingAffiliated With: Diversified Healthcare Systems

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-168• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 169: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ALTERNATIVE INSURANCE RESOURCES(202) 871-3229

CHECK BENEFIT CARDDIAGNOS-TECHS, INCAffiliated With: ALTERNATIVE INSURANCE RESOURCES

Fund No:PlanType: Group Health

ALTERNATIVE INSURANCE RESOURCES(202) 871-3229

ALTERNATIVE INSURANCE RESOURCESPO Box 660787BIRMINGHAM AL 35266

ADMINISTRATIVE CONCEPTS INC(888) 293-9229

UM NOT APPLICABLEDICKINSON COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS, INC.

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS INC(888) 293-9229

ADMINISTRATIVE CONCEPTS INC

997 Old Eagle School Rd. #215WAYNE PA 19087-1706

Attn: Customer Service Dept

HEALTHCARE MANAGEMENT ADMINISTRATORS INC(800) 869-7093

HEALTHCARE MANAGEMENT ADMINISTRATORS INC(425) 289-5142

DIGESTIVE HEALTH SPECIALISTSAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

HEALTHCARE MANAGEMENT ADMINISTRATORS INC(800) 869-7093 Ext 117

HEALTHCARE MANAGEMENT ADMINISTRATORS INCPO Box 85008BELLEVUE WA 98015

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.

DILCON COMMUNITY SCHOOLAffiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.PO Box 25160SCOTTSDALE AZ 85255-0102

COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 846-8060

HEALTH CARE STRATEGIES(800) 582-1535

DINGLEY PRESS IPNAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATORPO Box 2365SOUTH BURLINGTON VT 05407

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-169• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 170: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 846-8060

HEALTH CARE STRATEGIES(800) 582-1535

DINGLEY PRESS JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATORPO Box 2365SOUTH BURLINGTON VT 05407

COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 846-8060

HEALTH CARE STRATEGIES(800) 582-1535

DINGLEY PRESS SCAN DIRECTAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATORPO Box 2365SOUTH BURLINGTON VT 05407

MBA OF MARYLAND(307) 347-6151

MOUNTAIN STATES REVIEW(307) 347-7979

DIOCESE OF CHEYENNEAffiliated With: MBA OF WYOMING 13039

Fund No:PlanType: Group Health

MBA OF MARYLAND(307) 347-6151

MBA OF MARYLANDPO Box 98WORLAND WY 82401

FCE BENEFIT ADMINISTRATORS(800) 899-9355

UM NOT APPLICABLEDIPLOMATIC PAINTING & BUILDING SERVICES COMPANY

Affiliated With: FCE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS(800) 899-9355

FCE BENEFIT ADMINISTRATORS4615 WALZEN RD STE 300SAN ANTONIO TX 78218

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLEDIPLOMATIC PAINTING & BUILDING SERVICES COMPANY

Affiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-170• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 171: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

T R PAUL INC.(800) 678-8161

T R PAUL INC.DIRECT MEDIA, INC.Affiliated With: T R PAUL INC

Fund No:PlanType: Group Health

T R PAUL INC.(800) 678-8161

T R PAUL INC.PO Box 5508NEWTON CT 06470-5508

PREFERRED HEALTH PLANS INC.(800) 832-8212

CHECK BENEFIT CARDDISMAS CHARITIES INCAffiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.PO Box 437017Louisville KY 40253

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMIN. CORP.Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

CORESOURCE, INC.(800) 223-3843

CORESOURCE, INC.(800) 223-3843

DIVERSIFIED COMMUNICATIONSAffiliated With: COURESOURCE, INC

Fund No:PlanType: Group Health

CORESOURCE, INC.(800) 223-3843

CORESOURCE, INC.PO Box 83301LANCASTER PA 17608-3301

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

DIVERSIFIED CONTRACTORS, INC.

Affiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-171• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Diversified Health Care Services, Inc.(714) 918-2590 Ext 104

Diversified Health Care Services, Inc.(714) 918-2590 Ext 104

Diversified Health Care Service (DHSI)

Affiliated With: Diversified Health Care Service

Fund No:PlanType: Workers' Compensation

Diversified Health Care Services, Inc.(714) 918-2590 Ext 104

Diversified Health Care Services, Inc.201 East Sandpointe, Suite 320Santa Ana CA 92707

CONTACT EMPLOYER CONTACT EMPLOYERDiversified Healthcare SystemsAffiliated With: Fair Isaac Corporation

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CHECK BENEFIT CARD CHECK BENEFIT CARDDIXON BROS, INCAffiliated With: WESTERN HEALTH

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

BAC(614) 863-8780

BAC(614) 863-8780

DLZ CORPORATIONAffiliated With: BUSINESS ADMINISTRATORS AND CONSULTANTS

Fund No:PlanType: Group Health

BAC(614) 863-8780

BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068

CONTACT EMPLOYER CONTACT EMPLOYERDMIAffiliated With: CompIQ #13910

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(800) 293-3131

CompIQ Corporation35 Tesla Way #100Irvine CA 92618

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-172• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 173: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDDOLESE BROS COAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

Health Design Plus(877) 230-0990

CHECK BENEFIT CARD(800) 434-1305

Donatos Pizzeria CorporationAffiliated With: Health Design Plus

Fund No:PlanType: Group Health

Health Design Plus(877) 230-0990

Health Design PlusPO Box 2582HUDSON OH 44236

EBPA(800) 578-3272

CHECK BENEFIT CARDDORKS UNLIMITED JMSAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

EBPA(800) 578-3272

CHECK BENEFIT CARDDORKS UNLIMITED WRAP % JMSAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

CHECK BENEFIT CARD CHECK BENEFIT CARDDOUG ANDRUS DISTRIBUTINGAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-173• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 174: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MARTIN BOYER(800) 442-7247

CHECK BENEFIT CARDDOUGLAS COUNTY SCHOOL DISTRICT

Affiliated With: HEALTHCOMP TPA

Fund No:PlanType: Group Health

HEALTHCOMP TPA(800) 442-7247

HEALTHCOMP TPAPO Box 45018Fresno CA 93718

CHECK BENEFIT CARD CHECK BENEFIT CARDDOUGLASS FERTILIZER CHEMICAL INC

Affiliated With: HERITAGE CONSULTANTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

INTERPLAN HEALTH GROUP(800) 266-5896

AHH(614) 818-3222

DOWCO INCAffiliated With: INTERPLAN HEALTH GROUP

Fund No:PlanType: Group Health

INTERPLAN HEALTH GROUP(800) 266-5896

INTERPLAN HEALTH GROUP

PO Box 2388 CSTOW OH 44224

Attn: Supervisor of the Claims Dept

FISERV HEALTH KANSAS(800) 235-7160

TRUSTMARK LIFE INSURANCE CO.(800) 725-6566

DOWELL ENTERPRISES INCAffiliated With: FISERV HEALTH - KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

CHECK BENEFIT CARDDOWN EAST TOYOTA BUICKAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-174• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 175: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CENBEN USA(614) 797-5204

CHECK BENEFIT CARDDR SYSTEMSAffiliated With: CENBEN USA INC

Fund No:PlanType: Group Health

CENBEN USA(614) 797-5204

CENBEN USA

4079 Executive PkwyWesterville OH 43081

Attn: Melissa Joseph

CONSUMER HEALTH SOLUTIONS(877) 573-9541

CHECK BENEFIT CARDDRIVERS CHOICEAffiliated With: CONSUMER HEALTH SOLUTIONS

Fund No:PlanType: Group Health

CONSUMER HEALTH SOLUTIONS(877) 573-9541

CONSUMER HEALTH SOLUTIONS333 SOUTH PINE STSPARTANBURG SC 29302

BENEFIT PLANNERS LTD(800) 218-1004

BENEFIT PLANNERS LTD(800) 218-1004

DRIVETIME AUTOMOTIVEAffiliated With: BENEFIT PLANNERS LTD

Fund No:PlanType: Group Health

BENEFIT PLANNERS LTD(800) 218-1004

BENEFIT PLANNERS LTDPO Box 690450SAN ANTONIO TX 78269

PREFERRED HEALTH PLANS INC.(800) 832-8212

CHECK BENEFIT CARDDRYWALL SYSTEMS PLUSAffiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.PO Box 437017Louisville KY 40253

DUBLIN VAMC CHECK BENEFIT CARDDUBLIN VAMC 3546Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

DUBLIN VAMC DUBLIN VAMC

1826 VETERANS BLVDDUBLIN GA 31021

Attn: FEE BASIS 04

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-175• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Western Health(605) 719-4600 or (888) 341-1766

Western Health(605) 719-4640 or (800) 229-0892

Duhamel Broadcasting EnterprisesAffiliated With: Rapid City Regional Hospital DBA Western Health

Fund No:PlanType: Group Health

Western Health(605) 719-4600 or (888) 341-1766

Western Health529 Kansas City St Ste 200Rapid City SD 57701

RESOURCEONE ADMINSTRATORS(800) 967-2077

GROUP INSURANCE SERVICE CENTER INC(800) 816-1206

DUNCAN EQUIPMENT COMPANYAffiliated With: RESOURCEONE ADMINISTRATORS

Fund No:PlanType: Group Health

RESOURCEONE ADMINSTRATORS(800) 967-2077

RESOURCEONE ADMINSTRATORS

PO Box 489BUCKEYSTOWN MD 21717

Attn: Mary Shepherd

THE EPOCH GROUP(800) 255-6065

THE EPOCH GROUP(800) 255-6065

DUNCAN EQUIPMENT COMPANYAffiliated With: THE EPOCH GROUP

Fund No:PlanType: Group Health

THE EPOCH GROUP(800) 255-6065

THE EPOCH GROUP6717 SHAWNEE MISSION PARKWAYOVERLAND PARK KS 66202

PRIMARY PHYSICIANCARE, INC.(704) 527-8102

PRIMARY PHYSICIANCARE, INC.(704) 523-2758

DUNCAN-PARNELLAffiliated With: PRIMARY PHYSICIANCARE INC

Fund No:PlanType: Group Health

PRIMARY PHYSICIANCARE, INC.(704) 527-8102

PRIMARY PHYSICIANCARE, INC.PO Box 11088CHARLOTTE NC 28220

EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002

UM NOT APPLICABLE(800) 367-9939

DUNELAND SCHOOL CORPORATION

Affiliated With: EMPLOYEE BENEFIT CONSULTANTS INC

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002

EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-176• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 177: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

NGS AMERICAN8005211555

NGS AMERICAN8005211555

DURA AUTOMOTIVEAffiliated With: NGS AMERICAN

Fund No:PlanType: Group Health

NGS AMERICAN8005211555

NGS AMERICAN, INC.PO Box 7676DETROIT MI 48080

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

DURHAM EXCHANGE CLUB INDUSTRIES

Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

DURHAM VAMC CHECK BENEFIT CARDDURHAM VAMC 3135Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

DURHAM VAMC DURHAM VAMC

508 FULTON STDURHAM NC 27705

Attn: FEE BASIS

CHECK BENEFIT CARD CHECK BENEFIT CARDDUVAL ASPHALTAffiliated With: UNITED BENEFITS, INC.

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

DYNAMIC POWER SOURCE, LLCAffiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-177• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 178: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBPA(802) 846-8060

CHECK BENEFIT CARDDYNAPOWER CORPORATION JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARDDYNAPOWER CORPORATION WRAP JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

DYNATEC CORP USAAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

NORTH AMERICAN ADMINISTRATORS INC(877) 777-6076

AMERICAN HEALTH HOLDINGS INC(800) 337-0506

DYSON KYSSNER MORAN CORPORATION

Affiliated With: NORTH AMERICAN ADMINISTRATORS - NY

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS INC(877) 777-6076

NORTH AMERICAN ADMINISTRATORS INCPO Box 1065AMHERST NY 14226

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-178• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 179: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SRT ADMINISTRATORS(888) 690-2020

HINES & ASSOCIATES(800) 944-9401

DZILTH NA DITH HLE SCHOOLAffiliated With: SRT ADMINISTRATORS INC

Fund No:PlanType: Group Health

SRT ADMINISTRATORS(888) 690-2020

SRT ADMINISTRATORSPO Box 25160SCOTTSDALE AZ 85255-0102

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

E GADSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

E GADS TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(307) 347-6151

MOUNTAIN STATES REVIEW(307) 347-7979

E H OFTEDAL & SONS INCAffiliated With: MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULT

Fund No:PlanType: Group Health

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(307) 347-6151

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTSPO Box 98WORLAND WY 82401

EBMS(406) 245-3575

EBMS CARELINK(406) 245-3575

EAGLE GROUPAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

EBMS(406) 245-3575

EBMSPO Box 21367BILLINGS MT 59104-1367

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-179• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 180: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GROUP & PENSION ADMINISTRATORS(800) 827-7223

CHECK BENEFIT CARDEagle Pass ISD (Travel)Affiliated With: GROUP & PENSION ADMINISTRATORS

*

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

SELF INSURED SERVICES COMPANY (SISCO)(319) 583-7344

CHECK BENEFIT CARDEAST BALT COMMAffiliated With: SELF INSURED SERVICES COMPANY SISCO

Fund No:PlanType: Group Health

SELF INSURED SERVICES COMPANY (SISCO)(319) 583-7344

SELF INSURED SERVICES COMPANY (SISCO)PO Box 389DUBUQUE IA 52004-0389

PEARCE ADMINISTRATION(888) 722-1668

UM NOT APPLICABLEEAST CAROLINA UNIVERSITYAffiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(888) 722-1668

PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408

STUDENT ASSURANCE SERVICES INC(800) 328-2739

CHECK BENEFIT CARDEAST CENTRAL COLLEGEAffiliated With: STUDENT ASSURANCE SERVICES INC

Fund No:PlanType: Group Health

STUDENT ASSURANCE SERVICES INC(800) 328-2739

STUDENT ASSURANCE SERVICES INC333 N. MAIN STREETSTILLWATER MN 55082

MORRIS ASSOCIATES(800) 950-6789

CHECK BENEFIT CARDEAST CENTRAL ILLINOIS PIPE TRADES H & W FUND

Affiliated With: MORRIS ASSOCIATES

Fund No:PlanType: Group Health

MORRIS ASSOCIATES(800) 950-6789

MORRIS ASSOCIATES9045 E 59TH STINDIANAPOLIS IN 46250

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-180• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 181: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDEAST GEORGIA COLLEGE AIH0058087

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDEAST GEORGIA COLLEGE AIH0058097

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

EAST ORANGE VA MEDICAL CENTER

CHECK BENEFIT CARDEAST ORANGE VA MEDICAL CENTER 3119

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

EAST ORANGE VA MEDICAL CENTER

EAST ORANGE VA MEDICAL CENTER

385 TREEMONT AVEEAST ORANGE NJ 07018

Attn: FEE BASIS 04

CONTACT EMPLOYER CONTACT EMPLOYEREastern AllianceAffiliated With: Eastern Alliance Insurance Group

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)Exclude PT providers

CONTACT EMPLOYER CONTACT EMPLOYER

EASTERN BENEFIT SYSTEMS, INC.(800) 524-0227

BEECH STREET(800) 227-7464

EASTERN BENEFIT SYSTEMS, INC.

Fund No:PlanType: Group Health

EASTERN BENEFIT SYSTEMS, INC.(800) 524-0227

EASTERN BENEFIT SYSTEMS, INC.200 Freeway Dr, EastEast Orange 07018

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-181• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 182: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EASTERN COLORADO VA HC SYSTEM

CHECK BENEFIT CARDEASTERN COLORADO VA HCS 3532

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

EASTERN COLORADO VA HC SYSTEM

EASTERN COLORADO VA HC SYSTEM1055 CLERMONT STDENVER CO 80220

CONSOLIDATED HEALTH PLANS INC(800) 633-7867

CHECK BENEFIT CARDEASTERN NAZARENE COLLEGEAffiliated With: CONSOLIDATED HEALTH PLANS INC

Fund No:PlanType: Group Health

CONSOLIDATED HEALTH PLANS INC(800) 633-7867

CONSOLIDATED HEALTH PLANS INC195 STAFFORD STSPRINGFIELD MA 01104

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

EASTERN OREGON UNIVERSITY INTERNATIONAL AND DOMESTIC

Affiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

HEALTH PLAN INC5087522480

CMS INC(866) 325-1550

EASTPOINT PROPERTIESAffiliated With: HEALTH PLANS, INC.

Fund No:PlanType: Group Health

HEALTH PLAN INC(866) 325-1550

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

EATON CORPORATION(800) 891-6506

CHECK BENEFIT CARDEaton CorporationAffiliated With: Eaton Corporation

Fund No:PlanType: Group Health

EATON CORPORATION(800) 891-6506

EATON CORPORATIONPO Box 8400London KY 40742

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-182• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 183: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDEATON METAL PRODUCTSAffiliated With: CNIC HEALTH SOLUTIONS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARDEBMS EMPLOYEE HEALTH PLANAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARD

EDWARD HINES JR VAMC CHECK BENEFIT CARDEDWARD HINES JR VAMC 3162Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

EDWARD HINES JR VAMC EDWARD HINES JR VAMC

5TH AVE & ROOSEVELT RDHINES IL 60141

Attn: FEE SERVICES

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

EDWARD M BERSTEIN & ASOCIATES - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

GREATER LA HCS (SEPULVEDA VAMC)PO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

EFFICIENT ENTERPRISES TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-183• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 184: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TALL TREE ADMINISTRATORS8774534201

UM NOT APPLICABLEEL CENTRO REGIONAL MEDICAL CENTER

Affiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS8774534201

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

DIRECT CARE AMERICA(800) 266-5896

CHECK BENEFIT CARDEL ENCANTO INCAffiliated With: THE CHANDLER GROUP #13352

Fund No:PlanType: Group Health

DIRECT CARE AMERICA(800) 266-5896

DIRECT CARE AMERICAPO Box 2090 CSTOW OH 44224

PARADIGM HEALTH CORPORATION(888) 621-7900

CHECK BENEFIT CARDEL PASO FIRST HEALTH PLANSAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

EL PASO VAMC CHECK BENEFIT CARDEL PASO VAMC 3174Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

EL PASO VAMC EL PASO VAMC

5001 N PEIDRASEL PASO TX 79930

Attn: FEE BASIS - 04

CONTACT EMPLOYER CONTACT EMPLOYERElectric Insurance CompanyAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-184• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 185: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER First HealthElectric Insurance CompanyAffiliated With: Electric Insurance Company

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

First Health First HealthPO Box 11930Tucson AZ 85734

CHECK BENEFIT CARD CHECK BENEFIT CARDElectrical Construction Industry Health and Welfare Fund

Fund No: V5123PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

ELECTRICAL WHOLESALE SUPPLY CO., INC.

Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

DIRECT CARE AMERICA(800) 266-5896

CHECK BENEFIT CARDELECTROLUX HOME PRODUCTS INC GEORGIA

Affiliated With: THE CHANDLER GROUP

Fund No:PlanType: Group Health

DIRECT CARE AMERICA(800) 266-5896

DIRECT CARE AMERICAPO Box 2090 CSTOW OH 44224

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDELIZABETH CITY STATE UNIVERSITY

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(888) 722-1668

PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-185• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 186: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDELK HILLS SCHOOLAffiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

THE KEMPTON GROUP(405) 521-1711

CHECK BENEFIT CARDELKVIEW GENERAL HOSPITALAffiliated With: THE KEMPTON GROUP INC

Fund No:PlanType: Group Health

THE KEMPTON GROUP(405) 521-1711

THE KEMPTON GROUPPO Box 54889OKLAHOMA CITY OK 73154

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDELLAAffiliated With: UnitedHealthcare StudentResources #11689

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARDELM ELECTRIC WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLEELWYN, INCAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-186• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 187: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYEREM ManagementAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

EMC Insurance Companies(800) 880-1279 Ext 2068

EMC Insurance Companies(800) 880-1279 Ext 2068

EMC Insurance CompaniesAffiliated With: EMC Insurance Companies

Fund No:PlanType: Workers' Compensation

EMC Insurance Companies(800) 880-1279 Ext 2068

EMC Insurance Companies717 MulberryDes Moines IA 50309

CORESOURCE INC(866) 682-3152

CORESOURCE INC(866) 831-5677

EMERGENCY MEDICINE PHYSICIANS

Affiliated With: CORESOURCE INC

Fund No:PlanType: Group Health

CORESOURCE INC(866) 682-3152

CORESOURCE INCPO Box 2920CLINTON OH 52733-2920

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARDEMERITUS ASSISTED LIVINGAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYEREmerson ElectricAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-187• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 188: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8003659036

CHECK BENEFIT CARDEMERSON TELECOMMUNICATION PRODUCTS INC

Affiliated With: THE EPOCH GROUP L C

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8003659036

CHECK BENEFIT CARD

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

EMINENCE SPEAKER, LLCAffiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

Insurers Administrative Corporation (IAC)(800) 843-3106

Med-Valu(800) 522-2161

EMPIRE FIRE & MARINEAffiliated With: INSURERS ADMINISTRATIVE CORPORATION #11337

Fund No:PlanType: Group Health

Insurers Administrative Corporation (IAC)(800) 843-3106

Insurers Administrative Corporation (IAC)PO Box 828Park Ridge IL 60068-0828

Benefits/Eligibility(800) 843-3106

CHECK BENEFIT CARDEmpire Fire and MarineAffiliated With: Insurers Administrative Corporation

Fund No:PlanType: Group Health

Benefits/Eligibility(800) 843-3106

Benefits/EligibilityPO Box 39119Phoenix AZ 85069-9119

CONTACT EMPLOYER CONTACT EMPLOYEREmploy BridgeAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-188• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 189: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDEMPLOYEE BENEFIT MANAGEMENT SERVICES

Affiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

EMPLOYEE BENEFIT PLAN ADMINISTRATION(800) 268-7298

HEALTHCARE STRATEGIES(800) 582-1535

EMPLOYEE BENEFIT PLAN ADMINISTRATION IPN

Affiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATION

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT PLAN ADMINISTRATION(603) 773-4521

EMPLOYEE BENEFIT PLAN ADMINISTRATION

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

EMPLOYEE BENEFIT PLAN ADMINISTRATION(800) 268-7298

HEALTHCARE STRATEGIES(800) 582-1535

EMPLOYEE BENEFIT PLAN ADMINISTRATION JMS

Affiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATION

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT PLAN ADMINISTRATION(603) 773-4521

EMPLOYEE BENEFIT PLAN ADMINISTRATION

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

EMPLOYEE BENEFIT PLAN ADMINISTRATION(800) 268-7298

HEALTHCARE STRATEGIES(800) 582-1535

EMPLOYEE BENEFIT PLAN ADMINISTRATION NATIONAL WRAP SCANDIRECT

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT PLAN ADMINISTRATION(603) 773-4521

EMPLOYEE BENEFIT PLAN ADMINISTRATION

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-189• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 190: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

ENCORE PRODUCTIONSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

ENCORE PRODUCTIONS - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

EBMS(800) 777-3575

CHECK BENEFIT CARDENERGY LABORATORIES/EBMSAffiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

EBMS(800) 777-3575

EBMSPO Box 21367BILLINGS MT 59104-1367

ACORDIA NATIONAL(888) 685-7774

CHECK BENEFIT CARDENERGY WESTAffiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR

Fund No:PlanType: Group Health

ACORDIA NATIONAL(888) 685-7774

ACORDIA NATIONAL

CNIC HEALTH SOLUTIONS(800) 426-7453

CNIC HEALTH SOLUTIONS(800) 426-7453

ENGINEERED DATA PRODUCTS HOLDINGS LLC

Affiliated With: CINC HEALTH SOLUTIONS

Fund No:PlanType: Group Health

CNIC HEALTH SOLUTIONS(800) 426-7453

CNIC HEALTH SOLUTIONSPO Box 3559ENGLEWOOD CO 80155-3559

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-190• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 191: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDENGINEERED QUALITY PLASTICSAffiliated With: THE EPOCH GROUP L C

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SELF INSURED PLANS LLC

MedWatch(800) 432-8421

ENGLEWOOD AREA FIRE CONTROL DISTRICT

Affiliated With: SELF INSURED PLANS LLC

Fund No:PlanType: Group Health

SELF INSURED PLANS LLC SELF INSURED PLANS LLC1016 COLLIER CENTER STE 200NAPLES FL 34103

GROUP & PENSION ADMINISTRATORS INC(800) 827-7223

HEALTH WATCH(800) 827-7223

ENNIS, INCAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS INC(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

AMERIBEN SOLUTIONS(800) 786-7930

CHECK BENEFIT CARDENSIGN US DRILLING %Affiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

AMERIBEN SOLUTIONS(800) 786-7930

CHECK BENEFIT CARDENSIGN US DRILLING PEPMAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-191• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 192: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MIDWEST SECURITY ADMINISTRATORS INC(608) 783-8718

UM NOT APPLICABLEENZYMATIC THERAPY, INCAffiliated With: MIDWEST SECURITY ADMINISTRATORS

Fund No:PlanType: Group Health

MIDWEST SECURITY ADMINISTRATORS INC(608) 783-8718

MIDWEST SECURITY ADMINISTRATORS INC2700 Midwest Dr.ONALASKA WI 54650

CONTACT EMPLOYER CONTACT EMPLOYEREpicAffiliated With: Innovative Risk Management

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

EPISCOPAL CHURCH HOMEAffiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

CHECK BENEFIT CARD CHECK BENEFIT CARDEPT MCGILL BEARINGAffiliated With: THE EPOCH GROUP #10469

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

ERIE VAMC CHECK BENEFIT CARDERIE VAMC 3125Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

ERIE VAMC ERIE VAMC

135 E 38TH STERIE PA 16504

Attn: FEE BASIS 174E

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-192• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 193: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

UNITED MEDICAL RESOURCES(513) 619-3227

CHECK BENEFIT CARDERLANGER TUBULAR CORPAffiliated With: UNITED MEDICAL RESOURCES

*

Term Effective: 12/31/2007Fund No:PlanType: Group Health

UNITED MEDICAL RESOURCES(513) 619-3227

UNITED MEDICAL RESOURCESPO Box 145804CINCINNATI OH 45250

HEALTHCOMP(559) 499-2450

HEALTHCOMP(559) 499-2450

EskatonAffiliated With: HEALTHCOMP

Fund No:PlanType: Group Health

HEALTHCOMP(559) 499-2450

HEALTHCOMPPO Box 45018Fresno CA 93718

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDESKAY CORPORATIONAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

CONTACT EMPLOYER CONTACT EMPLOYEREstes Express LinesAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CHECK BENEFIT CARDEVANGELICAL BENEFIT TRUST FUND (EBT)

Affiliated With: MBA OF MARYLAND

Fund No:PlanType: Group Health

CONTACT EMPLOYER CONTACT EMPLOYER

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-193• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 194: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EVANSVILLE OPC VA CHECK BENEFIT CARDEVANSVILLE OPC VA 3309Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

EVANSVILLE OPC VA EVANSVILLE OPC VA

500 E WALNUT STEVANSVILLE IN 47713

Attn: FEE BASIS

GROUP & PENSION ADMINISTRATORS INC(800) 827-7223

CHECK BENEFIT CARDEVERCOM SYSTEMSAffiliated With: GROUP AND PENSION ADMINISTRATORS INC

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS INC(800) 827-7223

GROUP & PENSION ADMINISTRATORS INCPO Box 749075DALLAS TX 75374-9075

CONTACT EMPLOYER CONTACT EMPLOYEREverest ACCA San FranciscoAffiliated With: Everest ACCA

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

CONTACT EMPLOYER CONTACT EMPLOYEREverest NationalAffiliated With: Everest SRS

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

EVEREST NATIONAL INSURANCE CO.(949) 330-6892

EVEREST NATIONAL INSURANCE CO.(949) 330-6892

EVEREST NATIONAL INSURANCE CO.

Affiliated With: EVEREST NATIONAL INSURANCE CO.

Fund No:PlanType: Workers' Compensation

EVEREST NATIONAL INSURANCE CO.(949) 330-6892

EVEREST NATIONAL INSURANCE CO.65 Enterprise Suite 235Aliso Viejo CA 92656

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-194• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 195: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDEVOLUTION BUSINESS SOLUTIONS

Affiliated With: TALL TREE AADMINISTRATORS

*

Term Effective: 11/1/2007Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDEXCEL CORPORATIONAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

Brokerage Concepts, Inc.(888) 554-7629

PERFORMAX / AMERICAN HEALTH HOLDING(614) 818-3222

EXPERIENCE WORKS, INC.Affiliated With: PERFORMAX BCI

Fund No:PlanType: Group Health

Brokerage Concepts, Inc.(888) 554-7629

Brokerage Concepts, Inc.PO Box 61505KING OF PRUSSIA PA 19406

BOON CHAPMAN(800) 252-9653

PRIME DX(800) 477-4625

EZCORP, INC.Affiliated With: BOON CHAPMAN BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

BOON CHAPMAN(800) 252-9653

BOON CHAPMANPO Box 9201AUSTIN TX 78766

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

F RODGERS SPECIALTY CONTRACTORS INC

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-195• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 196: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FARA - F. A. Richard & Associates, Inc.(985) 624-6740

FARA - F. A. Richard & Associates, Inc.(985) 624-6740

F. A. Richard & Associates, Inc.Affiliated With: F. A. Richard & Associates, Inc.

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)Exclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)

FARA - F. A. Richard & Associates, Inc.(985) 624-6740

FARA - F. A. Richard & Associates, Inc.1625 W. Causeway ApproachMandeville LA 70471

MERCER ADMINISTRATION(800) 394-6888

CHECK BENEFIT CARDFABRICUT, INC.Affiliated With: MERCER ADMINISTRATION

Fund No:PlanType: Group Health

MERCER ADMINISTRATION(800) 394-6888

MERCER ADMINISTRATION701 Market St Ste 1350St Louis MO 63101

CONTACT EMPLOYER CONTACT EMPLOYERFair Isaac CorporationAffiliated With: Fair Isaac Corporation

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

CONTACT EMPLOYER CONTACT EMPLOYER

PIONEER MANAGEMENT SYSTEMS(413) 534-8658

UM NOT APPLICABLEFairfield University International Students

Affiliated With: PIONEER MANAGEMENT SYSTEMS

*

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(413) 534-8658

PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01089

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDFAIRMONT HOTELS RESORTSAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-196• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 197: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GISC, INC(800) 242-4472

GISC TOTALCARE(800) 999-1077

Falvey LinenAffiliated With: GROUP INSURANCE SERVICE CENTER

*

Fund No:PlanType: Group Health

GISC, INC(800) 242-4472

GISC, INC20 WINTER STPEMBROKE MA 02359

FISERV HEALTH INC(800) 235-7160

AVIDYN HEALTH(214) 647-6194

FAMILY HOME HEALTH AGENCYAffiliated With: FISERV HEALTH

Fund No:PlanType: Group Health

FISERV HEALTH INC(800) 235-7160

FISERV HEALTH INCPO Box 520Pueblo CO 81002-0520

FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.(800) 990-9058

HCMFANCOR INCAffiliated With: FMH BENEFIT SERVICES INC

Fund No:PlanType: Group Health

FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.(800) 990-9058

FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.PO Box 25946OVERLAND PARK KS 66225-5946

BAC(614) 863-8780 Ext 3102

BAC(614) 863-8780

FANNING/HOWEY ASSOCIATES, INC.

Affiliated With: BUSINESS ADMINISTRATORS & CONSULTANTS

Fund No:PlanType: Group Health

BAC(614) 863-8780 Ext 3102

BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068

CBCA Administrators Inc CBCA Administrators IncFANSTEELAffiliated With: CBCA Administrators, Inc.

Fund No:PlanType: Group Health

CBCA Administrators Inc CBCA Administrators IncPO Box 902Beattyville KY 41311

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-197• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 198: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FARA - F. A. Richard & Associates, Inc.(985) 624-6740

FARA - F. A. Richard & Associates, Inc.(985) 624-6740

FARA AvondaleAffiliated With: F. A. Richard & Associates, Inc.

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)Exclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)

FARA - F. A. Richard & Associates, Inc.(985) 624-6740

FARA - F. A. Richard & Associates, Inc.1625 W. Causeway ApproachMandeville LA 70471

FARA - F. A. Richard & Associates, Inc.(985) 624-6740

FARA - F. A. Richard & Associates, Inc.(985) 624-6740

FARA IngallsAffiliated With: F. A. Richard & Associates, Inc.

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)Exclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)

FARA - F. A. Richard & Associates, Inc.(985) 624-6740

FARA - F. A. Richard & Associates, Inc.1625 W. Causeway ApproachMandeville LA 70471

HEALTH NET FEDERAL SERVICES(916) 985-1259

CHECK BENEFIT CARDFARGO VAMC 3707Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(916) 985-1259

HEALTH NET FEDERAL SERVICES2025 AEROJET RDRANCHO CORDOVA CA 95742

PATIENT ADVOCATES LLC PATIENT ADVOCATES LLC

FARLEY AND SONAffiliated With: PATIENT ADVOCATES LLC

Fund No:PlanType: Group Health

PATIENT ADVOCATES LLC PATIENT ADVOCATES LLCPO Box 1959Gray ME 04039

DIRECT CARE AMERICA(800) 266-5896

CHECK BENEFIT CARDFARMER NATIONAL BANKAffiliated With: THE CHANDLER GROUP #13352

Fund No:PlanType: Group Health

DIRECT CARE AMERICA(800) 266-5896

DIRECT CARE AMERICAPO Box 2090 CSTOW OH 44224

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-198• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FMH / HCM(800) 990-9058

FMH / HCM(800) 990-9058

FAULTLESS LINENAffiliated With: FMH BENEFIT SERVICES, INC.

Fund No:PlanType: Group Health

FMH / HCM(800) 990-9058

FMH / HCM

HEALTHLINK GROUP BENEFIT SERVICES, INC.

FAYETTE R III SCHOOLSAffiliated With: GROUP BENEFIT SERVICES, INC.

Fund No:PlanType: Group Health

GROUP BENEFIT SERVICES, INC.

HEALTHLINKPO Box 419104SAINT LOUIS MO 63141-9104

FAYETTEVILLE ARKANSAS VAMC

CHECK BENEFIT CARDFAYETTEVILLE ARKANSAS VAMC 3103

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

FAYETTEVILLE ARKANSAS VAMC

FAYETTEVILLE ARKANSAS VAMC

1100 NORTH COLLEGEFAYETTEVILLE AR 72703

Attn: FEE BASIS 04FB

FAYETTEVILLE NC VAMC CHECK BENEFIT CARDFAYETTEVILLE NC VAMC 3136Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

FAYETTEVILLE NC VAMC FAYETTEVILLE NC VAMC

2300 RAMSEY STFAYETTEVILLE NC 28301

Attn: FEE BASIS BUSINESS OFFICE (04)

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDFAYETTEVILLE STATE UNIVERSITY

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(888) 722-1668

PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-199• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FCCI Insurance Group(800) 226-3224

FCCI Insurance Group(800) 226-3224

FCCI Insurance GroupAffiliated With: FCCI Insurance Group

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

FCCI Insurance Group(800) 226-3224

FCCI Insurance Group6300 University PkwySarasota FL 34240

ADVENTIST HEALTH SYSTEM WEST

CHECK BENEFIT CARDFEATHER RIVER HOSPITALAffiliated With: ADVENTIST HEALTH SYSTEM/WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM WEST

ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002

Auxiant(800) 475-2232

CHECK BENEFIT CARDFEATHERLITE COACHES, INCAffiliated With: HEALTH DATA SERVICES

Fund No:PlanType: Group Health

Auxiant(800) 475-2232

AuxiantPO Box 75008Cedar Rapids IA 52401

STAR HEALTHCARE NETWORK(212) 581-8228

UM NOT APPLICABLEFEDERAL ASSISTAffiliated With: STAR HEALTHCARE NETWORK INC

*

Fund No:PlanType: Group Health

STAR HEALTHCARE NETWORK(212) 581-8228

STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019

GLOBALHEALTH(405) 280-5600

GLOBALHEALTH(405) 230-8781

Federal GovernmentAffiliated With: GLOBALHEALTH AND GENERATION HEALTHCARE

Fund No:PlanType: Group Health

GLOBALHEALTH(405) 280-5600

GLOBALHEALTH7001 NE 10th StOklahoma City OK 73104

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-200• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

NHBC(888) 621-7900

CHECK BENEFIT CARDFEDERATED INNSURANCEAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC) 12717

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

CHECK BENEFIT CARD CHECK BENEFIT CARDFEDERATED MUTUAL INSURANCE COMPANY

Affiliated With: FEDERATED MUTUAL INSURANCE COMPANY

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SISCO(800) 457-4726

CHECK BENEFIT CARDFEHR GRAHAM & ASSOCIATESAffiliated With: SELF INSURED SERVICE COMPANY SISCO

Fund No:PlanType: Group Health

SISCO(800) 457-4726

SISCOPO Box 389DUBUQUE IA 52004-0389

Underwriters Safety & Claims Inc.(800) 678-1536

Underwriters Safety & Claims Inc.(800) 678-1536

Feintool US Operations IncAffiliated With: Underwriters Safety & Claims Inc.

Fund No:PlanType: Group Health

Underwriters Safety & Claims Inc.(800) 678-1536

First HealthPO Box 8399Scottsdale AZ 85252-8399

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDFELICIAN COLLEGEAffiliated With: UnitedHealthcare StudentResources #11689

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

STUDENT INSURANCE A DIVISION OF UICIPO Box 809026DALLAS TX 75038

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-201• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERFerrellgasAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Corporate Beneifit Services of America(800) 925-2272

Corporate Beneifit Services of America(800) 925-2272

FH-Savings-Corporate Benefit Services of America

Affiliated With: FH-Savings-Corporate Benefit Services of America

Fund No:PlanType: Group Health

Corporate Beneifit Services of America(800) 925-2272

Corporate Beneifit Services of America400 Highway 169 South, Ste 800Minneapolis MN 55426-1141

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.(800) 284-2273

FI PPOAffiliated With: OSF HEALTHPLANS, INC.

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128

CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295

CHECK BENEFIT CARDFidelity MortgageAffiliated With: Carolina Benefit Administrators

Fund No:PlanType: Group Health

CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295

CAROLINA BENEFIT ADMINISTRATORS333 SOUTH PINE STSPARTANBURG SC 29302

Benefits/Eligibility(800) 843-3106

CHECK BENEFIT CARDFidelty Security LifeAffiliated With: Insurers Administrative Corporation #962500302

Fund No:PlanType: Group Health

Benefits/Eligibility(800) 843-3106

Benefits/Eligibility

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-202• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 203: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

FINDLAY MANAGEMENT GOUP INC. - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 742-7345

FINDLAY MANAGEMENT GROUP INC

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CONTACT EMPLOYER CONTACT EMPLOYERFiremans Fund Insurance CompanyAffiliated With: Firemans Fund Insurance Company

Fund No:PlanType: Workers' Compensation

Includes Specialized Physical Therapy

CONTACT EMPLOYER NOT APPLICABLEPO Box 23010Tucson AZ 85734

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDFIRST AMERICAN BANKAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

WAUSAU BENEFITS, INC.(715) 841-7802

CHECK BENEFIT CARDFIRST COMMUNITY BANKAffiliated With: WAUSAU BENEFITS INC

Fund No:PlanType: Group Health

WAUSAU BENEFITS, INC.(715) 841-7802

WAUSAU BENEFITS, INC.

PO Box 8046WAUSAU WI 54401-8046

Attn: LeAnn Fichtner

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-203• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERFirst Health Group Corp.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

America's TPA(952) 896-4888

CHECK BENEFIT CARDFIRST NATIONAL BANK HOLDINGS COMPANY - PEPM

Affiliated With: AMERICA'S TPA

Fund No:PlanType: Group Health

America's TPA(952) 896-4888

America's TPAPO Box 398220Bloomington MN 55439

America's TPA(952) 896-4888

CHECK BENEFIT CARDFIRST NATIONAL BANK HOLDINGS COMPANY - TRAVEL

Affiliated With: AMERICA'S TPA

Fund No:PlanType: Group Health

America's TPA(952) 896-4888

America's TPAPO Box 398220Bloomington MN 55439

CHECK BENEFIT CARD CHECK BENEFIT CARDFIRST NATIONAL BANK OF ARDMORE

Affiliated With: FISERVE HEALTH KANSAS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

FCE BENEFIT ADMINISTRATORS(800) 899-9355

CHECK BENEFIT CARDFIRST SUPPORT SERVICES INCAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-204• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EQUITABLE PLAN SERVICES(405) 755-2929

CHECK BENEFIT CARDFIRST UNITED BANK & TRUSTAffiliated With: EQUITABLE PLAN SERVICES

Fund No:PlanType: Group Health

EQUITABLE PLAN SERVICES(405) 755-2929

EQUITABLE PLAN SERVICESPO Box 720460OKLAHOMA CITY OK 73172

Benefit Planners(800) 292-5386

CHECK BENEFIT CARDFISERVAffiliated With: BENEFIT PLANNERS

Fund No:PlanType: Group Health

Benefit Planners(800) 292-5386

Benefit PlannersPO Box 690450SAN ANTONIO TX 78269

EBPA(800) 578-3272

CHECK BENEFIT CARDFITZ VOGT AND ASSOCIATES LTDAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDFLEETWOOD ENTERPRISESAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

FLETCHER JONES MANAGEMENT INC - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-205• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

FLETCHER JONES MANAGEMENT, INC. - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

CHECK BENEFIT CARD8005514049

CHECK BENEFIT CARDFLEXIBLE TECHNOLOGIES INCAffiliated With: P5 HEALTH PLAN SOLUTIONS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8005514049

CHECK BENEFIT CARD

NGS AMERICAN8005211555

NGS AMERICAN8005211555

FLINT GROUPAffiliated With: NGS AMERICAN INC

Fund No:PlanType: Group Health

NGS AMERICAN8005211555

NGS AMERICANPO Box 7676DETROIT MI 48080

CADENT ADMINSTRATORS, INC.

CHECK BENEFIT CARDFLORIDA COMPREHENSIVE HEALTH ASSOCIATION

Affiliated With: CADENT ADMINISTRATORS INC

Fund No:PlanType: Group Health

CADENT ADMINSTRATORS, INC.

CADENT ADMINSTRATORS, INC.1004 118th Ave NSt Petersburg FL 33716

PEARCE ADMINISTRATION(843) 622-6001

UM NOT APPLICABLEFLORIDA KEYS COMMUNITY COLLEGE

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-206• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Florida League of Cities(800) 756-3042

Florida League of Cities(877) 676-3890

Florida League of CitiesAffiliated With: Florida League of Cities

Fund No:PlanType: Group Health

Florida League of Cities(800) 756-3042

Florida League of CitiesPO Box 538140Orlando FL 32853-8140

GALLAGHER BENEFIT ADMINISTRATORS INC(866) 471-6037

CHECK BENEFIT CARDFLORISTS TRANSWORLD DELIVERY (FTD)

Affiliated With: GALLAGHER BENEFIT ADMINISTRATORS INC

Fund No:PlanType: Group Health

GALLAGHER BENEFIT ADMINISTRATORS INC(866) 471-6037

GALLAGHER BENEFIT ADMINISTRATORS INC750 WARRENVILLE RD STE 200LISLE IL 60532

HEALTHSCOPE BENEFITS INC(877) 240-0142

CHECK BENEFIT CARDFOOD GIANT SUPERMARKETS INC

Affiliated With: HEALTHSCOPE BENEFITS INC #11491

Fund No:PlanType: Group Health

HEALTHSCOPE BENEFITS INC(877) 240-0142

HEALTHSCOPE BENEFITS INCPO Box 619055DALLAS TX 75261

PRINCIPAL FINANCIAL GROUP

CHECK BENEFIT CARDFOOTHILL DEANZA COMMUNITY COLLEGE DISTRICT - FACULTY

Affiliated With: CORESOURCE, MN

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP

PRINCIPAL FINANCIAL GROUPPO Box 39710COLORADO SPRINGS CO 80949

ASSURECARE(800) 759-1311

Careline UR(763) 383-4800

FOREST OIL CORPAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

(800) 759-1311 ASSURECARE340 Quadrangle DrBolingbrook IL 60440

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-207• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDFORMOST PACKAGINGAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEFORT CALLEY UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDFORT VALLEY STATE UNIV AIH0058107

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDFORT VALLEY STATE UNIV AIH0058117

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

Forte(800) 580-1642

Forte(800) 580-2273

ForteAffiliated With: Forte

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

Forte(800) 580-1642

Forte

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-208• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURANT HEALTH(800) 743-8469

CHECK BENEFIT CARDFORTIS REMOTE REPRICINGAffiliated With: ASSURANT HEALTH

Fund No:PlanType: Group Health

ASSURANT HEALTH(800) 743-8469

ASSURANT HEALTH

CHECK BENEFIT CARD CHECK BENEFIT CARDFOSTER ASSOCIATES INCAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

FOUNTAINBLEAU RESORTS TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

ASSURECARE(800) 968-6616

CARELINE(763) 383-4800

FOX BROTHERSAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823

NHBC(888) 621-7900

CHECK BENEFIT CARDFOX EVERETT INSURANCE PEPMAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-209• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GILSBAR(985) 898-1673

CHECK BENEFIT CARDFRANCIS DRILLING FLUIDS LTDAffiliated With: GILSBAR, INC.

Fund No:PlanType: Group Health

GILSBAR(985) 898-1673

GILSBARPO Box 998COVINGTON LA 70434

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDFRANCIS MARION UNIVERSITY AMH9029757

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437

EQUITABLE PLAN SERVICES(405) 755-2929

CHECK BENEFIT CARDFRANCIS TUTTLE TECHNOLOGY CENTER

Affiliated With: EQUITABLE PLAN SERVICES

Fund No:PlanType: Group Health

EQUITABLE PLAN SERVICES(405) 755-2929

EQUITABLE PLAN SERVICESPO Box 720460OKLAHOMA CITY OK 73172

CONTACT EMPLOYER CONTACT EMPLOYERFrank Gates Service CompanyAffiliated With: Frank Gates Service Company

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

ADMINISTRATIVE CONCEPTS INC(888) 293-9229

UM NOT APPLICABLEFRANKLIN & MARSHALL COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS, INC.

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS INC(888) 293-9229

ADMINISTRATIVE CONCEPTS INC

997 Old Eagle School Rd. #215WAYNE PA 19087-1706

Attn: Customer Service Dept

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-210• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 211: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

FRASIER TIMBER UNLIMITEDAffiliated With: NORTH AMERICAN ADMINISTRATORS-NY

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226

THE EPOCH GROUP, LC(800) 255-6065

SHORMAN SOLUTIONS(800) 255-6065

FRC ELECTRICAL INDUSTRIESAffiliated With: THE EPOCH GROUP 10469

Fund No:PlanType: Group Health

THE EPOCH GROUP, LC(800) 255-6065

THE EPOCH GROUP, LCPO Box 12170OVERLAND PARK KS 66282

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARDFREDS PLUMBING AND HEATING WRAP JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

CBSA(952) 593-6438

GUIDED2HEALTH(952) 593-6447

FREEDOM GRAPHICS SYSTEMS, INC

Affiliated With: CORPORATE BENEFIT SERVICE OF AMERICA

Fund No:PlanType: Group Health

CBSA(952) 593-6438

CBSA400 Highway 169 South, Ste 800Minneapolis MN 55426-1141

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-211• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 212: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FREEDOM LIFE INSURANCE CO. OF AMERICA

FREEDOM LIFE INSURANCE CO. OF AMERICA(800) 387-9027

FREEDOM LIFE INSURANCE CO. OF AMERICA

Affiliated With: FREEDOM LIFE INSURANCE CO. OF AMERICA

Fund No:PlanType: Group Health

FREEDOM LIFE INSURANCE CO. OF AMERICA

FREEDOM LIFE INSURANCE CO. OF AMERICA110 W 7TH ST STE 300FORT WORTH TX 76120

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

FREMONT MILLWORK CO.Affiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

HEALTH NET FEDERAL SERVICES(916) 985-1259

CHECK BENEFIT CARDFRESNO VA MEDICAL CENTER 3188

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(916) 985-1259

HEALTH NET FEDERAL SERVICES2025 AEROJET RDRANCHO CORDOVA CA 95742

CONSOLIDATED HEALTH PLANS(800) 633-7867

UM NOT APPLICABLEFringe MIni-Med Hospital - Hospital & Professional

Affiliated With: CONSOLIDATED HEALTH PLANS

Fund No:PlanType: Group Health

CONSOLIDATED HEALTH PLANS(800) 633-7867

CONSOLIDATED HEALTH PLANS195 STAFFORD STSPRINGFIELD MA 01104

CONSOLIDATED HEALTH PLANS(800) 633-7867

UM NOT APPLICABLEFringe Mini-Med Professional OnlyAffiliated With: CONSOLIDATED HEALTH PLANS

Fund No:PlanType: Group Health

CONSOLIDATED HEALTH PLANS(800) 633-7867

CONSOLIDATED HEALTH PLANS195 STAFFORD STSPRINGFIELD MA 01104

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-212• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH PLAN INC(508) 752-2480

CARE MANAGEMENT SERVICES(866) 325-1550

FRISBIE MEMORIAL HOSPITALAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

FCE BENEFIT ADMINISTRATORS(800) 899-9355

CHECK BENEFIT CARDFROST INDUSTRIESAffiliated With: FCE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS(800) 899-9355

FCE BENEFIT ADMINISTRATORS4615 WALZEN RD STE 300SAN ANTONIO TX 78218

FT WAYNE VA MEDICAL CENTER

CHECK BENEFIT CARDFT WAYNE VA MEDICAL CENTER 3159

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

FT WAYNE VA MEDICAL CENTER

FT WAYNE VA MEDICAL CENTER

2121 LAKE AVEFT WAYNE IN 46805

Attn: FEE BASIS 136A

BAS(709) 799-7400

CHECK BENEFIT CARDFull -O-Pep AppliancesAffiliated With: BENEFIT ADMINISTRATIVE SYSTEMS

Fund No:PlanType: Group Health

BAS(709) 799-7400

BAS17475 JOVANNA DRHOMEWOOD IL 60430

CHECK BENEFIT CARD CHECK BENEFIT CARDFULLER THEOLOGICAL SEMINARY

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-213• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

FULLERTON COLLEGE/NORTH ORANGE COUNTY COMMUNITY COLLEGE DISTRICT

Affiliated With: AMERIBEN SOLUTIONS

Term Effective: 8/31/2007Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

CHECK BENEFIT CARD7753526901

CHECK BENEFIT CARDFUNDIS TRUCKING COMPANYAffiliated With: CDS GROUP HEALTH

Fund No:PlanType: Group Health

CHECK BENEFIT CARD7753526901

CHECK BENEFIT CARD

America's TPA(952) 896-1255

CHECK BENEFIT CARDFURST- MCNESS COMPANYAffiliated With: AMERICAS TPA

Fund No:PlanType: Group Health

America's TPA(952) 896-1255

America's TPAPO Box 398220Bloomington MN 55439

DIVERSIFIED HEALTHCARE SVCS

DIVERSIFIED HEALTHCARE SVCS

FUTURE CARE MEDCHECK

Fund No:PlanType: Group Health

DIVERSIFIED HEALTHCARE SVCS

DIVERSIFIED HEALTHCARE SVCS201 SANDPOINTESANTA ANA CA 92707

ASSURECARE(800) 968-6616

CARELINE(763) 383-4800

G & C INDUSTRIESAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-214• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8014742555

CHECK BENEFIT CARDG E JOHNSON CONSTRUCTION CO INC

Affiliated With: P5 HEALTH PLAN SOLUTIONS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8014742555

CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERGAB RobbinsAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

SRT ADMINISTRATORS(800) 879-8500

SRT ADMINISTRATORSGADSDEN ELEMENTARY SCHOOL DISTRICT

Affiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS(800) 879-8500

SRT ADMINISTRATORSPO Box 25160SCOTTSDALE AZ 85255-0102

GROUP INSURANCE SERVICE CENTER(800) 242-4472

GISC TOTALCARE(800) 242-4472

GAFTEK, LLCAffiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

GROUP INSURANCE SERVICE CENTER(800) 242-4472

GROUP INSURANCE SERVICE CENTER20 WINTER STPEMBROKE MA 02359

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGAINESVILLE COLLEGE AIH 0058127

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-215• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGAINESVILLE COLLEGE AIH0058137

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEGAINESVILLE COLLEGE UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

AMERIHEALTH ADMINISTRATORS(800) 480-5032

AMERIHEALTH ADMINISTRATORS(800) 952-3404

GALAXY SCIENTIFIC CORPORATION

Affiliated With: AMERIHEALTH ADMINISTRATORS

Fund No:PlanType: Group Health

AMERIHEALTH ADMINISTRATORS(800) 480-5032

AMERIHEALTH ADMINISTRATORS720 BLAIR MILL RDHORSHAM PA 19044

First Health(800) 370-0594

CONTACT EMPLOYERGallagher Bassett Managed Care Services

Affiliated With: Gallagher Bassett Managed Care Services

Fund No:PlanType: Workers' Compensation

First Health(800) 370-0594

First HealthPO Box 23812Tucson AZ 85734

CONTACT EMPLOYER NOT APPLICABLEGallagher Bassett Services, Inc.Affiliated With: Gallagher Bassett Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-216• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDGallagher Woodsmall

Fund No:PlanType: Group Health

-Please refer to Gallagher Benefit Administrators, Inc.

CHECK BENEFIT CARD CHECK BENEFIT CARD

MCA ADMINISTRATORS INC(800) 922-4966

CHECK BENEFIT CARDGALLIKER DAILY COMPANYAffiliated With: MCA ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

MCA ADMINISTRATORS INC(800) 922-4966

MCA ADMINISTRATORS INC820 PARISH STPITTSBURGH PA 15220

CONTACT EMPLOYER CONTACT EMPLOYERGAMBRO HealthcareAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

GAMING PARTNERS INTERNATIONAL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

GAMING PARTNERS INTERNATIONAL - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-217• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SELF INSURED PLANS LLC

MedWatch(800) 432-8421

GARGIULIO INCAffiliated With: SELF INSURED PLANS LLC

Fund No:PlanType: Group Health

SELF INSURED PLANS LLC SELF INSURED PLANS LLC1016 COLLIER CENTER STE 200NAPLES FL 34103

EBC EBC ReviewGarland Company TheAffiliated With: SUPERIEN HEALTH NETWORK

Fund No:PlanType: Group Health

Refer to Intercorp

SUPERIEN HEALTH NETWORK

SUPERIEN HEALTH NETWORKPO Box 2388STOW OH 44224

CHECK BENEFIT CARD CHECK BENEFIT CARDGARY WILLIAMS ENERGY CORPORATION

Affiliated With: AMERICAN ADMINISTRATIVE GROUP

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PACIFIC LIFE & ANNUITY COMPANY(800) 542-6642

CHECK BENEFIT CARDGASDEN LAWN & LANDSCAPEAffiliated With: PACIFIC LIFE & ANNUITY

Fund No:PlanType: Group Health

PACIFIC LIFE & ANNUITY COMPANY(800) 542-6642

PACIFIC LIFE & ANNUITY COMPANYPO Box 295Onalaska WI 54650

Western Health(605) 719-4600 or (888) 341-1766

Western Health(605) 719-4640 or (800) 229-0892

Gases PlusAffiliated With: Rapid City Regional Hospital DBA Western Health

Fund No:PlanType: Group Health

Western Health(605) 719-4600 or (888) 341-1766

Western Health529 Kansas City St Ste 200Rapid City SD 57701

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-218• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BUSINESS ADMINISTRATORS & CONSULTANTS INC(614) 863-8780

BUSINESS ADMINISTRATORS & CONSULTANTS INC(614) 863-8780

GBS CORPAffiliated With: BUSINESS ADMINISTRATORS & CONSULTANTS

Fund No:PlanType: Group Health

BUSINESS ADMINISTRATORS & CONSULTANTS INC(614) 863-8780

BUSINESS ADMINISTRATORS & CONSULTANTS INC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068

CONTACT EMPLOYER CONTACT EMPLOYERGE Young and CoAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER First Health(800) 370-0594

GE/ERC

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER First HealthPO Box 23812Tucson AZ 85734

EBMS(800) 777-3575

EBMS(800) 777-3575

GELCO CONSTRUCTIONAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

EBMS(800) 777-3575

EBMSPO Box 21367BILLINGS MT 59104-1367

CHECK BENEFIT CARD CHECK BENEFIT CARDGELITA USAAffiliated With: SELECT BENEFIT ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-219• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDGEMINI INDUSTRIES INCAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

COMBINED BENEFIT ADMINISTRATORS(559) 275-3984

CHECK BENEFIT CARDGEMPERLE ENTERPRISESAffiliated With: COMBINED BENEFITS ADMINISTRATORS

Fund No:PlanType: Group Health

COMBINED BENEFIT ADMINISTRATORS(559) 275-3984

COMBINED BENEFIT ADMINISTRATORS4704 W. Jennifer Ave. #104FRESNO CA 93722

Coventry Health Care(724) 778-5362

CHECK BENEFIT CARDGENERAL ELECTRICAffiliated With: COVENTRY HEALTH CARE

Fund No:PlanType: Group Health

Coventry Health Care(724) 778-5362

Coventry Health Care120 E Kensinger DrCranberry Township PA 16066

CHECK BENEFIT CARD CHECK BENEFIT CARDGENERAL GROWTH PROPERTIES INC

Affiliated With: ALLIED BENEFIT SYSTEMS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

TRUSTEED PLANS SERVICE CORPORATION(800) 426-9786

AMERICAN HEALTH HOLDINGS(888) 877-7994

GENERAL PLASTICS MFGAffiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE CORPORATION(800) 426-9786

TRUSTEED PLANS SERVICE CORPORATIONPO Box 1894TACOMA WA 98401-1894

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-220• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 221: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDGENERAL RUBBER AND PLASTIC OF LOUISVILLE INC

Affiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

Genesis Managed Care(704) 321-3909

Genesis Managed Care(704) 321-3909

Genesis Managed Care

Fund No:PlanType: Workers' Compensation

Genesis Managed Care(704) 321-3909

Genesis Managed CarePO Box 17076Charlotte NC 28227

CONTACT EMPLOYER CONTACT EMPLOYERGENEX Services Exclusive - CCN Transition

Affiliated With: GENEX Services, Inc.

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERGENEX Services Exclusive AUTOAffiliated With: GENEX Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERGenex Services, Inc.Affiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-221• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 222: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERGENEX Services, Inc. EPPAffiliated With: GENEX Services, Inc.

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

EASTERN BENEFIT SYSTEMS, INC.(800) 524-0227

CHECK BENEFIT CARDGENLYTE THOMAS GROUP, LLCAffiliated With: EASTERN BENEFIT SYSTEMS, INC

Fund No:PlanType: Group Health

EASTERN BENEFIT SYSTEMS, INC.(800) 524-0227

EASTERN BENEFIT SYSTEMS, INC.200 Freeway Dr, EastEast Orange 07018

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDGEORGE FOX UNIVERSITYAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

HEALTH PLAN INC(508) 752-2480

CARE MANAGEMENT SERVICES(886) 325-1550

GEORGE J FOSTER CO INC. CITIZEN PUBLISHING

Affiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INCPO Box 5199WESTBOROUGH MA 01581

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

GEORGE SCHMITT & CO.Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-222• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 223: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEGEORGIA COLLEGE & STATE UNIVERSITY UNDERGRAD

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGEORGIA COLLEGE AND STATE UNIVERSITY AIH0058167

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGEORGIA COLLEGE AND STATE UNIVERSITY AIH0058177

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGEORGIA HIGHLANDS COLLEGE AIH0058197

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-223• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 224: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGEORGIA HIGHLANDS COLLEGE IAH0058187

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEGEORGIA HIGHLANDS COLLEGE UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDGEORGIA INSTITUTE OF TECHNOLOGY AIH0000286

Affiliated With: MAKSIN MANAGEMENT CORPORATION

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 722-1668

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGEORGIA INSTITUTE OF TECHNOLOGY AIH0058207

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-224• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 225: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGEORGIA INSTITUTE OF TECHNOLOGY AIH0058217

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEGEORGIA INSTITUTE OF TECHNOLOGY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

CONTACT EMPLOYER CONTACT EMPLOYERGeorgia PacificAffiliated With: GENEX Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGEORGIA PERIMETER COLLEGE AIH0058237

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-225• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 226: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEGEORGIA PERIMETER COLLEGE UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGEORGIA SOUTHERN UNIV AIH0058247

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGEORGIA SOUTHERN UNIV AIH0058257

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEGEORGIA SOUTHERN UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-226• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 227: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGEORGIA SOUTHWESTERN STATE UNIVERSITY AIH0058267

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGEORGIA SOUTHWESTERN STATE UNIVERSITY AIH0058277

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEGEORGIA SOUTHWESTERN STATE UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGEORGIA STATE UNIVERSITY - AIH0058287

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-227• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 228: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGEORGIA STATE UNIVERSITY - AIH0058297

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEGEORGIA STATE UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

ADMINISTRATIVE CONCEPTS INC(888) 293-9229

UM NOT APPLICABLEGETTYSBURG COLLEGEAffiliated With: ADMINISTRATIVE CONCEPTS, INC.

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS INC(888) 293-9229

ADMINISTRATIVE CONCEPTS INC

997 Old Eagle School Rd. #215WAYNE PA 19087-1706

Attn: Customer Service Dept

PREFERRED CARE, INC.(215) 639-6208

CHECK BENEFIT CARDGETTYSBURG HEALTH ADMINISTRATORS

Affiliated With: PREFERRED CARE INC

Fund No:PlanType: Group Health

PREFERRED CARE, INC.(215) 639-6208

PREFERRED CARE, INC.1300 VIRGINIA DR STE 315FT. WASHINGTON PA 19034

PACIFIC LIFE & ANNUITY COMPANY

CHECK BENEFIT CARDGIANGRECO MEDICAL GROUP INC

Affiliated With: PACIFIC LIFE & AMUINITY COMPANY

Fund No:PlanType: Group Health

PACIFIC LIFE & ANNUITY COMPANY

PACIFIC LIFE & ANNUITY COMPANYPO Box 295Onalaska WI 54650

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-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.

Page 229: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ADVANCED BENEFIT SOLUTIONS LLC(888) 419-1094

ARIZONA FOUNDATION FOR MEDICAL CARE(800) 852-8001

GILBERT HOSPITALAffiliated With: ADVANCED BENEFIT SOLUTIONS LLC

Fund No:PlanType: Group Health

ADVANCED BENEFIT SOLUTIONS LLC(888) 419-1094

ADVANCED BENEFIT SOLUTIONS LLCPO Box 71490PHOENIX AZ 85050

GROUP & PENSION ADMINISTRATORS(800) 827-7223

CHECK BENEFIT CARDGinny's Copying Services inc (TRAVEL)

Affiliated With: GROUP & PENSION ADMINISTRATORS

*

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

PINNACLE CLAIMS MANAGEMENT INC(800) 777-7898

UM NOT APPLICABLEGIUMARRA VINEYARDSAffiliated With: PINNACLE CLAIMS MANAGEMENT INC

Fund No:PlanType: Group Health

PINNACLE CLAIMS MANAGEMENT INC(800) 777-7898

PINNACLE CLAIMS MANAGEMENT INCPO Box 2220NEWPORT BEACH CA 92658

TRUSTEED PLANS SERVICE CORPORATION(800) 426-9786

AMERICAN HEALTH HOLDINGS(888) 877-7994

GLACIER FISH COMPANYAffiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE CORPORATION(800) 426-9786

TRUSTEED PLANS SERVICE CORPORATIONPO Box 1894TACOMA WA 98401-1894

Professional Benefit Administrators, Inc.(630) 655-3755

CHECK BENEFIT CARDGLEN OAK VEBA TRUSTAffiliated With: PROFESSIONAL BENEFIT ADMINISTRATORS INC (PBA)

Fund No:PlanType: Group Health

Professional Benefit Administrators, Inc.(630) 655-3755

Professional Benefit Administrators, Inc.900 Jorie Blvd Ste 250Oakbrook IL 60523

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-229• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 230: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GLOBAL EXCEL MANAGEMENT(819) 566-2901

GLOBAL EXCEL MANAGEMENT(819) 566-2901

GLOBAL EXCEL MANAGEMENTAffiliated With: GLOBAL EXCEL MANAGEMENT

Fund No:PlanType: Group Health

GLOBAL EXCEL MANAGEMENT(819) 566-2901

GLOBAL EXCEL MANAGEMENT73 QUEEN STLENNOXVILLE QC J1M 1J3

STAR HEALTHCARE NETWORK(212) 581-8228

UM NOT APPLICABLEGLOBAL EXCHANGE INCAffiliated With: STAR HEALTHCARE NETWORK INC

*

Fund No:PlanType: Group Health

STAR HEALTHCARE NETWORK(212) 581-8228

STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019

International Medical Group, Inc.(800) 628-4664

International Medical Group, Inc.(800) 628-4664

Global Select WorldwideAffiliated With: International Medical Group Inc

Fund No:PlanType: Group Health

International Medical Group, Inc.(800) 628-4664

International Medical Group, Inc.2960 N Meridian StIndianapolis IN 46208

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

CHECK BENEFIT CARDGlobalcare IndividualsAffiliated With: International Medical Group, Inc.

Fund No:PlanType: Group Health

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

CHECK BENEFIT CARDGlobalcare ScholarsAffiliated With: International Medical Group, Inc.

Fund No:PlanType: Group Health

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-230• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 231: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

G M WHITE CONSTRUCTION, INC(508) 763-8868

CHECK BENEFIT CARDGM WHITE CONSTRUCTION INCAffiliated With: ULTRABENEFITS

Fund No:PlanType: Group Health

G M WHITE CONSTRUCTION, INC(508) 763-8868

G M WHITE CONSTRUCTION, INC867 MIDDLE RDACUSHNET MA 02743

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

GMP INTERNATIONALAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

GMP RETIREDAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

IAA(800) 283-2524

HEALTHCARE STRATEGIES INC(800) 582-1535

GODWIN PUMPS OF AMERICA INCAffiliated With: INSURANCE ADMIN OF AMERICA INC

Fund No:PlanType: Group Health

IAA(800) 283-2524

IAAPO Box 5082MT LAUREL NJ 08054

Zenith Administrators(800) 382-6278

Zenith Administrators(800) 382-6278

Gold Coast Joint Benefit TrustAffiliated With: Gold Coast Joint Benefit Trust

Fund No:PlanType: Group Health

The First Health® Network is not used for Behavioral Health or Chiropractic services.

Zenith Administrators(800) 382-6278

Zenith AdministratorsPO Box 7356San Francisco CA 94120-7356

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-231• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 232: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

GOLDEN GATE UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

GOLDEN RULE INSURANCE COMPANY(317) 297-4189

CHECK BENEFIT CARDGOLDEN RULE INSURANCE COMPANY

Affiliated With: GOLDEN RULE INSURANCE COMPANY

Fund No:PlanType: Group Health

GOLDEN RULE INSURANCE COMPANY(317) 297-4189

GOLDEN RULE INSURANCE COMPANY712 11TH ST.LAWRENCEVILLE IL 62439

TRANSWESTERN INSURANCE ADMINISTRATORS, INC.(559) 499-2000

CHECK BENEFIT CARDGOLDEN STATE BULB GROWERS, INC

Affiliated With: TRANSWESTERN INSURANCE

Fund No:PlanType: Group Health

TRANSWESTERN INSURANCE ADMINISTRATORS, INC.(559) 499-2000

TRANSWESTERN INSURANCE ADMINISTRATORS, INC.955 N StreetFresno CA 93721

CONTACT EMPLOYER CONTACT EMPLOYERGoldkistAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN

HINES & ASSOCIATES(800) 528-2498

GOLTEN MARINE CO.Affiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)

Term Effective: 8/31/2007Fund No:PlanType: Group Health

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-232• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 233: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

GOOD VOCATIONS HEALTH & BENEFIT SYSTEMS

Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

PATIENT ADVOCATES LLC(800) 290-8559

UM NOT APPLICABLEGood Will HinckleyAffiliated With: PATIENT ADVOCATES LLC

*

Fund No:PlanType: Group Health

PATIENT ADVOCATES LLC(800) 290-8559

PATIENT ADVOCATES LLCPO Box 1959Gray ME 04039

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

GOODFELLOW CORP - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLEGOODWILL CENTRAL FLORIDAAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

GOODWILL EASTER SEALS OF THE MIAMI INC.

Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-233• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 234: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FCE BENEFIT ADMINISTRATORS(800) 899-9355

CHECK BENEFIT CARDGOODWILL FORT WORTHAffiliated With: FCE BENEFIT ADMINISTRATOR

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS(800) 899-9355

FCE BENEFIT ADMINISTRATORS4615 WALZEN RD STE 300SAN ANTONIO TX 78218

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

GOODWILL INDUSTRIAL SERVICES CORPORATION

Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 523-0582

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH & WELFARE BENEFIT(800) 283-4927

GOODWILL INDUSTRIES OF CENTRAL INDIANA

Affiliated With: HEALTH AND WELFARE BENEFIT SYSTEMS INC

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC3241 ELECTRIC RD BLDG D STE 2-BROANOKE VA 24018

CORESOURCE(866) 280-4120

UM NOT APPLICABLEGoodwill Industries of Lower South Carolina

Affiliated With: CORESOURCE

Fund No:PlanType: Group Health

CORESOURCE(866) 280-4120

CORESOURCEPO Box 2920CLINTON OH 52733-2920

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

GOODWILL INDUSTRIES OF NORTH GEORGIA

Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-234• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 235: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLEGOODWILL INDUSTRIES OF NORTH LOUISIANA

Affiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

CHECK BENEFIT CARDGOODWILL LOWER SOUTH CAROLINA

Affiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLEGOODWILL OF NORTH FLORIDA DBA GINFL SERVICES

Affiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

GOODWILL SERVICES INC.Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

GROUP & PENSION ADMINISTRATORS(800) 827-7223

HEALTH WATCH(972) 238-7900

Goose Creek TravelAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-235• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 236: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONSOLIDATED HEALTH PLANS INC(800) 633-7867

CHECK BENEFIT CARDGORDON COLLEGEAffiliated With: CONSOLIDATED HEALTH PLANS INC

Fund No:PlanType: Group Health

CONSOLIDATED HEALTH PLANS INC(800) 633-7867

CONSOLIDATED HEALTH PLANS INC195 STAFFORD STSPRINGFIELD MA 01104

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDGORDON COLLEGE AIH0058307Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEGORDON COLLEGE UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PIONEER MANAGEMENT SYSTEMS(877) 868-9060

CHECK BENEFIT CARDGORDON CONWELL THEOLOGICAL SEMINARY

Affiliated With: PIONEER MANAGEMENT SYSTEMS

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(877) 868-9060

PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01090

HEALTHCOMP(800) 442-7247

HEALTHCOMP(800) 755-7247

GOWAN COMPANYAffiliated With: HEALTHCOMP TPA

Fund No:PlanType: Group Health

HEALTHCOMP(800) 442-7247

HEALTHCOMPPO Box 45018Fresno CA 93718

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-236• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 237: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDGOWAN MILLING COMPANYAffiliated With: TRANSWESTERN INSURANCE ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

CHECK BENEFIT CARDGRADY MEMORIAL HOSPITALAffiliated With: WATERSTONE BENEFITS ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

GRAEAGLE CONSTRUCTION & DEVELOPMENT LLC

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

GRAFOXATIONAffiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

GLOBALCARE(678) 341-1811

UM NOT APPLICABLEGRAHAM ENTERPRISES - PEPMAffiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-237• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 238: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GLOBALCARE(678) 341-1811

UM NOT APPLICABLEGRAHAM ENTERPRSES - % OF SAVINGS

Affiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005

GRAND JUNCTION VAMC CHECK BENEFIT CARDGRAND JUNCTION VAMC 3533Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

GRAND JUNCTION VAMC GRAND JUNCTION VAMC

WILLIAM ST off HWY 12 WESTFORT HARRISON MT 59636

Attn: FEE BASIS

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

GRAND SIERRA CONSULTINGAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CHECK BENEFIT CARD CHECK BENEFIT CARDGRANGER MEDICAL CLINICAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

HEALTH PLAN INC(508) 752-2480

CHECK BENEFIT CARDGRANITE STATE GLASSAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-238• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 239: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Benefit Planners(800) 292-5386

CHECK BENEFIT CARDGRANT PRIDECOAffiliated With: BENEFIT PLANNERS

*

Fund No:PlanType: Group Health

Benefit Planners(800) 292-5386

Benefit PlannersPO Box 690450SAN ANTONIO TX 78269

The Gray Insurance Company(713) 671-2534 (909) 353-6800

The Gray Insurance Company(713) 671-2534

Gray Insurance Company TheAffiliated With: Gray Insurance Company The

Fund No:PlanType: Workers' Compensation

ADVENTIST RISK MANAGEMENT, INC.(800) 293-3131 (909) 353-6800

The Gray Insurance Company1717 East Loop Ste 333Houston TX 77029

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDGRAY TELEVISION INCAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.

GREASEWOOD SPRINGS COMMUNITY SCHOOL

Affiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.PO Box 25160SCOTTSDALE AZ 85255-0102

CONTACT EMPLOYER CONTACT EMPLOYERGreat American InsuranceAffiliated With: Fair Isaac

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-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.

Page 240: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERGreat American Insurance CompanyAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850

AMERICAN HEALTH GROUP(888) 877-7994

GREAT BASIN GOLDAffiliated With: TRUSTEED PLANS SERVICE CORP

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850

TRUSTEED PLANS SERVICE CORPORATIONPO Box 1894TACOMA WA 98401-1894

American Administrative Group Inc.(877) 782-6828

American Administrative Group Inc.(800) 538-5222

Great Lakes Dredge and Dock Company

Affiliated With: American Administrative Group

Fund No:PlanType: Group Health

American Administrative Group Inc.(877) 782-6828

American Administrative Group Inc.PO Box 5227LISLE IL 60532ECS Payor ID 57283

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLEGREAT PLAINSAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

CHECK BENEFIT CARDGREAT PLAINS REGIONAL MEDICAL CTR

Affiliated With: WATERSTONE BENEFITS ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-240• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 241: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTHCOMP(800) 442-7247

HEALTHCOMP(800) 755-7247

GREAT WESTERN MALTINGAffiliated With: HEALTHCOMP TPA

Fund No:PlanType: Group Health

HEALTHCOMP(800) 442-7247

HEALTHCOMPPO Box 45018Fresno CA 93718

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADVANTAGE(818) 715-0558

GREAT WHITE ENERGY SERVICES, LLC

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

*

Term Effective: 10/31/2007Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORS3121 QUAIL SPRINGS PKWYOKLAHOMA CITY OK 73134

GREATER LA HCS (SEPULVEDA VAMC)

CHECK BENEFIT CARDGREATER LA HCS (SEPULVEDA VAMC) 3189

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

GREATER LA HCS (SEPULVEDA VAMC)

GREATER LA HCS (SEPULVEDA VAMC)

16111 PLUMMER STSEPULVEDA CA 91343

Attn: BLDG 1, ROOM A165

CONTACT EMPLOYER CONTACT EMPLOYERGreater NY New JerseyAffiliated With: Greater New York Company

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

GROUP INSURANCE SERVICE CENTER, INC(781) 829-8595 Ext 136

CHECK BENEFIT CARDGREEN MOUNTAIN COMMUNICATIONS INC

Affiliated With: GROUP INSURANCE SERVICE CENTER INC

Fund No:PlanType: Group Health

GROUP INSURANCE SERVICE CENTER, INC(781) 829-8595 Ext 136

GROUP INSURANCE SERVICE CENTER, INC20 WINTER STPEMBROKE MA 02359

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-241• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 242: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDGREENE CONCRETE CUTTINGAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD8002615511

CHECK BENEFIT CARDGREENWOOD CONSTRUCTIONAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8002615511

CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDGREER AND SONSAffiliated With: CAROLINA BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

BUSINESS ADMINISTRATORS & CONSULTANTS INC(800) 521-2654

CHECK BENEFIT CARDGREY WOLF DRILLINGAffiliated With: BUSINESS ADMINISTRATORS AND CONSULTANTS

Fund No:PlanType: Group Health

BUSINESS ADMINISTRATORS & CONSULTANTS INC(800) 521-2654

BUSINESS ADMINISTRATORS & CONSULTANTS INCPO Box 107REYNOLDSBURG OH 43068

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDGRIFFIN TELEVISION OKC, LLCAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-242• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 243: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MERITAIN HEALTH(877) 777-6076

GUIDED2HEALTH(952) 593-6447

GRIFFITH ENERGY SERVICESAffiliated With: CORPORATE BENEFIT SERVICE OF AMERICA

Fund No:PlanType: Group Health

MERITAIN HEALTH(877) 777-6076

MERITAIN HEALTHPO Box 1065AMHERST NY 14226

MEDICAL CLAIMS SERVICES, INC.(888) 225-0522

AMERICAN HEALTH HOLDINGS INC(800) 592-9858

GROB SYSTEMS INCAffiliated With: MEDICAL CLAIMS SERVICE INC

Fund No:PlanType: Group Health

MEDICAL CLAIMS SERVICES, INC.(888) 225-0522

MEDICAL CLAIMS SERVICES, INC.1 WALL ST STE 2ARAVENSWOOD WV 26164

CHECK BENEFIT CARD CHECK BENEFIT CARDGROSSMONT CUYAMACA COMMUNITY COLLEGE DISTRICT

Affiliated With: BENEFIT AND RISK MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

GROUP & PENSION ADMINISTRATORS(800) 827-7223

HEALTH WATCH(972) 238-7900

GROUP & PENSION ADMINISTRATORS

Affiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

GLOBALCARE(678) 341-1811

GROUP HEALTH MANAGERS

GROUP HEALTH MANAGERSAffiliated With: GLOBALCARE, INC.

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-243• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 244: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GLOBALCARE(910) 485-0510

HINES & ASSOCIATES(800) 670-7718

GROUP MANAGEMENT SERVICES - DLORAH, INC. GMS-402

Affiliated With: GLOBALCARE, INC.

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005

GLOBALCARE(678) 341-1811

HINES & ASSOCIATES(800) 670-7718

GROUP MANAGEMENT SERVICES - EL DORADO CLAIMS SERVICES - GMS-452

Affiliated With: GLOBALCARE, INC.

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005

GLOBALCARE(678) 341-1811

HINES & ASSOCIATES(800) 670-7718

GROUP MANAGEMENT SERVICES - MARSHALL ENGINES INC. GMS-435

Affiliated With: GLOBALCARE, INC.

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005

GLOBALCARE(678) 341-1922

UM NOT APPLICABLEGROUP MANAGEMENT SERVICES - TASLER

Affiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1922

GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-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.

Page 245: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

THE EPOCH GROUP(800) 365-9036

INTRACORP(800) 716-8506

GROUP360 INC.Affiliated With: THE EPOCH GROUP #10469

Fund No:PlanType: Group Health

THE EPOCH GROUP(800) 365-9036

THE EPOCH GROUP10795 Watson RdSt. Louis MO 63129

CHECK BENEFIT CARD CHECK BENEFIT CARDGROUPE SEB USA DBA ROWENTA

Affiliated With: EASTERN BENEFITS SYSTEMS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Benefits/Eligibility(800) 843-3106

CHECK BENEFIT CARD(800) 522-2161

Guarantee Life Insurance CompanyAffiliated With: Insurers Administrative Corporation #962500302

Fund No:PlanType: Group Health

Benefits/Eligibility(800) 843-3106

Benefits/EligibilityPO Box 828Park Ridge IL 60068-0828

Insurers Administrative Corporation (IAC)(800) 843-3106

Med-Valu(800) 522-2161

GUARANTEE LIFE INSURANCE COMPANY

Affiliated With: INSURERS ADMINISTRATIVE CORPORATION #11337

Fund No:PlanType: Group Health

Insurers Administrative Corporation (IAC)(800) 843-3106

Insurers Administrative Corporation (IAC)PO Box 828Park Ridge IL 60068-0828

NGS AMERICAN8005211555

NGS AMERICAN8005211555

GUARDIAN INDUSTRIESAffiliated With: NGS AMERICAN INC

Fund No:PlanType: Group Health

NGS AMERICAN8005211555

NGS AMERICANPO Box 7676DETROIT MI 48080

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-245• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 246: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CENTRAL BENEFITS(800) 223-2900

QUANTUM HEALTH(800) 257-2038

GUERNSEY COUNTYAffiliated With: HEALTHSCOPE BENEFITS INC

Fund No:PlanType: Group Health

CENTRAL BENEFITS(800) 223-2900

CENTRAL BENEFITSPO Box 619053DALLAS TX 75261-9053

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLEGULF COAST ENTERPRISESAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

CHECK BENEFIT CARD CHECK BENEFIT CARDGULF INDUSTRIES, INC. / SIGNAL COMMUNICATION CORP.

Affiliated With: FARA BENEFIT SERVICES, INC.

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

HEALTH NET FEDERAL SERVICES(214) 387-3232

CHECK BENEFIT CARDGULFPORT VAMC 3104Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(214) 387-3232

HEALTH NET FEDERAL SERVICES

400 VETERANS AVEBILOXI MS 39531

Attn: FEE BASIS 136F

ASSURECARE(800) 759-7422

Careline UR(763) 383-4800

GYPSUM MANAGEMENT AND SUPPLY COMPANY

Affiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 759-7422

ASSURECARE340 Quadrangle DrBolingbrook IL 60440

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-246• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 247: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8002218942

CHECK BENEFIT CARDH S DEVELOPERSAffiliated With: TRANSWESTERN INSURANCE ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8002218942

CHECK BENEFIT CARD

HCH ADMINISTRATION INC(800) 447-3227

HCH ADMINISTRATION INC(877) 876-5969

H C DUKE AND SON INCAffiliated With: HEALTH DATA SERVICES INC (HDS) 12791

Fund No:PlanType: Group Health

HCH ADMINISTRATION INC(800) 447-3227

HCH ADMINISTRATION INCPO Box 1986PEORIA IL 61656

CHECK BENEFIT CARD CHECK BENEFIT CARDH K CONTRACTORS INCAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDHAA PREFERRED PARTNERS LLCAffiliated With: HAA PREFERRED PARTNERS LLC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

HAAS CABINET CO INCAffiliated With: PREFERRED HEALTH PLAN INC 962550088

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(502) 992-4535

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-247• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 248: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDHALIFAX REGIONAL HEALTH SYSTEM PPO

Affiliated With: SENTARA HEALTH MANAGEMENT

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDHALL MANAGEMENT GROUPAffiliated With: HEALTHCOMP ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

DELTA HEALTH SYSTEMS(209) 939-3426

DELTA TEAM CARE(800) 336-0123

HALLMARK AVIATION GROUPAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(209) 939-3426

DELTA HEALTH SYSTEMSPO Box 2128STOCKTON CA 95201

GISC, INC(800) 242-4472

GISC TOTALCARE(800) 999-1077

HAMILTON STORAGE TECH INC..Affiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

GISC, INC(800) 242-4472

GISC, INC20 WINTER STPEMBROKE MA 02359

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

HAMMEL, GREEN & ABRAHAMSON, INC.

Affiliated With: PREFERREDONE ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICESPO Box 59212MINNEAPOLIS MN 55459

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-248• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 249: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PATIENT ADVOCATES LLC PATIENT ADVOCATES LLC

HAMMOND LUMBER COMPANYAffiliated With: PATIENT ADVOCATE LLC

Fund No:PlanType: Group Health

PATIENT ADVOCATES LLC PATIENT ADVOCATES LLCPO Box 1959Gray ME 04039

PIONEER MANAGEMENT SYSTEMS(877) 868-9060

CHECK BENEFIT CARDHAMPSHIRE COLLEGEAffiliated With: PIONEER MANAGEMENT SYSTEMS

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(877) 868-9060

PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01090

HAMPTON VAMC CHECK BENEFIT CARDHAMPTON VAMC 3548Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HAMPTON VAMC HAMPTON VAMC100 EMANCIPATION DRHAMPTON VA 23667

ADVENTIST HEALTH SYSTEM WEST

CHECK BENEFIT CARDHANFORD COMMUNITY MEDICAL CENTER

Affiliated With: ADVENTIST HEALTH SYSTEM/WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM WEST

ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002

DELTA HEALTH SYSTEMS(800) 556-7265

DELTA TEAMCARE(877) 464-1441

HANFORD JOINT UNION HIGH SCHOOL DISTRICT

Affiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(800) 556-5918

DELTA HEALTH SYSTEMSPO Box 1147STOCKTON CA 95201

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-249• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 250: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SELF INSURED PLANS LLC(239) 403-7884

CHECK BENEFIT CARDHANNIBAL CARBIDE TOOL INCAffiliated With: SELF INSURED PLANS

Fund No:PlanType: Group Health

SELF INSURED PLANS LLC(239) 403-7884

SELECT CARE RISK MANAGEMENT CORPORATION1016 COLLIER CENTER WAY STE 200NAPLES FL 34110

CONTACT EMPLOYER Citizens Insurance Co.(800) 322-9025

Hanover Insurance Company AUTOAffiliated With: The Hanover Insurance Company

Fund No:PlanType: Auto

Citizens Insurance Co.(800) 322-9025

Citizens Insurance Co.PO Box 290Howell MI 48844

CONTACT EMPLOYER CONTACT EMPLOYERHanover Insurance Company WCAffiliated With: Hanover Insurance Company

Fund No:PlanType: Workers' Compensation

-Also recognized as Citizens Insurance Company of America, Massachusetts Bay Insurance Company and Hanover American Insurance Company

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERHansen GroupAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295

CHECK BENEFIT CARDHarbor Furniture MFGAffiliated With: Carolina Benefit Administrators

Fund No:PlanType: Group Health

CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295

CAROLINA BENEFIT ADMINISTRATORS333 SOUTH PINE STSPARTANBURG SC 29302

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-250• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 251: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

HARD ROCKAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

HARD ROCK - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

PATIENT ADVOCATES LLC CHECK BENEFIT CARDHARDWOOD PRODUCTS COMPANY

Affiliated With: PATIENT ADVOCATE LLC

Fund No:PlanType: Group Health

PATIENT ADVOCATES LLC PATIENT ADVOCATES LLCPO Box 1959Gray ME 04039

EBMS(800) 777-3575

CHECK BENEFIT CARDHARDWOODS SPECIALTY PRODUCTS US LP

Affiliated With: EBMS (EMPLOYEE BENEFIT MANAGEMENT SERVICES)

Fund No:PlanType: Group Health

EBMS(800) 777-3575

EBMSPO Box 21367BILLINGS MT 59104-1367

CONTACT EMPLOYER CONTACT EMPLOYERHarford Mutual InsuranceAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-251• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 252: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

NORTH AMERICAN ADMINISTRATORS(800) 397-2122

CHECK BENEFIT CARDHARLAN SPRAGUE DAWLEYAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS(800) 397-2122

NORTH AMERICAN ADMINISTRATORSPO Box 730AMHERST NY 14226

CHECK BENEFIT CARD CHECK BENEFIT CARDHARLEY MARINE SERVICESAffiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

GISC, INC(800) 242-4472

GISC TOTALCARE(800) 999-1077

HARLFINGER COMPANIESAffiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

GISC, INC(800) 242-4472

GISC, INC20 WINTER STPEMBROKE MA 02359

GISC, INC(800) 242-4472

GISC TOTALCARE(800) 999-1077

HARLFINGER COMPANIES / HARPAK, LD PLASTICS, FBM

Affiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

GISC, INC(800) 242-4472

GISC, INC20 WINTER STPEMBROKE MA 02359

CHECK BENEFIT CARD CHECK BENEFIT CARDHAROLD'S STORES INCAffiliated With: THE EPOCH GROUP #10469

Term Effective: 8/31/2007Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-252• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 253: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

HARPER COMPANIESAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

GROUP & PENSION ADMINISTRATORS INC(972) 238-7900

HEALTH WATCH(972) 238-7900

HARPER CORPORATE SERVICESAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS INC(972) 238-7900

GROUP & PENSION ADMINISTRATORS INC12770 MERIT DR STE 200DALLAS TX 75251

CHECK BENEFIT CARD CHECK BENEFIT CARDHarrington Benefit ServicesAffiliated With: Harrington Benefit Services

Fund No:PlanType: Group Health

-Network participation is contingent upon proper member identification. The First Health® Network Logo must be on the benefit card.

CHECK BENEFIT CARD CHECK BENEFIT CARD

ECS Payor ID 95266

HEALTHCOMP TPA(800) 442-7247

CHECK BENEFIT CARDHARRIS FARMSAffiliated With: HEALTHCOMP THIRD PARTY ADMINISTRATORS

Fund No:PlanType: Group Health

HEALTHCOMP TPA(800) 442-7247

HEALTHCOMP TPAPO Box 45018Fresno CA 93718

CHECK BENEFIT CARD CHECK BENEFIT CARDHARRIS MORAN SEEDAffiliated With: HEALTHCOMP ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-253• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 254: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

The Hartford(800) 762-0666

CONTACT EMPLOYERHartford TheAffiliated With: Hartford The

Fund No:PlanType: Workers' Compensation

Includes Specialized Physical Therapy

The Hartford(800) 762-0666

The HartfordPO Box 4020Wheaton IL 60189

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

HARTT TRANSPORTATIONAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

HEALTHCARE MANAGEMENT ADMINISTRATORS(425) 462-1000

HEALTHCARE MANAGEMENT ADMINISTRATORS(425) 462-1000

HARTUNG INDUSTRIES INCAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS #11608

Fund No:PlanType: Group Health

HEALTHCARE MANAGEMENT ADMINISTRATORS(425) 462-1000

HEALTHCARE MANAGEMENT ADMINISTRATORS220 120TH Ave NE Bldg DBellevue WA 98005

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

HARVEST FORDAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

NGS AMERICAN8005211555

NGS AMERICAN8005211555

HAWK CORPORATIONAffiliated With: NGS AMERICAN INC

Fund No:PlanType: Group Health

NGS AMERICAN8005211555

NGS AMERICANPO Box 7676DETROIT MI 48080

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-254• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERHawkeye Security WCAffiliated With: RAM

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERHCA The Healthcare CompanyAffiliated With: HCA

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

HCJB RadioAffiliated With: International Medical Group, Inc.

Fund No:PlanType: Group Health

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

International Medical Group, Inc.2960 N Meridian StIndianapolis IN 46208

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

HCP PACKAGING USA INCAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

Amalgamated Life Insurance Co.

Amalgamated Life Insurance Co.(800) 356-0850

Health and Welfare Luggage IndustryAffiliated With: Amalgamated Life Insurance Co.

Fund No:PlanType: Group Health

Amalgamated Life Insurance Co.(212) 539-5681

Amalgamated Life Insurance Co.730 Broadway8th Fl ClaimsNew York NY 10003ECS Payor ID 13550

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-255• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Health Net Inc(800) 289-2818

First Health(800) 932-6690

Health Net ArizonaAffiliated With: Health Net Inc

Fund No: V5058PlanType: Group Health

The First Health® Network is not used for Behavioral Health services.

Health Net Inc(800) 289-2818

ACS/Health Net IncPO Box 14225Lexington KY 40512

Health Net Inc(800) 641-7761

First Health(800) 932-6690

Health Net CaliforniaAffiliated With: Health Net Inc

Fund No: V5056PlanType: Group Health

Health Net Inc(800) 641-7761

Health Net Commercial ClaimsPO Box 14702Lexington KY 40512

Health Net Inc(800) 641-7761

Health Net Inc(800) 977-7282

Health Net California Travel BenefitAffiliated With: Health Net Inc

Fund No: V5057PlanType: Group Health

Health Net Inc(800) 641-7761

Health Net Commercial ClaimsPO Box 14702Lexington KY 40512

Health Net Inc(888) 747-7823

First Health(800) 932-6690

Health Net New York Out of Area Plans

Affiliated With: Health Net Inc

Fund No: V5059PlanType: Group Health

The First Health® Network is not used for Behavioral Health services.

Health Net Inc(888) 747-7823

Health Net IncPO Box 14700Lexington KY 40512

Health Net Inc(203) 402-4899

UM NOT APPLICABLEHEALTH NET NORTHEAST - IPI BRICKLAYERS TRAVEL

Affiliated With: HEALTH NET INC

Fund No:PlanType: Group Health

Health Net Inc(203) 402-4899

Health Net Inc1 Far Mill CrossingShelton CT 06484

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-256• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Health Net Inc(888) 747-7823

Health Net Inc(888) 747-7823

Health Net Northeast Travel Member Benefit

Affiliated With: Health Net Inc

Fund No: V5050PlanType: Group Health

The First Health® Network is not used for Behavioral Health services.

Health Net Inc(888) 747-7823

Health Net IncPO Box 14700Lexington KY 40512

Health Net Inc(203) 402-4899

UM NOT APPLICABLEHEALTH NET NORTHEAST-IPI/BRICKLAYERS TRAVEL

Affiliated With: HEALTH NET INC.

Fund No:PlanType: Group Health

Health Net Inc(203) 402-4899

Health Net Inc1 Far Mill CrossingShelton CT 06484

Health Net Inc(888) 802-7001

First Health(800) 932-6690

Health Net OregonAffiliated With: Health Net Inc

Fund No: V5057PlanType: Group Health

The First Health® Network is not used for Behavioral Health services.

Health Net Inc(888) 802-7001

Health Net IncPO Box 14130Lexington KY 40512

Health Net Inc(888) 802-7001

Health Net Inc(888) 802-7001

Health Net Oregon Travel BenefitAffiliated With: Health Net Inc

Fund No: V5057PlanType: Group Health

The First Health® Network is not used for Behavioral Health services.

Health Net Inc(888) 802-7001

Health Net IncPO Box 14130Lexington KY 40512

GLOBALCARE, INC.8008601111

Health Plan of Upper Ohio Valley(740) 695-3585

HEALTH PLAN OF UPPER OHIO VALLEY

Affiliated With: GLOBALCARE, INC.

Fund No:PlanType: Group Health

GLOBALCARE, INC.6783411722

GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-257• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH PLAN INC(800) 343-7674

CHECK BENEFIT CARDHEALTH PLANS INC % OF SAVI NGS

Affiliated With: HEALTHPLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(800) 343-7674

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

HEALTH PLAN INC(508) 752-2480

CMS(866) 325-1550

HEALTH PLANS INC. - PEPMAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

GLOBALCARE, INC.6783411722

HINES & ASSOCIATES(800) 944-9401

HEALTH PLUS OF MICHIGANAffiliated With: GLOBALCARE INC

Fund No:PlanType: Group Health

GLOBALCARE, INC.6783411722

GLOBALCARE, INC.6875 SHILOH RD EALPHARETTA GA 30005

FISERV HEALTH KANSAS(800) 235-7160

AVIDYN HEALTH(866) 802-1328

HEALTH SYSTEMS OF KENTUCKYAffiliated With: FISERV HEALTH - KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

MERITAIN HEALTH(800) 455-1938

EMPLOYERS RISK SERVICES(800) 705-3765

HealthcoAffiliated With: MERITAIN HEALTH

Fund No:PlanType: Group Health

MERITAIN HEALTH(800) 455-1938

MERITAIN HEALTHPO Box 1090EVANSVILLE IN 47706

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-258• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 259: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURECARE(800) 759-1311

Careline UR(763) 383-4800

HEARTWOOD CREATIONSAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 759-1311

ASSURECARE340 Quadrangle DrBolingbrook IL 60440

ASSOCIATED THIRD PARTY ADMINISTRATORS(800) 637-4333

ASSOCIATED THIRD PARTY ADMINISTRATORS

HEAT AND FROST INSULATORS AND ASBESTOS WRKS H W FUND

Affiliated With: ASSOCIATED THIRD PARTY ADMINISTRATORS

Fund No:PlanType: Group Health

ASSOCIATED THIRD PARTY ADMINISTRATORS(800) 637-4333

ASSOCIATED THIRD PARTY ADMINISTRATORSPO Box 2590PASADENA CA 91102-2590

Health Net Inc(800) 289-2818

Health Net Inc(800) 289-2818

Heath Net Arizona Travel Member Benefit

Affiliated With: Health Net Inc

Fund No: V5058PlanType: Group Health

The First Health® Network is not used for Behavioral Health services.

Health Net Inc(800) 289-2818

ACS/Health Net IncPO Box 14225Lexington KY 40512

CORESOURCE CORESOURCEHEIDELBERG USAAffiliated With: CORESOURCE INC

Fund No:PlanType: Group Health

CORESOURCE CORESOURCEPO Box 2920CLINTON OH 52733-2920

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDHELLENIC COLLEGE / HOLY GREEK ORTHODOX SCHOOL

Affiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

STUDENT INSURANCE A DIVISION OF UICIPO Box 809026DALLAS TX 75038

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-259• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ULTRABENEFITS INC(866) 858-7223

CHECK BENEFIT CARDHENKE SASS WOLF OF AMERICA INC

Affiliated With: ULTRABENEFITS, INC.

Fund No:PlanType: Group Health

ULTRABENEFITS INC(866) 858-7223

ULTRABENEFITS INCPO Box 763WESTBORO MA 01581

ULTRABENEFITS INC(866) 858-7223

CHECK BENEFIT CARDHENKE SASS WOLF OF AMERICA INC

Affiliated With: ULTRABENEFITS, INC.

Fund No:PlanType: Group Health

ULTRABENEFITS INC(866) 858-7223

ULTRABENEFITS INCPO Box 763WESTBORO MA 01581

EMPLOYEE BENEFIT ADMINISTRATORS(626) 294-2800

EMPLOYEE BENEFIT ADMINISTRATORS(626) 294-2800

HENRY MAYO NEWHALL MEMORIAL HOSPITAL

Affiliated With: EMPLOYEE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT ADMINISTRATORS(626) 294-2800

EMPLOYEE BENEFIT ADMINISTRATORS424 N FIRST AVEARCADIA CA 91006

CHECK BENEFIT CARD3129068000

CHECK BENEFIT CARDHERBST LAZAR BELL INCAffiliated With: ALLIED BENEFIT SYSTEMS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD3129068000

CHECK BENEFIT CARD

HEALTHCOMP THIRD PARTY ADMINISTRATORS INC(800) 442-7247

CHECK BENEFIT CARDHERCULES INDUSTRIESAffiliated With: HEALTHCOMP THIRD PARTY ADMINISTRATORS

Fund No:PlanType: Group Health

HEALTHCOMP THIRD PARTY ADMINISTRATORS INC(800) 442-7247

HEALTHCOMP THIRD PARTY ADMINISTRATORS INCPO Box 45018FRESNO CA 93721

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-260• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 261: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTHDATAINSIGHTS DBA MVPPO(800) 952-5277

PPHA(407) 246-1848

HEWITT CONTRACTING COMPANY, INC.

Affiliated With: HEALTHDATAINSIGHTS DBA MCPPO

Fund No:PlanType: Group Health

HEALTHDATAINSIGHTS DBA MVPPO(800) 952-5277

HEALTHDATAINSIGHTS DBA MVPPO7083 Grand National Dr. #104ORLANDO FL 32819

CONTACT EMPLOYER CONTACT EMPLOYERHewitt, Coleman and Associates, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 816-6049

UM NOT APPLICABLEHIAWATHA COMMUNITY HOSPTIAL

Affiliated With: WATERSTONE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 816-6049

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

ACORDIA NATIONAL(888) 685-7774

CHECK BENEFIT CARDHICKORY SPRINGS MANUFACTURING CO

Affiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR

*

Fund No:PlanType: Group Health

ACORDIA NATIONAL(888) 685-7774

ACORDIA NATIONAL

EMPLOYEE BENEFIT CONSULTANTS(800) 472-6630

MEDICAL COST MANAGEMENT(800) 367-9938

HILL VIEW RETIREMENT CENTERAffiliated With: EMPLOYEE BENEFIT CONSULTANTS

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT CONSULTANTS(800) 472-6630

EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-261• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SISCO(800) 547-4726

CHECK BENEFIT CARDHILLCREST FAMILY SERVICEAffiliated With: SISCO/Cottingham & Butler

Fund No:PlanType: Group Health

SISCO(800) 547-4726

SISCOPO Box 389DUBUQUE IA 52004-0389

CONTACT EMPLOYER CONTACT EMPLOYERHinz Claim Management Inc

Fund No:PlanType: Workers' Compensation

Hinz Claim Management, Inc.(217) 698-1280

Hinz Claim Management, Inc.2815 Old Jacksonville Rd Ste 204Springfield IL 62704

HMA Administrators, LLC(617) 581-6655 Ext 228

CHECK BENEFIT CARDHMA ADMINISTRATORS, LLCAffiliated With: HMA ADMINISTRATORS, LLC

Fund No:PlanType: Group Health

HMA Administrators, LLC(617) 581-6655 Ext 228

HMA Administrators, LLC7 Wells Avenue, Suite 24Newton MA 02459

BENEFIT CONCEPTS, INC.(610) 337-2600

UM NOT APPLICABLEHMA DIRECTAffiliated With: BROKERAGE CONCEPTS INC/BENEFIT CONCEPTS INC

Fund No:PlanType: Group Health

BENEFIT CONCEPTS, INC.(610) 337-2600

BENEFIT CONCEPTS, INC.PO Box 60608King of Prussia PA 19406

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.(800) 284-2273

HMOAffiliated With: OSF HEALTHPLANS, INC.

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-262• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FISERV HEALTH INC(210) 558-2100

CHECK BENEFIT CARDHOBBY LOBBYAffiliated With: HEALTH DATA SERVICES

Fund No:PlanType: Group Health

FISERV HEALTH INC(210) 558-2100

FISERV HEALTH INCPO Box 690450SAN ANTONIO TX 78269

EBA&M(800) 776-1545

HINES & ASSOCIATES(800) 528-2498

HOFFINGER INDUSTRIESAffiliated With: EBA&M

Fund No:PlanType: Group Health

EBA&M(800) 776-1545

EBA&MPO Box 5079WESTLAKE VILLAGE CA 91359

EBA&M(714) 668-8920

CHECK BENEFIT CARDHOFFINGER INDUSTRIES, INC.Affiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT (EBA&M)

Fund No:PlanType: Group Health

EBA&M(714) 668-8920

EBA&MPO Box 5079WESTLAKE VILLAGE CA 91359

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

HOLDEN BUSINESS FORMSAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

NORTH AMERICA ADMINISTRATORS, L.P.

HOLLADAY PROPERTY SERVICES MIDWEST, INC.

Affiliated With: NORTH AMERICA ADMINISTRATORS, L.P.-TENNESSEE

Fund No:PlanType: Group Health

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-263• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBPA(802) 846-8060

CHECK BENEFIT CARDHOLYOKE HOSPITAL WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

CHECK BENEFIT CARD8004427247

CHECK BENEFIT CARDHOME STREET BANKAffiliated With: HEALTHCOMP ADMINISTRATORS INC

*

Term Effective: 12/31/2007Fund No:PlanType: Group Health

CHECK BENEFIT CARD8004427247

CHECK BENEFIT CARD

HONOLULU VAMC CHECK BENEFIT CARDHONOLULU VAMC 3183Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HONOLULU VAMC HONOLULU VAMC

459 PATTERSON RDHONOLULU HI 96819

Attn: FEE 043MD

ADMINISTRATIVE SOLUTIONS INC(678) 339-0211

CHECK BENEFIT CARDHOOVER MATERIALS HANDLING GROUP

Affiliated With: ADMINISTRATIVE SOLUTIONS, INC.

Fund No:PlanType: Group Health

ADMINISTRATIVE SOLUTIONS INC(678) 339-0211

ADMINISTRATIVE SOLUTIONS INCPO Box 2490ALPHARETTA GA 30023

AMERIBEN SOLUTIONS(800) 654-7900 (800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

HOPE UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-264• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 265: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HORIZON GOODWILL INDUSTRIESAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

Horizon Managed Care(916) 631-1220

Horizon Managed Care(916) 631-1220

Horizon Managed CareAffiliated With: CompIQ #13910

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(800) 293-3131

Horizon Managed Care2868 Prospect Park DrRancho Cordova CA 95670

Mountain States Administrative Services(520) 722-7133

Hines and Associates(847) 214-2780

HORIZON MOVING SYSTEMAffiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

Mountain States Administrative Services(520) 722-7133

Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710

MMA(800) 348-7468

CHECK BENEFIT CARDHorizon Transport IncAffiliated With: MENNONITE MUTUAL AID

*

Fund No:PlanType: Group Health

MMA(800) 348-7468

MMAPO Box 483GOSHEN IN 46527

SRT ADMINISTRATORS(888) 690-2020

HINES & ASSOCIATES(800) 944-9401

HORNE'S LODGING PROPERTIESAffiliated With: SRT ADMINISTRATORS

Fund No:PlanType: Group Health

SRT ADMINISTRATORS(888) 690-2020

SRT ADMINISTRATORSPO Box 25160SCOTTSDALE AZ 85255-0102

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-265• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 266: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERHortica Insurance CompanyAffiliated With: GENEX Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

THE LOOMIS COMPANY(866) 473-6615

CHECK BENEFIT CARDHospitality Partners Health & Welfare Trust

Affiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(866) 473-6615

THE LOOMIS COMPANY850 N PARK RDWYOMISSING PA 19610

COASTAL TPA, INC.(800) 564-7475

HINES & ASSOCIATES(800) 592-8097

HOUSING AUTHORITY-COUNTY OF MONTEREY WRAP

Affiliated With: COASTAL TPA, INC.

Fund No:PlanType: Group Health

COASTAL TPA, INC.(800) 564-7475

COASTAL TPA, INC.PO Box 80308SALINAS CA 93912

MERCER ADMINISTRATION(800) 290-7303

CHECK BENEFIT CARDHOUSING BENEFITS PLANAffiliated With: MARSH ADVANTAGE AMERICA 10442

Fund No:PlanType: Group Health

MERCER ADMINISTRATION(800) 290-7303

MERCER ADMINISTRATIONPO Box 4542IOWA CITY IA 52244

HEALTH NET FEDERAL SERVICES(214) 387-3232

CHECK BENEFIT CARDHOUSTON VA MEDICAL CENTER 3101

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(214) 387-3232

HEALTH NET FEDERAL SERVICES

2002 HOLCOMB BLVDHOUSTON TX 77030

Attn: 04FRM (FEE BASIS)

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-266• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 267: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FISERV HEALTH INC(800) 235-7160

AVIDYN HEALTH(214) 647-4417

HOWARD BAERAffiliated With: FISERV HEALTH KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH INC(800) 235-7160

FISERV HEALTH INC300 W DOUGLAS STE 800WICHITA KS 67202

WAUSAU BENEFITS, INC.(800) 826-9781

WAUSAU BENEFITS, INC.(800) 808-4424

HOWARD SUPPLY COMPANY INCAffiliated With: WAUSAU BENEFITS INC 12851

Fund No:PlanType: Group Health

WAUSAU BENEFITS, INC.(800) 826-9781

WAUSAU BENEFITS, INC.PO Box 8013WAUSAU WI 54402-8013

HRH Insurance HRH InsuranceHRH InsuranceAffiliated With: Fair Isaac Corporation

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

HRH Insurance HRH Insurance

WELLS FARGO TPA, INC.(800) 624-8605

CHECK BENEFIT CARDHUB FOLDING BOXAffiliated With: ACCORDIA NATIONAL

Fund No:PlanType: Group Health

WELLS FARGO TPA, INC.(304) 353-8661

WELLS FARGO TPA, INC.602 VIRGINIA ST EASTCHARLESTON WV 25301

HUDSON VALLEY VA HEALTHCARE SYSTEM

CHECK BENEFIT CARDHUDSON VALLEY VA HEALTHCARE SYSTEM 3198

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HUDSON VALLEY VA HEALTHCARE SYSTEM

HUDSON VALLEY VA HEALTHCARE SYSTEM

CAMPUS RT 9DCASTLE POINT NY 12511

Attn: FEE BASIS 136M

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-267• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 268: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8007159414

CHECK BENEFIT CARDHUISH DETERGENTS INCAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8007159414

CHECK BENEFIT CARD

DELTA HEALTH SYSTEMS DELTA HEALTH SYSTEMS

HUNTINGTON MEMORIAL HOSPITAL

Affiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS DELTA HEALTH SYSTEMSPO Box 1168STOCKTON CA 95201

HUNTINGTON VAMC CHECK BENEFIT CARDHUNTINGTON VAMC 3149Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HUNTINGTON VAMC HUNTINGTON VAMC

1540 SPRING VALLEY DRHUNTINGTON WV 25704

Attn: FEE BASIS (136F)

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

HUTCHISON & STEFFENAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

CHECK BENEFIT CARD8004427247

CHECK BENEFIT CARDHYDRAULIC CONTROLSAffiliated With: HEALTHCOMP ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8004427247

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-268• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 269: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MIDWEST SECURITY ADMINISTRATORS INC(800) 236-8672

UM NOT APPLICABLEHYDRITE CHEMICAL COMPANYAffiliated With: MIDWEST SECURITY ADMINISTRATORS

Fund No:PlanType: Group Health

MIDWEST SECURITY ADMINISTRATORS INC(800) 236-8672

MIDWEST SECURITY ADMINISTRATORS INC2700 Midwest Dr.ONALASKA WI 54650

Hygeia Corporation(416) 595-1094 Ext 243

Hygeia Corporation(416) 595-1094 Ext 243

Hygeia CorporationAffiliated With: Hygeia Corporation

Fund No:PlanType: Group Health

Hygeia Corporation(416) 595-1094 Ext 243

Hygeia Corporation121 Richmond St W PenthouseToronto, Ontario Canada M5H 2K1

CHECK BENEFIT CARD CHECK BENEFIT CARDI.U.P.A.T. DISTRICT COUNCIL 78 HEALTH AND WELFARE FUND

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

INSURERS ADMINISTRATIVE CORP. C/O CCN(800) 843-3106

CHECK BENEFIT CARDIAC INTERNATIONALAffiliated With: INSURERS ADMINISTRATIVE CORPORATION

Fund No:PlanType: Group Health

INSURERS ADMINISTRATIVE CORP. C/O CCN(800) 843-3106

INSURERS ADMINISTRATIVE CORP. C/O CCNPO Box 5190TAMPA FL 33675-5190

FLORIDA HEALTH ADMINISTRATORS(954) 366-0111

CORVEL CORPORATION(517) 784-0821

IBC GROUP, INC.Affiliated With: FLORIDA HEALTH ADMINISTRATORS DBA FHA-TPA DIVISION

Fund No:PlanType: Group Health

FLORIDA HEALTH ADMINISTRATORS(954) 366-0111

FLORIDA HEALTH ADMINISTRATORSPO Box 327810Fort Lauderdale FL 33332

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-269• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 270: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

COMPUSYS(800) 628-6562

UM NOT APPLICABLEIBEW WESTERN UTILITIES HEALTH & WELFARE TRUST FUND / ID MT OR WA WY

Affiliated With: IBEW WESTERN UTILITIES HEALTH & WELFARE TRUST FUND

Fund No:PlanType: Group Health

COMPUSYS(800) 628-6562

COMPUSYS2156 W 2200 SSALT LAKE CITY UT 84119-1326

COMPUSYS(800) 628-6562

UM NOT APPLICABLEIBEW WESTERN UTILITIES HEALTH AND WELFARE FUND/ ID MT OR WA WY

Affiliated With: IBEW WESTERN UTILITIES HEALTH & WELFARE FUND

Fund No:PlanType: Group Health

COMPUSYS(800) 628-6562

COMPUSYS2156 W 2200 SSALT LAKE CITY UT 84119-1326

IBEW-NECA Southwestern Health and Benefit Fund(800) 527-0320

First Health(800) 932-3869

IBEW-NECA Southwestern Health & Benefit Fund

Affiliated With: IBEW-NECA Southwestern Health & Benefit Fund

Fund No:PlanType: Group Health

IBEW-NECA Southwestern Health and Benefit Fund(800) 527-0320

IBEW-NECA Southwestern Health and Benefit Fund4040 McEwen Ste 100Dallas TX 75244-5092

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

IBS INDUSTRIES INCAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-270• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 271: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SMITH ADMINISTRATORS(800) 261-5511

SERVICE ASSOCIATES(800) 261-5511

IDAHO OPAL & GEMAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

SMITH ADMINISTRATORS(800) 261-5511

SMITH ADMINISTRATORS3761 S. 700 E.SALT LAKE CITY UT 84106

CHECK BENEFIT CARD CHECK BENEFIT CARDIDAHO STATE UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

CHECK BENEFIT CARD HEALTH SPECIAL RISK, INC4001 N JOSEY LANECARROLLTON TX 75007

CI(817) 479-2115

CHECK BENEFIT CARDIDAHO STATE UNIVERSITY-STUDENTS

Affiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 785-2446

TRUE CHOICEPO Box 700307DALLAS TX 75370

STRATEGIC HEALTH DEVELOPMENT CORP(888) 532-3467

STRATEGIC HEALTH DEVELOPMENT CORP(888) 532-3467

IEC GROUP BENEFIT TRUST FUND

Affiliated With: MEDICAL BENEFITS ADMINISTRATORS OF MD, INC.

Fund No:PlanType: Group Health

STRATEGIC HEALTH DEVELOPMENT CORP(888) 532-3467

STRATEGIC HEALTH DEVELOPMENT CORP9501 N. E. 2ND AVENUEMIAMI SHORES FL 33138

CONTACT EMPLOYER CHECK BENEFIT CARDIGA GROUP EMPLOYEE BENEFIT TRUST

Affiliated With: MBA OF MARYLAND

Fund No:PlanType: Group Health

CONTACT EMPLOYER CONTACT EMPLOYER

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-271• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 272: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

STATE OF ILLINOIS(217) 782-2548

STATE OF ILLINOIS(217) 782-2548

Illinois Industrial Commission (IIC)Affiliated With: STATE OF ILLINOIS

Fund No:PlanType: Workers' Compensation

STATE OF ILLINOIS(217) 782-2548

STATE OF ILLINOIS604 William G. Stratton Office BuildingSpringfield IL 62706

INTERNATIONAL MANAGED CARE SERVICES(305) 463-9696

CHECK BENEFIT CARDIMCS PUERTO RICOAffiliated With: INTERNATIONAL MANAGED CARE SERVICES

Fund No:PlanType: Group Health

INTERNATIONAL MANAGED CARE SERVICES(305) 463-9696

INTERNATIONAL MANAGED CARE SERVICES7205 Corporate Center Dr. #405MIAMI FL 33126

BENEFIT SYSTEMS & SERVICES, INC.(630) 789-2093

CHECK BENEFIT CARDIMI FABI (USA), INC.Affiliated With: BENEFIT ADMINISTRATIVE SYSTEMS, LTD.

*

Fund No:PlanType: Group Health

BENEFIT SYSTEMS & SERVICES, INC.(630) 789-2093

BENEFIT SYSTEMS & SERVICES, INC.760 Pasquinelli Dr. STE 320WESTMONT IL 60559

HEALTH PLAN INC(508) 752-2480

CMS(866) 325-1550

IMMUNOGEN, INCAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

BENEFIT ADMINISTRATIVE SYSTEMS(708) 647-3434

CHECK BENEFIT CARDIMPRESSIONS PRINTINGAffiliated With: AMERICAN TRUST ADMINISTRATORS

Fund No:PlanType: Group Health

BENEFIT ADMINISTRATIVE SYSTEMS(708) 647-3434

BENEFIT ADMINISTRATIVE SYSTEMS17475 JOVANNA DRHOMEWOOD IL 60430

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-272• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 273: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Indemni-Med Management(972) 606-9100 Ext 1308

Indemni-Med Management (Clinical Operations)(972) 606-9108

Indemni-Med ManagementAffiliated With: Indemni-Med Management

Fund No:PlanType: Workers' Compensation

Indemni-Med Management(972) 606-9100 Ext 1308

Indemni-Med Management2080 N Highway 360 Ste 345Grand Prairie TX 75050

GROUP & PENSION ADMINISTRATORS(800) 827-7223

CHECK BENEFIT CARDIndependent Bank Group Inc. (TRAVEL)

Affiliated With: GROUP & PENSION ADMINISTRATORS

*

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

CHECK BENEFIT CARD CHECK BENEFIT CARDINDEPENDENT MEAT COMPANYAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDINDEPENDENT MEDICAL SYSTEMS

Affiliated With: STAR HEALTHCARE NETWORK INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.(800) 990-9058

CHECK BENEFIT CARDINDEPENDENT STAVE COMPANY INC

Affiliated With: FMH BENEFIT SERVICES INC A DIVISION OF CORESOURCE

Fund No:PlanType: Group Health

FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.(800) 990-9058

FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURCE, INC.PO Box 25946OVERLAND PARK KS 66225-5946

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-273• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 274: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BMI HEALTHPLANS(918) 335-0450

HEALTH REVIEW, LLCINDIAN ELECTRIC COOPERATIVE INC

Affiliated With: BMI HEALTHPLANS, INC.

Fund No:PlanType: Group Health

BMI HEALTHPLANS(918) 335-0450

BMI HEALTHPLANSPO Box 14379SPRINGFIELD MO 65814

CHECK BENEFIT CARD CHECK BENEFIT CARDINDIAN SUMMER CARPET MILLSAffiliated With: AMERICAN HEALTHCARE ALLIANCE

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PREFERRED HEALTH PLANS INC.(800) 832-8212

CHECK BENEFIT CARDINDIANA FURNITURE INDUSTRIES, INC

Affiliated With: PREFERRED HEALTH PLANS INC

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.PO Box 437017Louisville KY 40253

CONTACT EMPLOYER CONTACT EMPLOYERIndiana Insurance Auto COAffiliated With: RAM

Fund No:PlanType: Auto

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERIndiana Insurance WCAffiliated With: RAM

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-274• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 275: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERIndiana LumbermensAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDINDIANA STATE UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

Professional Benefit Administrators, Inc.(800) 435-5694

ICM(800) 728-0327

INDIANA WESLEYAN UNIVERSITYAffiliated With: PROFESSIONAL BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

Professional Benefit Administrators, Inc.(800) 435-5694

Professional Benefit Administrators, Inc.900 Jorie Blvd Ste 250Oakbrook IL 60523

INDIANAPOLIS VA MEDICAL CENTER

CHECK BENEFIT CARDINDIANAPOLIS VA MEDICAL CENTER 3156

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

INDIANAPOLIS VA MEDICAL CENTER

INDIANAPOLIS VA MEDICAL CENTER

1700 E 38TH STMARION IN 46953

Attn: FEE BASIS 136C3

HEALTHCOMP(559) 499-2450

CHECK BENEFIT CARDINDUSTRIAL METAL SUPPLIESAffiliated With: HEALTHCOMP ADMINISTRATORS

Fund No:PlanType: Group Health

HEALTHCOMP(559) 499-2450

HEALTHCOMPPO Box 45018Fresno CA 93718

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-275• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTHCOMP(559) 499-2450

CHECK BENEFIT CARDINDUSTRIAL METAL SUPPLYAffiliated With: HEALTHCOMP ADMINISTARTORS INC.

Fund No:PlanType: Group Health

HEALTHCOMP(559) 499-2450

HEALTHCOMPPO Box 45018Fresno CA 93718

THIRD PARTY ADMINISTRATIVE SERVICES(520) 670-0227

THIRD PARTY ADMINISTRATIVE SERVICES(520) 670-0227

INDUSTRIAL MOTOR AND CONTROL

Affiliated With: THIRD PARTY ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

THIRD PARTY ADMINISTRATIVE SERVICES(520) 670-0227

THIRD PARTY ADMINISTRATIVE SERVICES7493 N Oracle Rd Ste 200Tucson AZ 85704

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

INDUSTRIAL SAFETY SUPPLYAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

GLOBALCARE, INC. GLOBALCARE, INC.INDUSTRY BUYING GROUPAffiliated With: GLOBALCARE, INC.

Fund No:PlanType: Group Health

GLOBALCARE, INC. GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005

INETICO, INC.(813) 258-2200

UM NOT APPLICABLEINETICO - PEPMAffiliated With: INETICO, INC.

Fund No:PlanType: Group Health

INETICO, INC.(813) 258-2200

INETICO, INC.PO Box 10972TAMPA FL 33679

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-276• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

INETICO, INC.(813) 258-2200

UM NOT APPLICABLEINETICO - TRAVEL WRAPAffiliated With: INETICO, INC.

Fund No:PlanType: Group Health

INETICO, INC.(813) 258-2200

INETICO, INC.3902 Henderson BlvdTampa FL 33679

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDINFINIA INCAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

CHECK BENEFIT CARD CHECK BENEFIT CARDINFORMATION SYSTEMS SOLUTIONS INTERNATIONAL

Affiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDINFRA-METALS COAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDINGLEWOOD UNIFIED SCHOOL DISTRICT

Affiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-277• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

KMG AMERICA(800) 822-1274

CHECK BENEFIT CARDINLAND SEAFOODAffiliated With: KHS, A KMG AMERICA COMPANY

Fund No:PlanType: Group Health

KMG AMERICA(800) 822-1274

KMG AMERICAPO Box 1000LANCASTER SC 29721

AMERICAN HEALTH HOLDINGS INC

AMERICAN HEALTH HOLDINGS INC

INNERPAC INC - PERFORMAXAffiliated With: NORTH AMERICAN ADMINISTRATORS - NY

Fund No:PlanType: Group Health

AMERICAN HEALTH HOLDINGS INC

AMERICAN HEALTH HOLDINGS INC921 EASWINDWESTERVILLE OH 43081

INNOVATIVE ADMINISTRATIVE SERVICES(949) 442-6600

CHECK BENEFIT CARDINNOVATIVE ADMINISTRATIVE SERVICES (WRAP)

Affiliated With: INNOVATIVE ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

INNOVATIVE ADMINISTRATIVE SERVICES(949) 442-6600

INNOVATIVE ADMINISTRATIVE SERVICES540 WALD AVEIRVINE CA 92618

BENEFIT MANAGEMENT INC.(800) 290-1368

CHECK BENEFIT CARDINNOVIA FILMS INCAffiliated With: BENEFIT MANAGEMENT INC #962501916

Fund No:PlanType: Group Health

BENEFIT MANAGEMENT INC.(800) 290-1368

BENEFIT MANAGEMENT INC.PO Box 1090GREAT BEND KS 67530

EBPA(802) 846-8060

CHECK BENEFIT CARDINSTITUTE OF PROFESSIONAL PRACTICE JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-278• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

INSURCORPAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

INSURERS ADMINISTRATIVE CORP. C/O CCN(800) 843-3106

CHECK BENEFIT CARDINSURERS ADMINISTRATIVE CORPORATION

Affiliated With: INSURERS ADMINISTRATIVE CORPORATION

Fund No:PlanType: Group Health

INSURERS ADMINISTRATIVE CORP. C/O CCN(800) 843-3106

INSURERS ADMINISTRATIVE CORP. C/O CCNPO Box 5190TAMPA FL 33675-5190

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

INTEGRAL YOUTH SERVICESAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INCPO Box 1121Alhambra CA 91802-1121

CompIQ Corporation(949) 923-4021

CHECK BENEFIT CARDIntegrated Care SystemsAffiliated With: CompIQ #13910

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(949) 923-4021

CompIQ Corporation35 Tesla Way #100Irvine CA 92618

INTERPLAN HEALTH GROUP

PHCS Utilization Management(888) 404-7427

INTEGRATED DEVELOPMENT & MANUFACTURING

Affiliated With: INTERPLAN HEALTH GROUP

Fund No:PlanType: Group Health

INTERPLAN HEALTH GROUP(800) 266-5896

INTERPLAN HEALTH GROUP

PO Box 2388 CSTOW OH 44224

Attn: Supervisor of the Claims Dept

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-279• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 280: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

INTEGRITY CHRYSLER JEEP DODGE MEGASTORE

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

AMERICAN STERLING INSURANCE SERVICES(913) 498-9096

CHECK BENEFIT CARDINTERCONNECT DEVICES INCAffiliated With: AMERICAN STERLING

Term Effective: 10/31/2007Fund No:PlanType: Group Health

AMERICAN STERLING INSURANCE SERVICES(913) 498-9096

AMERICAN STERLING INSURANCE SERVICES10975 Grandview Dr, Ste 100 Bldg 27Overland Park KS 66210

CONTACT EMPLOYER CONTACT EMPLOYERIntermedAffiliated With: CompIQ #13910

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

GILSBAR(888) 472-4352

MedCom Services, Inc.(800) 643-4416

INTERMOUNTAIN CENTERS FOR HUMAN DEVELOPMENT

Affiliated With: GILSAR INC

Fund No:PlanType: Group Health

GILSBAR(888) 472-4352

GILSBARPO Box 2947COVINGTON LA 70434

International Brotherhood of Boilermakers(913) 342-2882

International Brotherhood of Boilermakers(888) 560-8932

International Brotherhood of Boilermakers

Affiliated With: Boilermakers National Health & Welfare Fund

Fund No:PlanType: Group Health

International Brotherhood of Boilermakers(913) 342-2882

International Brotherhood of BoilermakersPO Box 23825Tucson AZ 85734

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-280• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTHCOMP TPA(559) 499-2450

CHECK BENEFIT CARDINTERNATIONAL COFFEE AND TEA, LLC

Affiliated With: HEALTHCOMP TPA

Fund No:PlanType: Group Health

HEALTHCOMP TPA(559) 499-2450

HEALTHCOMP TPAPO Box 45018Fresno CA 93718

STUDENT RESOURCES(800) 237-0903 Ext 6352

CHECK BENEFIT CARDINTERNATIONAL COMMUNITY SERVICES MA

Affiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 10/31/2007Fund No:PlanType: Group Health

STUDENT RESOURCES(800) 237-0903 Ext 6352

STUDENT RESOURCES2301 W. PLANO PKWY #300PLANO TX 75075

INTERNATIONAL HEALTHCARE(619) 407-4082

INTERNATIONAL HEALTHCARE

INTERNATIONAL HEALTHCAREAffiliated With: INTERNATIONAL HEALTHCARE

Fund No:PlanType: Group Health

INTERNATIONAL HEALTHCARE(619) 407-4082

INTERNATIONAL HEALTHCARE303 HCHULA VISTA CA 91910

STAR HEALTHCARE NETWORK(212) 581-8228

UM NOT APPLICABLEINTERNATIONAL MED CAREAffiliated With: STAR HEALTHCARE NETWORK INC

*

Fund No:PlanType: Group Health

STAR HEALTHCARE NETWORK(212) 581-8228

STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019

CHECK BENEFIT CARD CHECK BENEFIT CARDINTERNATIONAL UNION OF INDUSTRIAL AND INDEPENDENT WORKERS

Affiliated With: GREENTREE ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-281• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERIntracorpAffiliated With: Intracorp

Fund No:PlanType: Workers' Compensation

Includes Specialized Physical TherapyIncludes Exclusive Preferred Providers (OCN ONLY)

CONTACT EMPLOYER First HealthPO Box 11158Scottsdale AZ 85271-1158

CONTACT EMPLOYER CONTACT EMPLOYERIntracorp AutoAffiliated With: Intracorp

Fund No:PlanType: Auto

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Underwriters Safety & Claims, Inc.(800) 678-1536

Bluegrass Health Network(800) 264-7502

Intratech Dental ProductsAffiliated With: Underwriters Safety & Claims Inc.

Fund No:PlanType: Group Health

Underwriters Safety & Claims, Inc.(800) 678-1536

Underwriters Safety & Claims, Inc.PO Box 23507Louisville KY 40223-0507

SMITH ADMINISTRATORS(801) 261-5511

SERVICE ADVOCATES(801) 261-5511

INUNISONAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

SMITH ADMINISTRATORS(801) 261-5511

SMITH ADMINISTRATORS428 E WINCHESTER ST, STE 200SALT LAKE CITY UT 84107

TRUSTEED PLANS SERVICE GROUP(800) 426-9786

QUALIS8007838606

Investco Insurance TrustAffiliated With: Trusteed Plans Service Corporation

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE GROUP(800) 426-9786

TRUSTEED PLANS SERVICE GROUPPO Box 1894TACOMA WA 98406-1705

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-282• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 283: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

IOWA CITY VA MEDICAL CENTER

CHECK BENEFIT CARDIOWA CITY VAMC 3709Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

IOWA CITY VA MEDICAL CENTER

IOWA CITY VA MEDICAL CENTER

HIGHWAY 6 WESTIOWA CITY IA 52246

Attn: FEE 136B

IRON MOUNTAIN VAMC CHECK BENEFIT CARDIRON MOUNTAIN VAMC 3163Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

IRON MOUNTAIN VAMC IRON MOUNTAIN VAMC

325 E H STIRON MOUNTAIN MI 49801

Attn: FEE BASIS 585/170

CHECK BENEFIT CARD CHECK BENEFIT CARDIRON WORKERS LOCAL 395 TRUST FUND

Affiliated With: IRON WORKERS LOCAL 395 TRUST FUND

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDIRVINE VALLEY COLLEGE INTL STUDENT SRVCS

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDIRVING VALLEY COLLEGEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-283• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 284: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GROUP & PENSION ADMINISTRATORS(800) 827-7223

CHECK BENEFIT CARDISCAR METALSAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(210) 691-0500

GROUP & PENSION ADMINISTRATORSPO Box 749075DALLAS TX 75374-9075

EBMS(800) 777-3575

EBMS CARELINK(406) 245-3575

ISEC INCAffiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES (EBMS)

Fund No:PlanType: Group Health

EBMS(800) 777-3575

EBMSPO Box 21367BILLINGS MT 59104-1367

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

IT Strategies OOAAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

BENEFIT ADMINISTRATIVE SYSTEMS(800) 523-0582

CHECK BENEFIT CARDI-TECH USA, INCAffiliated With: BENEFIT ADMINISTRATIVE SYSTEMS, LLC

Fund No:PlanType: Group Health

BENEFIT ADMINISTRATIVE SYSTEMS(800) 523-0582

BENEFIT ADMINISTRATIVE SYSTEMS7 JOVANNA DR STE 1BHOMEWOOD IL 60430

CHECK BENEFIT CARD CHECK BENEFIT CARDITRON INCAffiliated With: MARSH ADVANTAGE AMERICA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-284• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 285: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

J D STREETT & COMPANY, INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

IAA(856) 470-1200

HEALTHCARE STRATEGIES INC8885991515

J KNIPPER & COMPANYAffiliated With: INSURANCE ADMINISTRATORS OF AMERICA (IAA)

Fund No:PlanType: Group Health

IAA(856) 470-1200

IAA1934 OLNEY AVE STE 200CHERRY HILL NJ 08003

BENEFIT ADMINISTRATIVE SYSTEMS(708) 799-7400

CHECK BENEFIT CARDJ SQUAREAffiliated With: BENEFIT ADMINISTRATORS SYSTEMS

Fund No:PlanType: Group Health

BENEFIT ADMINISTRATIVE SYSTEMS(708) 799-7400

BENEFIT ADMINISTRATIVE SYSTEMS17475 JOVANNA DRHOMEWOOD IL 60430

ACORDIA NATIONAL(888) 685-7774

CHECK BENEFIT CARDJ.M. SMUCKERS COMPANYAffiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR

Fund No:PlanType: Group Health

ACORDIA NATIONAL(888) 685-7774

ACORDIA NATIONAL

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN(800) 776-1545

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN

JACK JONES TRUCKING, INC.Affiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN(800) 776-1545

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 5079WESTLAKE VILLAGE CA 91359

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-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.

Page 286: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Underwriters Safety & Claims Inc.(800) 678-1536

Underwriters Safety & Claims Inc.(800) 678-1536

Jackson Tube Service IncAffiliated With: Underwriters Safety & Claims Inc.

Fund No:PlanType: Group Health

Underwriters Safety & Claims Inc.(800) 678-1536

First HealthPO Box 3017Scottsdale AZ 85271

JACKSON VA MEDICAL CENTER

CHECK BENEFIT CARDJACKSON VA MEDICAL CENTER 3110

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

JACKSON VA MEDICAL CENTER

JACKSON VA MEDICAL CENTER

1500 E WOODROW WILSON DRJACKSON MS 39216

Attn: FEE BASIS 136E

EBPA(802) 846-8060

CHECK BENEFIT CARDJAGER DI PAOLA KEMP DESIGN JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

DELTA HEALTH SYSTEMS(559) 448-4148

DELTA TEAM CAREJAMES HARDIE BUILDING PRODUCTS

Affiliated With: THE PLAN HANDLERS INC

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(559) 448-4148

DELTA HEALTH SYSTEMSPO Box 80Stockton CA 95201

EQUITABLE PLAN SERVICES(405) 755-2929

CHECK BENEFIT CARDJAMES HODGE AUTO GROUPAffiliated With: EQUITABLE PLAN SERVICES

Fund No:PlanType: Group Health

EQUITABLE PLAN SERVICES(405) 755-2929

EQUITABLE PLAN SERVICESPO Box 720460OKLAHOMA CITY OK 73172

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-286• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 287: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PREFERRED HEALTH PLANS INC.(800) 832-8212

CHECK BENEFIT CARDJASPER SEATING COMPANY INCAffiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.PO Box 437017Louisville KY 40253

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

JBA CONSULTING % OF SAVINGSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

JBA CONSULTING ENGINEERS - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CBCA Administrators Inc(800) 631-3441

CHECK BENEFIT CARDJCB INCAffiliated With: CBCA Administrators, Inc.

Fund No:PlanType: Group Health

CBCA Administrators Inc(912) 691-3782

CBCA Administrators Inc4150 INTERNATIONAL PLAZA STE 900FORT WORTH TX 76109

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 240-8931

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

JCMAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 240-8931

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA2720 N. Tenaya Way, Room 507Las Vegas NV 89128

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-287• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 288: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURECARE(800) 759-1311

Careline UR(763) 383-4800

JDC LOGISTICSAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 759-1311

ASSURECARE340 Quadrangle DrBolingbrook IL 60440

SRT ADMINISTRATORS(800) 879-8500

SRT ADMINISTRATORSJEEHDEEZ 'A ACADEMY, INC.Affiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS(800) 879-8500

SRT ADMINISTRATORSPO Box 25160SCOTTSDALE AZ 85255-0102

SMITH ADMINISTRATORS, INC.(801) 261-5511

TRUSTMARK LIFE INSURANCE CO.(801) 261-5511

JEFFERSON COUNTYAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

SMITH ADMINISTRATORS, INC.(801) 261-5511

SMITH ADMINISTRATORS, INC.3761 S 700 E SUITE 202SALT LAKE CITY UT 84106

COOPERATIVE BENEFIT ADMINISTRATOR(402) 483-9200

CHECK BENEFIT CARDJEFFERSON ENERGY COOPERATIVE

Affiliated With: NATIONAL RURAL ELECTRIC COOPERATIVE ASSOCIATION

Fund No:PlanType: Group Health

COOPERATIVE BENEFIT ADMINISTRATOR(402) 483-9200

COOPERATIVE BENEFIT ADMINISTRATORPO Box 6249LINCOLN NE 68506-0249

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

Jefferson Rehabilitation Center IncAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

*

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-288• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 289: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

JEFFERSON STATE ROCK PRODUCTIONS, INC.

Affiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

JERRY'S NUGGET - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA8006248605

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDJESUIT HEALTH TRUST/HMSR-CHRISTIAN BROTHERS SERVICES

Affiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

GROUP & PENSION ADMINISTRATORS(800) 827-7223

CHECK BENEFIT CARDJetta Operating Company Inc. (TRAVEL)

Affiliated With: GROUP & PENSION ADMINISTRATORS

*

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

GLOBALCARE(888) 285-4864

AEGIS CARE MANAGEMENT(800) 868-1660

JFP BENEFIT MANAGEMENTAffiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(888) 285-4864

GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-289• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 290: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GLOBALCARE(888) 285-4864

CHECK BENEFIT CARDJFP BENEFIT MANAGEMENT PEPM

Affiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(888) 285-4864

GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005

CONTACT EMPLOYER CONTACT EMPLOYERJH Kelly GroupAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

CHECK BENEFIT CARDJK GUARDIAN SECURITY SERVICES

Affiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

JMA ARCHITECTURE STUDIO - PEPM

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

JMA ARCHITECTURE STUDIO - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-290• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 291: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLEJOB OPTIONSAffiliated With: FCE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

JOB SQUAD INCAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

CHECK BENEFIT CARDJOE BROWN COMPANY INCAffiliated With: WATERSTONE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

JOHN A MARTINAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

JOHN A MARTIN TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-291• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 292: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

JOHN ALDEN LIFE INSURANCE COMPANY(800) 328-4316

FortisJOHN ALDEN LIFE INSURANCE COMPANY

Affiliated With: ASSURANT HEALTH

Fund No:PlanType: Group Health

JOHN ALDEN LIFE INSURANCE COMPANY(800) 328-4316

JOHN ALDEN LIFE INSURANCE COMPANYPO Box 981602EL PASO TX 79998

JOHN ALDEN LIFE INSURANCE COMPANY(800) 328-4316

CHECK BENEFIT CARDJOHN ALDEN LIFE INSURANCE COMPANY - REMOTE REPRICING

Affiliated With: ASSURANT HEALTH

Fund No:PlanType: Group Health

JOHN ALDEN LIFE INSURANCE COMPANY(800) 328-4316

JOHN ALDEN LIFE INSURANCE COMPANYPO Box 1599BOISE ID 83701-1599

KEY BENEFIT ADMINISTRATORS(866) 387-0489

FORTIS BENEFITS INSURANCE COMPANY(866) 387-3407

JOHN ALDEN REWARDSAffiliated With: FORTIS BENEFITS INSURANCE COMPANY

Fund No:PlanType: Group Health

KEY BENEFIT ADMINISTRATORS(317) 284-7649

KEY BENEFIT ADMINISTRATORS8330 ALLISON POINT TRAILINDIANAPOLIS IL 46250

PRIMARY PHYSICIAN CARE(800) 446-5439

PRIMARY PHYSICIAN CARE(800) 582-7774

JOHN BOYLE AND COMPANY INCAffiliated With: PRIMARY PHYSICIANCARE INC

Fund No:PlanType: Group Health

PRIMARY PHYSICIAN CARE(800) 446-5439

PRIMARY PHYSICIAN CAREPO Box 11088CHARLOTTE NC 28220

CHECK BENEFIT CARD CHECK BENEFIT CARDJOHN BUNNING TRANSFER COMPANY

Affiliated With: REGIONAL CARE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-292• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 293: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

John Davis Trucking Co Inc - TravelAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDJOHN HAMMONS HOTELS INCAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

KLAIS & COMPANY INC(800) 331-1096

CHECK BENEFIT CARDJOHNSON & WALES UNIVERSITYAffiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(800) 331-1096

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

KLAIS & COMPANY INC(800) 331-1096

CHECK BENEFIT CARDJOHNSON & WALES UNIVERSITY PSPM

Affiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(800) 331-1096

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

STUDENT ASSURANCE SERVICES6514397098

CHECK BENEFIT CARDJOHNSON BIBLE COLLEGEAffiliated With: STUDENT ASSURANCE SERVICES

Fund No:PlanType: Group Health

STUDENT ASSURANCE SERVICES6514397098

STUDENT ASSURANCE SERVICES333 N. MAIN STREETSTILLWATER MN 55082

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-293• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 294: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

JOHNSON BROTHERS CORPAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

CHECK BENEFIT CARD CHECK BENEFIT CARDJOHNSTON EMPLOYEE BENEFIT ASSOCIATION

Affiliated With: FISERVE HEALTH KANSAS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDJOICO LABORATORIES INCAffiliated With: BENESIGHT INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

JONES VARGASAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)(714) 668-8920

HINES & ASSOCIATES(800) 528-2498

JON-LIN FOODSAffiliated With: EMPLOYEE BENEFITS ADMINISTRATION & MANAGEMENT

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)(714) 668-8920

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M)PO Box 5079WESTLAKE VILLAGE CA 91359

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-294• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 295: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDJORDAN OUTDOOR IMMERSION GRAPHICS

Affiliated With: PARAGON BENEFITS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARDJOSEPH CARRARA & SONS WRAP JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

HEALTHCOMP THIRD PARTY ADMINISTRATORS INC(800) 442-7247

CHECK BENEFIT CARDJOSEPH GALLO FARMSAffiliated With: HEALTHCOMP THIRD PARTY ADMINISTRATORS

Fund No:PlanType: Group Health

HEALTHCOMP THIRD PARTY ADMINISTRATORS INC(800) 442-7247

HEALTHCOMP THIRD PARTY ADMINISTRATORS INCPO Box 45018FRESNO CA 93721

GISC, INC(800) 242-4472

CHECK BENEFIT CARDJOSEPH MERRITTAffiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

GISC, INC7818298595 Ext 136

GISC, INC20 INDUSTRIAL PARK DRPEMBROKE MA 02359

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDJOY GLOBAL INCAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-295• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GLOBALCARE, INC.8008601111

JP Farley(800) 634-0173

JP FARLEYAffiliated With: GLOBALCARE, INC.

Fund No:PlanType: Group Health

GLOBALCARE, INC.6783411722

GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005

PRUDENTIAL OVERALL SUPPLY

PRUDENTIAL OVERALL SUPPLY

JR SIMPLOTAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRUDENTIAL OVERALL SUPPLY

PRUDENTIAL OVERALL SUPPLYPO Box 11210SANTA ANA CA 92711

PRINCIPAL FINANCIAL GROUP(888) 421-2926

PRINCIPAL FINANCIAL GROUP(800) 553-5044

JR SIMPLOT/UT MEMBERSAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(888) 421-2926

PRINCIPAL FINANCIAL GROUPPO Box 39710COLORADO SPRINGS CO 80949

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

JSA HEALTHCARE NEVADA LLC TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

HEALTH PLAN INC(508) 752-2480

CARE MANAGEMENT SERVICES(866) 325-1550

JSI STORE FIXTURES INCAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-296• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 297: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

JULIET - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

JUPITER MEDIA CORPORATIONAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

JUPITERMEDIAAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

JVSAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

K & D CONSTRUCTION - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-297• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 298: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ACS BENEFIT SERVICES INC(800) 849-5370

CHECK BENEFIT CARDKAESER COMPRESSORSAffiliated With: ACS BENEFIT SERVICES, INC.

Fund No:PlanType: Group Health

ACS BENEFIT SERVICES INC(800) 849-5370

ACS BENEFIT SERVICES INCPO Box 2000Winston-Salem SC 27102

CHECK BENEFIT CARD8003824661

CHECK BENEFIT CARDKAISER PERM ROCKY MOUNTAINAffiliated With: KAISER PERMANENTE INSURANCE COMPANY ROCKY MOUNTAIN

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8003824661

CHECK BENEFIT CARD

CHECK BENEFIT CARD8008132000

CHECK BENEFIT CARDKAISER PERMANENTE NORTH WEST

Affiliated With: KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8008132000

CHECK BENEFIT CARD

MET Team(800) 783-9281

CHECK BENEFIT CARDKaisers Contracting Cleaning Specialities Inc

Affiliated With: Midwest Security Administrators

Fund No:PlanType: Group Health

MET Team(800) 783-9281

MET Team2700 Midwest Dr.ONALASKA WI 54650

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

KALB CONSTRUCTION - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-298• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 299: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

KANSAS CITY VAMC CHECK BENEFIT CARDKANSAS CITY VAMC 3526Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

KANSAS CITY VAMC KANSAS CITY VAMC

4801 LINWOOD BLVDKANSAS CITY MO 64128

Attn: FEE BASIS 136E

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDKAYCAN LTDAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798

UM NOT APPLICABLEKAYSUN CORPORATIOMAffiliated With: EMPLOYEE BENEFIT CONSULTANT

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798

EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839

HEALTH PLAN INC5087522480

CMS INC(866) 325-1550

KBS BUILDING SYSTEMSAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC5087522480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

THE EPOCH GROUP(314) 821-3957

CHECK BENEFIT CARDKCG INCAffiliated With: THE EPOCH GROUP #10469

Fund No:PlanType: Group Health

THE EPOCH GROUP(314) 821-3957

THE EPOCH GROUP10793 WATSON RDST. LOUIS MO 63127-1036

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-299• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798

CHECK BENEFIT CARDKEENE TECHNOLOGY, INCAffiliated With: EMPLOYEE BENEFIT CONSULTANTS

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798

EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839

EBMS(800) 777-3575

CHECK BENEFIT CARDKELLER SUPPLY COMPANYAffiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES, INC.

Fund No:PlanType: Group Health

EBMS(800) 777-3575

EBMSPO Box 21367BILLINGS MT 59104-1367

THE LOOMIS COMPANY(877) 634-9814

CHECK BENEFIT CARDKEMA CONSULTINGAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(877) 634-9814

THE LOOMIS COMPANYPO Box 7045WYOMISSING PA 19610

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDKENNESAW STATE UNIV AIH0058327

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDKENNESAW STATE UNIV AIH0058337

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-300• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEKENNESAW STATE UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PEARCE ADMINISTRATION(843) 622-6001

UM NOT APPLICABLEKENTUCKY CHRISTIAN UNIVERSITY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDKERN HIGH SCHOOL DISTRICTAffiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

MANAGED CARE SYSTEMS6617167100

MANAGED CARE SYSTEMS(661) 716-7140

KERN VALLEY HEALTHCARE DISTRICT

Affiliated With: MANAGED CARE SYSTEMS

Fund No:PlanType: Group Health

MANAGED CARE SYSTEMS6617167100

MANAGED CARE SYSTEMS5080 CALIFORNIA AVE STE 120BAKERSFIELD CA 93309

P5 E HEALTH SERVICES, INC.(800) 348-6898

CHECK BENEFIT CARDKETTLE FOODSAffiliated With: P5 HEALTH PLAN SOLUTIONS

Fund No:PlanType: Group Health

P5 E HEALTH SERVICES, INC.(800) 348-6898

P5 E HEALTH SERVICES, INC.2455 E. Parleys Way #300Salt Lake City UT 84109

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-301• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BENEFIT ADMINISTRATIVE SYSTEMS(618) 628-0289

CHECK BENEFIT CARDKEY MANAGEMENT CO OF MISSOURI, LLC

Affiliated With: BENEFIT ADMINISTRATIVE SYSTEMS

Fund No:PlanType: Group Health

BENEFIT ADMINISTRATIVE SYSTEMS(618) 628-0289

BENEFIT ADMINISTRATIVE SYSTEMS17475 Jovanna Dr. STE 1BHOMEWOOD IL 60430

Key Risk Insurance Company(800) 366-1511

Key Risk Insurance Company(800) 366-1511

Key Risk Management Services, Inc.

Affiliated With: Key Risk Insurance Company

Fund No:PlanType: Workers' Compensation

Key Risk Insurance Company(800) 366-1511

Key Risk Insurance CompanyPO Box 49129Greensboro NC 27419

SELF INSURED BENEFIT ADMINISTRATORS, INC.(800) 683-7422

UM NOT APPLICABLEKEYS INSURANCE SERVICES INCAffiliated With: SELF INSURED BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

SELF INSURED BENEFIT ADMINISTRATORS, INC.(800) 683-7422

SELF INSURED BENEFIT ADMINISTRATORS, INC.101 STARCREST DRCLEARWATER FL 33758

EBPA(800) 578-3272

CHECK BENEFIT CARDKEYSPAN ENERGY DELIVERYAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDKEYWELL LLCAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-302• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDKIFI TV8Affiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.

KIN DAH LICHI 'I OLTAAffiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.PO Box 25160SCOTTSDALE AZ 85255-0102

BAC(614) 863-8780

BAC(614) 863-8780

KINETICS NOISE CONTROLAffiliated With: BUSINESS ADMINISTRATORS AND CONSULTANTS

Fund No:PlanType: Group Health

BAC(614) 863-8780

BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068

BUSINESS ADMINISTRATORS & CONSULTANTS INC(800) 521-2684

UM NOT APPLICABLEKING, CHAPMAN & BROUSSARD, INC

Affiliated With: BUSINESS ADMINISTRATORS & CONSULTANTS

Fund No:PlanType: Group Health

BUSINESS ADMINISTRATORS & CONSULTANTS INC(614) 863-8780

BUSINESS ADMINISTRATORS & CONSULTANTS INCPO Box 107REYNOLDSBURG OH 43068

C.L. FRATES AND COMPANY(405) 290-5696

CHECK BENEFIT CARDKINGFISHER REGIONAL HOSPITAL

Affiliated With: C L FRATES & COMPANY

Fund No:PlanType: Group Health

C.L. FRATES AND COMPANY(405) 290-5696

C.L. FRATES AND COMPANYPO Box 26967OKLAHOMA CITY OK 73126-0967

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-303• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDKINRO INCAffiliated With: BOON CHAPMAN BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARDKINROSS GOLD USA INCAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARD

EBMS CHECK BENEFIT CARDKINROSS GOLD USA INC TRAVELAffiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

EBMS EBMSPO Box 21367BILLINGS MT 59104-1367

BUTLER BENEFIT SERVICES(563) 327-2240

CHECK BENEFIT CARDKINSETH HOTEL COORPORATIONAffiliated With: SISCO/Cottingham & Butler

Fund No:PlanType: Group Health

BUTLER BENEFIT SERVICES(563) 327-2240

BUTLER BENEFIT SERVICES215 N MAIN ST STE 800DAVENPORT IA 52801

GLOBALCARE(678) 341-1922

UM NOT APPLICABLEKIPP & CO PACTRUSTAffiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1922

GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-304• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GLOBALCARE(678) 341-1922

UM NOT APPLICABLEKIPP AND COMPANY - WRG DESIGN

Affiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1922

GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

KITTRELL GARLOCK & ASSOCIATES

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

KLAIS & COMPANY INC(800) 331-1096

CHECK BENEFIT CARDKLAIS & COMPANY - PEPMAffiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(800) 331-1096

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

KLAMATH ALCOHOL & DRUG ABUSE, INC.

Affiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

KLAMATH CHILD AND FAMILY TREATMENT CENTER

Affiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-305• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

KLAMATH COUNTY EMPLOYESSAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

KLAMATH COUNTY SCHOOLSAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DRBEND OR 97702

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

KLAMATH FALLS CITY SCHOOLSAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

KLAMATH FAMILY HEAD STARTAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

KLAMATH FAMILY PRACTICEAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-306• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

KLAMATH HEALTH PARTNERSHIPAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

KLAMATH HOSPICEAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

KLAMATH MEDICAL CLINICAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

KLAMATH ORTHOPEDIC & SPORTS MEDICINE CLINIC

Affiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

KLAMATH RADIOLOGY ASSOCIATES, PC

Affiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-307• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 308: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PPC(800) 446-5439

PPC(704) 523-2758

KLAUSSNER FURNITURE INDUSTRIES, INC

Affiliated With: PRIMARY PHYSICIANCARE

Fund No:PlanType: Group Health

PPC(800) 446-5439

PPCPO Box 11088CHARLOTTE NC 28220

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

KNOWLEDGE HEALTHCARE, INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

THE EPOCH GROUP(314) 821-3957

HEALTHLINK(314) 821-3957

KOHNER PROPERTIESAffiliated With: THE EPOCH GROUP

Fund No:PlanType: Group Health

THE EPOCH GROUP(314) 821-3957

THE EPOCH GROUP10795 Watson RdSt. Louis MO 63129

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDKONOCTI UNIFIED SCHOOLSAffiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

ASSURECARE(800) 968-6616

CARELINE(763) 383-4800

KORTE ELECTRICAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-308• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 309: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTHSCOPE BENEFITS INC(866) 885-4944

HEALTHSCOPE BENEFITS INC(501) 218-7691

KOYO CORPORATIONAffiliated With: HEALTHSCOPE BENEFITS, INC

Fund No:PlanType: Group Health

HEALTHSCOPE BENEFITS INC(800) 560-4664

HEALTHSCOPE BENEFITS INC27 CORPORATE HILL DRLITTLE ROCK AR 72205

HEALTHSCOPE BENEFITS INC(866) 885-4944

HEALTHSCOPE BENEFITS INC(501) 218-7691

KRAFT FOODSAffiliated With: HEALTHSCOPE BENEFITS INC

Fund No:PlanType: Group Health

HEALTHSCOPE BENEFITS INC(800) 560-4664

HEALTHSCOPE BENEFITS INC27 CORPORATE HILL DRLITTLE ROCK AR 72205

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(810) 269-8723

KRALIS BROTHERS FOODSAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

AFFORDABLE BENEFIT ADMINISTRATORS INC(818) 842-0147

AFFORDABLE BENEFIT ADMINISTRATORS INC(818) 842-0147

KUMHO TIRE USA INCAffiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC. (ABA)

Fund No:PlanType: Group Health

AFFORDABLE BENEFIT ADMINISTRATORS INC(818) 842-0147

AFFORDABLE BENEFIT ADMINISTRATORS INCPO Box 10787BURBANK CA 91510-0787

SELF INSURED SERVICES COMPANY (SISCO)(800) 457-4726

HEALTHCORP(800) 457-4726

K-Z, Inc.Affiliated With: SISCO/Cottingham & Butler

Fund No:PlanType: Group Health

SELF INSURED SERVICES COMPANY (SISCO)(800) 457-4726

SELF INSURED SERVICES COMPANY (SISCO)PO Box 389DUBUQUE IA 52004-0389

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-309• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 310: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

THE LOOMIS COMPANY(800) 346-1223

HINES & ASSOCIATES(888) 826-5769

L ROBERT KIMBALL AND ASSOCIATES

Affiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(800) 346-1223

THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011

MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819

MIDWEST SECURITY ADMINISTRATORS, INC.

LAB SAFETY SUPPLYAffiliated With: MIDWEST SECURITY ADMINISTRATORS INC

Fund No:PlanType: Group Health

MIDWEST SECURITY ADMINISTRATORS, INC.(608) 783-8819

MIDWEST SECURITY ADMINISTRATORS, INC.PO Box 574ONALASKA WI 54650

EBPA(802) 846-8060

CHECK BENEFIT CARDLABEL TECH INC JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

THE LOOMIS COMPANY(866) 473-6615

CHECK BENEFIT CARDLABOR READYAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(866) 473-6615

THE LOOMIS COMPANY850 N PARK RDWYOMISSING PA 19610

CONTACT EMPLOYER CONTACT EMPLOYERLabor Ready, Inc.Affiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-310• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BUSINESS ADMINISTRATORS & CONSULTANTS INC(800) 521-2654

CHECK BENEFIT CARDLACK STORES INCAffiliated With: BUSINESS ADMINISTRATORS CONSULTANTS

Fund No:PlanType: Group Health

BUSINESS ADMINISTRATORS & CONSULTANTS INC(800) 521-2654

BUSINESS ADMINISTRATORS & CONSULTANTS INCPO Box 107REYNOLDSBURG OH 43068

EBPA(800) 578-3272

CHECK BENEFIT CARDLACONIA SAVINGS BANKAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

BENEFIRST LLC7818374402

AMERICAN HEALTH HOLDINGS(800) 641-3224

LAFRANCE BROTHERS, INC. ET AL

Affiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

BENEFIRST LLC7818374402

BENEFIRST LLC1020 PLAIN STMARSHFIELD MA 02050

CONTACT EMPLOYER CONTACT EMPLOYERLaidlaw TransportationAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

LAKE COUNTYAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-311• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PROFESSIONAL CLAIMS MGMT(800) 590-6500

CHECK BENEFIT CARDLAKE COUNTY GOVERNMENTAffiliated With: PROFESIONAL CLAIMS MANAGEMENT

Fund No:PlanType: Group Health

PROFESSIONAL CLAIMS MGMT(800) 590-6500

PROFESSIONAL CLAIMS MGMT16455 Frontage RdBurr Ridge IL 60527

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

LAKE DISTRICT HOSPITALAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDLAKE ELSINORE UNIFIED SCHOOLS

Affiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

CHECK BENEFIT CARDLAKE FOREST COLLEGEAffiliated With: PIONEER MANAGEMENT SERVICES

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

LAKE LAS VEGAS RESORTAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-312• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 313: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBMS(800) 777-3575

EBMS CARELINK4062453575

LAKESIDE INDUSTRIES, INCAffiliated With: EMPLOYEE BENEFIT MANAGAMENT SERVICES #15318

Fund No:PlanType: Group Health

EBMS(800) 777-3575

EBMSPO Box 21367BILLINGS MT 59104-1367

FISERV HEALTH KANSAS(800) 235-7160

TRUSTMARK LIFE INSURANCE CO.(800) 725-6566

LAKESIDE TRAVELAffiliated With: FISERV HEALTH - KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

GROUP & PENSION ADMINISTRATORS INC(972) 238-7900

HEALTH WATCH(972) 238-7900

LAMAR COUNTYAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS INC(972) 238-7900

GROUP & PENSION ADMINISTRATORS INC12770 MERIT DR STE 200DALLAS TX 75251

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDLAMAR UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

MERITAIN HEALTH(800) 455-1938

UM NOT APPLICABLELAND AIR EXPRESS INCAffiliated With: MERITAIN HEALTH

Fund No:PlanType: Group Health

MERITAIN HEALTH(800) 455-1938

MERITAIN HEALTHPO Box 1090EVANSVILLE IN 47706

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-313• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 314: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDLAND AIR EXPRESS OF N EAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

LANDAMRK COMMUNITIESAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(307) 347-6151

MOUNTAIN STATES REVIEW(307) 347-7979

LANDER MEDICAL CLINICAffiliated With: MANAGED BENEFITS ADMINISTRATORS & INS CONSULTANTS

Fund No:PlanType: Group Health

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(307) 347-6151

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTSPO Box 98WORLAND WY 82401

EBPA(800) 525-8788

CHECK BENEFIT CARDLANDMARK COLLEGE WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

EBPA(800) 525-8788

CHECK BENEFIT CARDLANDMARK COLLEGE WRAP VSTAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-314• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLELANDMARK SERVICES, INCAffiliated With: FCE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

CHECK BENEFIT CARD CHECK BENEFIT CARDLANDSCAPE DEVELOPMENT INCAffiliated With: PHYSICIANS DEVELOPMENT INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 742-7345

LAS VEGAS ATHLETIC CLUBAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

LAS VEGAS POLICE PROTECTIVE ASSOCIATION CIVILIAN EMPLOYEES

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Amalgamated Life Insurance Co.(212) 539-5104

ALICARE, Inc(800) 332-5426

Laundry, Dry Cleaning Workers & Allied Industries Health Fund

Affiliated With: Amalgamated Life Insurance Co

Fund No:PlanType: Group Health

Amalgamated Life Insurance Co.(212) 539-5104

Amalgamated Life Insurance Co.730 BroadwayNew York NY 10003

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-315• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 316: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PROFESSIONAL BENEFIT ADMINISTRATORS(800) 435-5694

CHECK BENEFIT CARDLAUREL HEALTH CARE COMPANYAffiliated With: PROFESSIONAL BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

PROFESSIONAL BENEFIT ADMINISTRATORS(800) 435-5694

PROFESSIONAL BENEFIT ADMINISTRATORSPO Box 4687OAKBROOK IL 60522-4687

MMSI(800) 965-6674

MMSI(800) 965-6674

LB WHITE COMPANYAffiliated With: MMSI

Fund No:PlanType: Group Health

MMSI(800) 965-6674

MMSI4001 41ST STREET NWROCHESTER MN 55901

GISC, INC(800) 242-4472

GISC TOTALCARE(800) 242-4472

LEADER DISTRIBUTION SYSTEMS INC

Affiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

GISC, INC(800) 242-4472

GISC, INC20 WINTER STPEMBROKE MA 02359

ASSURECARE(800) 968-6616

ASSURECARE(800) 968-6616

LEAR CORPORATIONAffiliated With: ASSURECARE OF ILLINOIS

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4050 HUNSACKER DR STE 110EAST LANSING MI 48823

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADVANTAGE(800) 825-3540

LEARFIELD COMMUNICATIONS, INC

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORS3121 QUAIL SPRINGS PKWYOKLAHOMA CITY OK 73134

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-316• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDLEASE CRUTCHER LEWISAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDLEAVITT GROUPAffiliated With: P5 HEALTH PLAN SOLUTIONS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDLEAVITT GROUP AGENCY ASSOCIATION

Affiliated With: P5 HEALTH SOLUTIONS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

HEALTH NET FEDERAL SERVICES(214) 387-3232

CHECK BENEFIT CARDLEBANON VAMC 3126Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(214) 387-3232

HEALTH NET FEDERAL SERVICES5504 HILL HEAVEN CTFRISCO TX 75035

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

LEDCOR HOLDINGS INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-317• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

LEDCOR HOLDINGS INC - TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

LEE AND RUSSELL LAW FIRM - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDLEGACY BANKAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

PRODUCERS EXCHANGE BENEFIT SERVICES INC.(800) 443-2595

CHECK BENEFIT CARDLEGACY INVESTMENTSAffiliated With: PRODUCERS EXCHANGE BENEFIT SERVICES INC

Fund No:PlanType: Group Health

PRODUCERS EXCHANGE BENEFIT SERVICES INC.(800) 443-2595

PRODUCERS EXCHANGE BENEFIT SERVICES INC.4004 BELT LINE RD STE 160ADDISON TX 75001

CHECK BENEFIT CARD CHECK BENEFIT CARDLEICA GEOSYSTEMSAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-318• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 319: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SELF INSURED BENEFIT ADMINISTRATORS, INC.(727) 532-0400

UM NOT APPLICABLELENNYS FURNITURE, INCAffiliated With: SELF INSURED BENEFIT ADMINISTRATORS, LLC

Fund No:PlanType: Group Health

SELF INSURED BENEFIT ADMINISTRATORS, INC.(727) 532-0400

SELF INSURED BENEFIT ADMINISTRATORS, INC.101 STARCREST DRCLEARWATER FL 33758

CHECK BENEFIT CARD8002779476

CHECK BENEFIT CARDLESCO RESTORATIONS INCAffiliated With: CORPORATE BENEFITS SERVICE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8002779476

CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERLetica CorporationAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CHECK BENEFIT CARD CHECK BENEFIT CARDLEW A CUMMINGS PRINTING INCAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDLEWIS AND CLARK UNIVERSITYAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-319• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

KHS, A KMG AMERICA COMPANY(803) 283-5378

KHS, A KMG AMERICA COMPANY(803) 283-2737

LEWIS M CARTER MANUFACTURING COMPANY

Affiliated With: KHS, A KMG AMERICA COMPANY

Fund No:PlanType: Group Health

KHS, A KMG AMERICA COMPANY(803) 283-5378

KHS, A KMG AMERICA COMPANYPO Box 1000LANCASTER SC 29721

KHS, A KMG AMERICA COMPANY(803) 283-5378

KHS, A KMG AMERICA COMPANY(803) 283-2737

LEWIS M CARTER MANUFACTURING COMPANY PEPM

Affiliated With: KHS, A KMG AMERICA COMPANY

Fund No:PlanType: Group Health

KHS, A KMG AMERICA COMPANY(803) 283-5378

KHS, A KMG AMERICA COMPANYPO Box 1000LANCASTER SC 29721

NORTH AMERICA ADMINISTRATORS, L.P.(615) 255-6654

MED-CERT(800) 356-7126

LEWIS SEEDSAffiliated With: NORTH AMERICA ADMNISTRATORS

Fund No:PlanType: Group Health

NORTH AMERICA ADMINISTRATORS, L.P.(615) 255-6654

NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

DIRECT CARE AMERICA(800) 266-5896

CHECK BENEFIT CARDLEXINGTON PRECISION CORPORATION

Affiliated With: THE CHANDLER GROUP #13352

Fund No:PlanType: Group Health

DIRECT CARE AMERICA(800) 266-5896

DIRECT CARE AMERICAPO Box 2090 CSTOW OH 44224

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-320• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 321: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

LEXINGTON VA MEDICAL CENTER

CHECK BENEFIT CARDLEXINGTON VA MEDICAL CENTER 3147

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

LEXINGTON VA MEDICAL CENTER

LEXINGTON VA MEDICAL CENTER

1101 VETERANS DRLEXINGTON KY 40502

Attn: 4-FEE

CHECK BENEFIT CARD8772615511

CHECK BENEFIT CARDLIBERTY GOLDAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8772615511

CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDLiberty Mutual Insurance CompanyAffiliated With: Liberty Mutual Insurance Company

Fund No:PlanType: Auto

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERLiberty Mutual Insurance Company/Liberty Northwest Companies

Affiliated With: Liberty Mutual Insurance Company/Liberty

Fund No: D8056PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

LICKING KNOX GOODWILLAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-321• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FISERV HEALTH KANSAS(800) 235-7160

TRUSTMARK LIFE INSURANCE CO.(800) 725-6566

LIDSEEN OF NORTH CAROLINAAffiliated With: FISERV HEALTH - KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

HILLCREST BENEFIT ADMINISTRATORS INC(800) 743-9264

STRATEGIC HEALTH DEVELOPMENT(800) 874-2378

LIFEGUARD TRANSPORTATION SERVICES INC

Affiliated With: HILLCREST BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

HILLCREST BENEFIT ADMINISTRATORS INC(800) 743-9264

HILLCREST BENEFIT ADMINISTRATORS INCPO Box 1516MOUNT DORA FL 32756

America's TPA(952) 896-4888

CHECK BENEFIT CARDLIFETIME FITNESSAffiliated With: AMERICA'S TPA

Fund No:PlanType: Group Health

America's TPA(952) 896-4888

America's TPAPO Box 398220Bloomington MN 55439

America's TPA(952) 896-4888

CHECK BENEFIT CARDLIFETIME FITNESS TRAVELAffiliated With: AMERICA'S TPA

Fund No:PlanType: Group Health

America's TPA(952) 896-4888

America's TPAPO Box 398220Bloomington MN 55439

LIFEWISE HEALTH PLAN OF OREGON(800) 722-3372

LIFEWISE HEALTH PLAN OF OREGON(800) 722-3372

LIFEWISE HEALTH PLAN OF OREGON

Affiliated With: LIFEWISE HEALTH PLAN OF OREGON

Term Effective: 9/6/2007Fund No:PlanType: Group Health

LIFEWISE HEALTH PLAN OF OREGON(800) 722-3372

LIFEWISE HEALTH PLAN OF OREGON815 S W BONDBEND OR 97702

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-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.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

THE LOOMIS COMPANY(800) 875-2364

CHN SOLUTIONS(800) 293-9795

LIFT-ALL COMPANYAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(800) 875-2364

THE LOOMIS COMPANYPO Box 14086READING PA 19612-4086

EBA&M(800) 776-1545

UM NOT APPLICABLELIMONEIRA COMPANYAffiliated With: EMPLOYEE BENEFITS ADMINISTRATION & MGMT (EBA&M)

Fund No:PlanType: Group Health

EBA&M(800) 776-1545

EBA&MPO Box 5079WESTLAKE VILLAGE CA 91359

CHECK BENEFIT CARD CHECK BENEFIT CARDLINCOLN UNIVERSITYAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Professional Benefit Administrators, Inc.(630) 655-3755

First Health(800) 522-8812

Lincolnway Affiliate SchoolsAffiliated With: Lincolnway Affiliate Schools

Fund No:PlanType: Group Health

Professional Benefit Administrators, Inc.(630) 655-3755

Professional Benefit Administrators, Inc.900 Jorie Blvd Ste 250Oakbrook IL 60523

MMA(800) 348-7468

CHECK BENEFIT CARDLINDEN A SHOWALTER CPAAffiliated With: MENNONITE MUTUAL AID

Fund No:PlanType: Group Health

MMA(800) 348-7468

MMAPO Box 483GOSHEN IN 46527

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-323• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GROUP INSURANCE SERVICE CENTER INC(800) 242-4472

CHECK BENEFIT CARDLINDENMEYER MUNROEAffiliated With: GROUP INSURANCE SERVICE CENTER INC

Fund No:PlanType: Group Health

GROUP INSURANCE SERVICE CENTER INC(800) 242-4472

GROUP INSURANCE SERVICE CENTER INCPO Box 9120MARSHFIELD MA 02050

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDLINFIELD COLLEGE - DOMESTICAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDLINFIELD COLLEGE INTERNATIONAL

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

LINK SNACKS INCAffiliated With: PREFERREDONE ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICESPO Box 59212MINNEAPOLIS MN 55459

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-324• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 325: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

LINTON-STOCKTON SCHOOL CORP

Affiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

CHECK BENEFIT CARD CHECK BENEFIT CARDLIPE ROLLWAY CORPORATION PRE 65 RETIREES

Affiliated With: THE EPOCH GROUP L C

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

BENEFIT CONCEPTS, INC.(610) 337-2600

CHECK BENEFIT CARDLIQUIDHUB INCAffiliated With: BENEFIT CONCEPTS INC

Fund No:PlanType: Group Health

BENEFIT CONCEPTS, INC.(610) 337-2600

BENEFIT CONCEPTS, INC.PO Box 61553KING OF PRUSSIA PA 19406

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.

LITTLE SINGER COMMUNITY SCHOOL

Affiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.PO Box 25160SCOTTSDALE AZ 85255-0102

LIUNA Staf Health and Welfare Plan(800) 548-6242

Ullicare(800) 848-9200

LIUNAAffiliated With: ULLICO

Fund No:PlanType: Group Health

LIUNA Staf Health and Welfare Plan(800) 548-6242

LIUNA Staf Health and Welfare Plan905 16th St NWWashington DC 20006ECS Payor ID 13142

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-325• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTHCOMP TPA CHECK BENEFIT CARDLIVERMORE UNIFIEDAffiliated With: HEALTHCOMP THIRD PARTY ADMINISTRATORS

Fund No:PlanType: Group Health

HEALTHCOMP TPA HEALTHCOMP TPAPO Box 45018Fresno CA 93718

INTERPLAN HEALTH GROUP(800) 266-5896

MAGNACARE(877) 335-4725

LOCAL 1730 ILA, MANAGEMENT LABOR WELFARE & PENSION FUNDS

Affiliated With: INTERPLAN HEALTH GROUP / SUPERIEN HEALTH PLAN

Fund No:PlanType: Group Health

INTERPLAN HEALTH GROUP(800) 266-5896

INTERPLAN HEALTH GROUP

PO Box 2388 CSTOW OH 44224

Attn: Supervisor of the Claims Dept

SUPERIEN HEALTH NETWORK(800) 266-5896

CHECK BENEFIT CARDLOCAL 348 PLAN D RD JETRO (RDC)

Affiliated With: SUPERIEN HEALTH NETWORK #18373

Fund No:PlanType: Group Health

SUPERIEN HEALTH NETWORK(800) 266-5896

SUPERIEN HEALTH NETWORK

PO Box 2388 CSTOW OH 44224

Attn: Supervisor of the Claims Dept

SUPERIEN HEALTH NETWORK(800) 266-5896

CHECK BENEFIT CARDLOCAL 348 PLAN J JETRO IN-NETWORK (JETINILA)

Affiliated With: SUPERIEN HEALTH NETWORK #18373

Fund No:PlanType: Group Health

SUPERIEN HEALTH NETWORK(800) 266-5896

SUPERIEN HEALTH NETWORK

PO Box 2388 CSTOW OH 44224

Attn: Supervisor of the Claims Dept

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-326• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SUPERIEN HEALTH NETWORK(800) 266-5896

CHECK BENEFIT CARDLOCAL 348 STAFF PLANAffiliated With: SUPERIEN HEALTH NETWORK #18373

Fund No:PlanType: Group Health

SUPERIEN HEALTH NETWORK(800) 266-5896

SUPERIEN HEALTH NETWORK

PO Box 2388 CSTOW OH 44224

Attn: Supervisor of the Claims Dept

CHECK BENEFIT CARD CHECK BENEFIT CARDLocal 75 CaliforniaAffiliated With: Amalgamated Life Insurance Co.

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CBSA(952) 593-6438

GUIDED2HEALTH(952) 593-6447

LODGING HOST HOTEL CORPORATION

Affiliated With: CORPORATE BENEFIT SERVICE OF AMERICA

Fund No:PlanType: Group Health

CBSA(952) 593-6438

CBSA400 Highway 169 South, Ste 800Minneapolis MN 55426-1141

C.L. FRATES AND COMPANY(405) 290-5696

CHECK BENEFIT CARDLOGAN MEDICAL CENTERAffiliated With: C L FRATES & COMPANY

Fund No:PlanType: Group Health

C.L. FRATES AND COMPANY(405) 290-5696

C.L. FRATES AND COMPANYPO Box 26967OKLAHOMA CITY OK 73126-0967

CONTACT EMPLOYER CONTACT EMPLOYERLogans RoadhouseAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-327• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 328: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MMSI(800) 965-6674

MMSI(800) 965-6674

LOGISTICS HEALTH INCAffiliated With: MMSI

Fund No:PlanType: Group Health

MMSI(800) 965-6674

MMSI4001 41ST STREET NWROCHESTER MN 55901

LOMA LINDA VA MEDICAL CENTER

CHECK BENEFIT CARDLOMA LINDA VA MEDICAL CENTER 3190

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

LOMA LINDA VA MEDICAL CENTER

LOMA LINDA VA MEDICAL CENTER

11201 BENTON STLOMA LINDA CA 92359

Attn: FEE BASIS - 11C

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDLONE PINE UNIFIED SCHOOLSAffiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDLONG BEACH CITY COLLEGEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

LONG BEACH VAMC CHECK BENEFIT CARDLONG BEACH VAMC 3191Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

LONG BEACH VAMC(916) 985-1259

LONG BEACH VAMC

5901 E 7TH STLONG BEACH CA 90822

Attn: FEE BASIS 04F

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-328• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 329: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882

PHYSICIAN CARE OF CALIFORNIA(714) 540-5882

LONG TERM CARE WORKERS HEALTH TRUST FUND

Affiliated With: PHYSICIANS CARE INSURANCE SERVICES

Fund No:PlanType: Group Health

PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882

PHYSICIANS CARE INSURANCE SERVICES, INC.PO Box 15165SANTA ANA CA 92735

THE LOOMIS COMPANY(877) 634-9814

CHECK BENEFIT CARDLOOMIS COMPANYAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(877) 634-9814

THE LOOMIS COMPANYPO Box 7045Wyomissing PA 19610

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDLOPEZ FOODS, INC.Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

CHECK BENEFIT CARD8006601014

CHECK BENEFIT CARDLOS ANGELES COUNTY FIREFIGHTERS LOCAL 1014

Affiliated With: LOS ANGELES COUNTY FIREFIGHTERS LOCAL 1014

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8006601014

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-329• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 330: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

LOS ANGELES HOTEL RESTAURANT EMPLOYER UNION WELFARE FUND2134848480

LOS ANGELES HOTEL RESTAURANT EMPLOYER UNION WELFARE FUND

LOS ANGELES HOTEL-RESTAURANT EMPLOYER UNION WLF FUND

Affiliated With: LOS ANGELES HOTEL-RESTAURANT EMPLOYER UNION WELF

Fund No:PlanType: Group Health

LOS ANGELES HOTEL RESTAURANT EMPLOYER UNION WELFARE FUND2134848480

LOS ANGELES HOTEL RESTAURANT EMPLOYER UNION WELFARE FUNDPO Box 57924LOS ANGELES CA 90057

CHECK BENEFIT CARD6109330300

CHECK BENEFIT CARDLOS RIOS COMMUNITY COLLEGE DISTRICT

Affiliated With: A G ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD6109330300

CHECK BENEFIT CARD

MACORI ADMINISTRATION(800) 285-8133

UM NOT APPLICABLELOUISIANA STATE UNIVERSITY - PENNINGTON

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

MACORI ADMINISTRATION(800) 285-8133

MACORI ADMINISTRATION19609 WIEDSPRING TX 77388

CHECK BENEFIT CARD CHECK BENEFIT CARDLOUISIANA STATE UNIVERSITY HEALTH SCIENCES CENTER

Affiliated With: STUDENT ASSURANCE SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-330• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 331: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

LOUISVILLE VAMC CHECK BENEFIT CARDLOUISVILLE VAMC 3150Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

LOUISVILLE VAMC LOUISVILLE VAMC

800 ZORN AVELOUISVILLE KY 40206

Attn: FEE BASIS (136F)

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

LOVARCAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARDLOVEJOY TOOL COMPANY WRAP JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

FMH BENEFIT SERVICES INC(800) 990-9058

CHECK BENEFIT CARDLOVES TRAVEL INCAffiliated With: FMH BENEFIT SERVICES INC

Fund No:PlanType: Group Health

FMH BENEFIT SERVICES INC(800) 990-9058

FMH BENEFIT SERVICES INCPO Box 25946OVERLAND PARK KS 66225-5946

Mountain States Administrative Services(520) 722-7133

Hines and Associates(847) 214-2780

LOVITT & TOUCHEAffiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES INC

Fund No:PlanType: Group Health

Mountain States Administrative Services(520) 722-7133

Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-331• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 332: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

LOWELL BROTHERS AND BAILEYAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

CONTACT EMPLOYER CONTACT EMPLOYERLSA ASSOCIATES, INC.Affiliated With: BENEFIT AND RISK MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CONTACT EMPLOYER CONTACT EMPLOYER

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDLSB INDUSTRIESAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

CHECK BENEFIT CARD CHECK BENEFIT CARDLUCAS TREE EXPERTS PEPMAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.

LUKACHUKAI COMMUNITY SCHOOL

Affiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.PO Box 25160SCOTTSDALE AZ 85255-0102

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-332• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 333: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDLUMBER INCAffiliated With: LUMBER INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDLUMBER PRODUCTSAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERLumbermans Underwriting AllianceAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

HEALTHCARE SOLUTIONS GROUP, INC.(800) 749-1422

CHECK BENEFIT CARDLYLE HUGHART WELFARE PLANAffiliated With: HEALTHCARE SOLUTIONS GROUP INC

Fund No:PlanType: Group Health

HEALTHCARE SOLUTIONS GROUP, INC.(800) 749-1422

HEALTHCARE SOLUTIONS GROUP, INC.PO Box 1309MUSKOGEE OK 74402

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDM D PPRODUCTS INCAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-333• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 334: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GROUP & PENSION ADMINISTRATORS(800) 827-7223

CHECK BENEFIT CARDM7 Aerospace TRAVELAffiliated With: GROUP & PENSION ADMINISTRATORS

*

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

MAC Risk Management, Inc.(800) 288-8415

MAC Risk Management, Inc.(800) 288-8415

MAC Risk Managament, Inc.Affiliated With: MAC Risk Managament

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

CONTACT EMPLOYER CONTACT EMPLOYER

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDMACON STATE COLLEGE AIH0058347

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEMACON STATE COLLEGE OF GA UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PERFORMAX / BROKERAGE CONCEPTS, INC.(888) 554-7629

PERFORMAX / AMERICAN HEALTH HOLDING(800) 337-0506

MACRO PLASTICS INCAffiliated With: BROKERAGE CONCEPTS INC/BENEFIT CONCEPTS INC.

Fund No:PlanType: Group Health

PERFORMAX / BROKERAGE CONCEPTS, INC.(888) 554-7629

PERFORMAX / BROKERAGE CONCEPTS, INC.PO Box 61505KING OF PRUSSIA PA 19406

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-334• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 335: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDMACSTEEL SERVICE CENTERS USA

Affiliated With: INNOVATIVE ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Benefits/Eligibility(800) 843-3106

CHECK BENEFIT CARD(800) 522-2161

Madison National Life Insurance Company Inc

Affiliated With: Insurers Administrative Corporation

Fund No:PlanType: Group Health

Benefits/Eligibility(800) 843-3106

Benefits/EligibilityPO Box 828Park Ridge IL 60068-0828

Insurers Administrative Corporation (IAC)(800) 843-3106

Med-Valu(800) 522-2161

MADISON NATIONAL LIFE INSURANCE COMPANY INC

Affiliated With: INSURERS ADMINISTRATIVE CORPORATION #11337

Fund No:PlanType: Group Health

Insurers Administrative Corporation (IAC)(800) 843-3106

Insurers Administrative Corporation (IAC)PO Box 828Park Ridge IL 60068-0828

PREFERRED HEALTH PLANS INC.(800) 832-8212

CHECK BENEFIT CARDMADISON PRECISION PRODUCTS INC

Affiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-335• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 336: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MADISON VAMC CHECK BENEFIT CARDMADISON VAMC 3164Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MADISON VAMC MADISON VAMC

2500 OVERLOOK TERRACEMADISON WI 53705

Attn: FEE 136

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

MedWatch(800) 432-8421

MADSEN KNEPPERS & ASSOCIATES, INC.

Affiliated With: PREFERRED BENEFIT ADMINISTRATORS INC.

Fund No:PlanType: Group Health

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INCPO Box 916188LONGWOOD FL 32791-6188

BENEFITS INCORPORATED(651) 636-8288

BENEFITS INCORPORATED(651) 636-8288

MAGSTAR TECHNOLOGIESAffiliated With: BENEFITS INCORPORATED

Fund No:PlanType: Group Health

BENEFITS INCORPORATED(651) 636-8288

BENEFITS INCORPORATED2277 W. Hwy 36 #316ROSEVILLE MN 55113-3887

HEALTH PLAN INC(508) 752-2480

CARE MANAGEMENT SERVICES(866) 325-1550

MAINE DISTRIBUTORS - %Affiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

HEALTH PLAN INC(800) 532-7575

CARE MANAGEMENT SERVICES(866) 325-1550

MAINE RUBBER INTERNATIONALAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC100 FRONT ST STE 600WORCESTER MA 01608

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-336• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 337: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MACORI ADMINISTRATION(281) 651-8787

CHECK BENEFIT CARDMAKSIN - WRAPAffiliated With: MAKSIN MANAGEMENT CORPORATION

Fund No: vPlanType: Group Health

MACORI ADMINISTRATION(281) 651-8787

MACORI ADMINISTRATION19609 WIEDSPRING TX 77388

SUPERIOR ADMINISTRATORS, INC.(714) 429-1700

CHECK BENEFIT CARD(702) 733-3145

MAMMOTH HOSPITALAffiliated With: SUPERIOR ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SUPERIOR ADMINISTRATORS, INC.(714) 429-1700

SUPERIOR ADMINISTRATORS, INC.3720 SOUTH SUSAN ST STE 200SANTA ANA CA 92704

CLAIMS AND BENEFIT MANAGEMENT INC(909) 902-1890

CHINCORP(702) 433-3145

MAMMOTH MOUNTAIN SKI AREAAffiliated With: CLAIMS AND BENEFIT MANAGEMENT INC

Fund No:PlanType: Group Health

CLAIMS AND BENEFIT MANAGEMENT INC(909) 902-1890

CLAIMS AND BENEFIT MANAGEMENT INC6251 SCHAEFER AVE STE MCHINO CA 91710

DELTA HEALTH SYSTEMS(559) 228-4198

DELTA TEAM CARE(800) 356-2395

MAMMOTH MOUNTAIN SKI RESORT

Affiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(559) 228-4198

DELTA HEALTH SYSTEMSPO Box 80Stockton CA 95201

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDMAMMOTH UNIFIED SCHOOLSAffiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-337• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 338: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ManageAbility Inc ManageAbility IncManageability, IncAffiliated With: FDI Group DBA Manageability, Inc

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

ManageAbility Inc ManageAbility Inc39500 High Pointe BlvdNovi MI 48375

MANAGED CARE SYSTEMS6617167100

CHECK BENEFIT CARDMANAGED CARE SYSTEMS LPAffiliated With: MANAGED CARE SYSTEMS LP

Fund No:PlanType: Group Health

MANAGED CARE SYSTEMS6617167100

MANAGED CARE SYSTEMS4550 California Ave Ste 500Bakersfield CA 93309

CHECK BENEFIT CARD CHECK BENEFIT CARDMANAGED HEALTH FUNDINGAffiliated With: MHF INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

BAC(614) 863-8780

BAC(614) 863-8780

MANAGEMENT INFORMATION DISCIPLINES

Affiliated With: BUSINESS ADMINISTRATORS AND CONSULTANTS

Fund No:PlanType: Group Health

BAC(614) 863-8780

BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068

MANCHESTER VA MEDICAL CENTER

CHECK BENEFIT CARDMANCHESTER VA MEDICAL CENTER 3117

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MANCHESTER VA MEDICAL CENTER

MANCHESTER VA MEDICAL CENTER

718 SMYTH RDMANCHESTER NH 03104

Attn: FEE BASIS 136F

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-338• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 339: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARDMANSFIELD PAPER COMPANY WRAP JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

INNOVATIVE ADMINISTRATIVE SERVICES8002723433

HEALTH ASSIST(866) 214-1106

MARAVILLAAffiliated With: INNOVATIVE ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

INNOVATIVE ADMINISTRATIVE SERVICES8002723433

INNOVATIVE ADMINISTRATIVE SERVICES540 WALD AVEIRVINE CA 92618

ADMINISTRATIVE SOLUTIONS INC(678) 339-0211

INNOVATIVE CARE MANAGEMENT(800) 398-7353

MARC-JAC POULTRYAffiliated With: ADMINISTRATIVE SOLUTIONS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE SOLUTIONS INC(678) 339-0211

ADMINISTRATIVE SOLUTIONS INCPO Box 2490ALPHARETTA GA 30023

MERITAIN HEALTH(800) 828-6922

HEALTHLINK(800) 624-2356

Marcone Appliance PartsAffiliated With: MERITAIN HEALTH

Fund No:PlanType: Group Health

MERITAIN HEALTH(800) 828-6922

MERITAIN HEALTH

PO Box 853921Richardson TX 75085-3921

Attn: Claims Dept

CHECK BENEFIT CARD CHECK BENEFIT CARDMARIAN MANORAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-339• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 340: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDMARICOPA COUNTY COMMUNITY COLLEGE AKA MCCCD

Affiliated With: ZENITH ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDMARICOPA INTAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDMARICOPA VOLAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882

PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882

MARIE CALLENDER PIE SHOPS INC

Affiliated With: PHYSICIANS CARE INSURANCE SERVICES INC

Fund No:PlanType: Group Health

PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882

PHYSICIANS CARE INSURANCE SERVICES, INC.1570 BROOKHOLLOW STE 208SANTA ANA CA 92705

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-340• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 341: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MARION IL VAMC CHECK BENEFIT CARDMARION IL VAMC 3523Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MARION IL VAMC MARION IL VAMC

2401 WEST MAINMARION IL 62959

Attn: FISCAL SERVICE 04C

MARION IN VA MEDICAL CENTER

CHECK BENEFIT CARDMARION IN VA MEDICAL CENTER 3157

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MARION IN VA MEDICAL CENTER

MARION IN VA MEDICAL CENTER

1700 E 38TH STMARION IN 46953

Attn: FEE BASIS 136C3

FISERV HEALTH KANSAS(800) 235-7160

TRUSTMARK LIFE INSURANCE CO.(800) 725-6566

MARKET LOGISTICS INCAffiliated With: FISERV HEALTH - KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

TRUSTEED PLANS SERVICE GROUP(800) 426-9786

AMERICAN HEALTH HOLDING(888) 877-7994

MARKET TRANSPORT LTDAffiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE GROUP(800) 426-9786

TRUSTEED PLANS SERVICE GROUPPO Box 1894TACOMA WA 98401-1894

NORTH AMERICA ADMINISTRATORS, L.P.(615) 255-6654

MED-CERT(800) 356-7126

MARQUETTE TRANSPORTATION COMPANY, INC.

Affiliated With: NORTH AMERICA ADMINISTRATORS

Fund No:PlanType: Group Health

NORTH AMERICA ADMINISTRATORS, L.P.(615) 255-6654

NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-341• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 342: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

MARQUIS COMPANIESAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

MARSHALL RETAIL GROUP LLCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

MARSHALL RETAIL GROUP LLC - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Cambridge(312) 821-8800

Cambridge(312) 821-8800

Martin BoyerAffiliated With: Cambridge

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

Cambridge(312) 821-8800

Cambridge175 W Jackson Ste 1000Chicago IL 60604

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

MARTIN HARRIS CONSTRUCTIONAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-342• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 343: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EMPLOYEE BENEFIT PLAN ADMINISTRATION(800) 525-8788

CHECK BENEFIT CARDMARTINS POINT HEALTHCARE JMS

Affiliated With: EMPLOYEE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT PLAN ADMINISTRATION(802) 846-8060

EMPLOYEE BENEFIT PLAN ADMINISTRATION

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

MARTINSBURG VA MEDICAL CENTER

CHECK BENEFIT CARDMARTINSBURG VA MEDICAL CENTER 3133

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MARTINSBURG VA MEDICAL CENTER

MARTINSBURG VA MEDICAL CENTER

510 BUTLER AVEMARTINSBURG WV 25401

Attn: FEE SVCS GB113

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

CHECK BENEFIT CARDMARYMOUNT COLLEGEAffiliated With: PIONEER MANAGEMENT SERVICES

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090

CI(817) 479-2115

CI(817) 479-2115

MARYMOUNT UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Term Effective: 8/31/2007Fund No:PlanType: Group Health

TRUE CHOICE(800) 785-2446

TRUE CHOICEPO Box 700307DALLAS TX 75370

STUDENT ASSURANCE SERVICES INC(800) 328-2739

CHECK BENEFIT CARDMARYVILLE UNIVERSITYAffiliated With: STUDENT ASSURANCE SERVICES INC

Fund No:PlanType: Group Health

STUDENT ASSURANCE SERVICES INC(800) 328-2739

STUDENT ASSURANCE SERVICES INC333 N. MAIN STREETSTILLWATER MN 55082

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-343• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 344: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

MASAMI FOODS, INC.Affiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

UNITED CLAIM SOLUTIONS(602) 393-4553

UM NOT APPLICABLEMASONRY INDUSTRY TRUSTAffiliated With: UNITED CLAIMS SOLUTIONS

Fund No:PlanType: Group Health

UNITED CLAIM SOLUTIONS(602) 393-4553

UNITED CLAIM SOLUTIONS10835 N 25TH AVE STE 105PHOENIX AZ 85029

CONSOLIDATED HEALTH PLANS INC(800) 633-7867

CHECK BENEFIT CARDMASSACHUSETTS COMMUNITY COLLEGES

Affiliated With: CONSOLIDATED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

CONSOLIDATED HEALTH PLANS INC(800) 633-7867

CONSOLIDATED HEALTH PLANS INC195 STAFFORD STSPRINGFIELD MA 01104

BENESIGHT INC(877) 718-6920

BENESIGHT MEDICAL MANAGEMENT(877) 718-6920

MASTER CRAFT FABRICSAffiliated With: BENESIGHT INC

Fund No:PlanType: Group Health

BENESIGHT INC(877) 718-6920

BENESIGHT INCPO Box 370PUEBLO CO 81002

EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798

AMERICAN HEALTH HOLDING(614) 818-3222

MASTERGRAPHICS, INCAffiliated With: EMPLOYEE BENEFIT CONSULTANTS

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798

EMPLOYEE BENEFIT CONSULTANTS215 STANFORD PARKWAYFINDLAY OH 45840

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-344• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 345: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Masters, Mates and Pilots Health & Benefit Plan(410) 850-8500

First Health(800) 213-1185

Masters, Mates & PilotsAffiliated With: Master Mates & Pilots Health and Benefit Plan

Fund No:PlanType: Group Health

Masters, Mates and Pilots Health & Benefit Plan(410) 850-8500

Masters, Mates and Pilots Health & Benefit Plan5700 Hammonds Ferry RdLinthicum Heights MD 21090-1996ECS Payor ID MMPHB

ASSURECARE(800) 759-1311

Careline UR(763) 383-4800

MATERIAL SERVICESAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 759-1311

ASSURECARE340 Quadrangle DrBolingbrook IL 60440

PATIENT ADVOCATES LLC CHECK BENEFIT CARDMATHEWS BROTHERSAffiliated With: PATIENT ADVOCATE LLC

Fund No:PlanType: Group Health

PATIENT ADVOCATES LLC PATIENT ADVOCATES LLCPO Box 1959Gray ME 04039

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDMATHIS BROTHERS FURNITUREAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

CONTACT EMPLOYER First Health(800) 931-3439

Matrix Absence Management IncAffiliated With: Matrix Absence Management Inc

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-345• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 346: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Matson Navigation Company Matson Navigation Company

Matson Navigation CompanyAffiliated With: Matson Navigation Company

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

Matson Navigation Company Matson Navigation Company555 12th StOakland CA 94607

May Department Stores(410) 298-1866

May Department Stores(410) 298-1866

May Department Stores Co - CentralAffiliated With: May Department Stores Co.

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

May Department Stores(410) 298-1866

May Department Stores7004 Security Blvd, Ste 304Baltimore MD 21244

May Department Stores(410) 298-1866

May Department Stores(410) 298-1866

May Department Stores Co - EasternAffiliated With: May Department Stores Co.

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

May Department Stores(410) 298-1866

May Department Stores7004 Security Blvd, Ste 304Baltimore MD 21244

May Department Stores(410) 298-1866

May Department Stores(410) 298-1866

May Department Stores Co - Western

Affiliated With: May Department Stores Co.

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

May Department Stores(410) 298-1866

May Department Stores7004 Security Blvd, Ste 304Baltimore MD 21244

MMSI(866) 222-3914

MMSI(866) 222-3914

MAYO FOUNDATIONAffiliated With: MAYO MANAGEMENT SERVICES INC

Fund No:PlanType: Group Health

MMSI(866) 222-3914

MMSI4001 41ST STREET NWROCHESTER MN 55901

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-346• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 347: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDMAYO FOUNDATION SCOTTSDALE

Affiliated With: MAYO MANAGEMENT SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

MERCER ADMINISTRATION(918) 732-4935

CHECK BENEFIT CARDMAYS HOUSECALL HOME HEALTH

Affiliated With: MARSH ADVANTAGE/MERCER ADMINISTRATION #10442

Fund No:PlanType: Group Health

MERCER ADMINISTRATION(918) 732-4935

MERCER ADMINISTRATIONONE W. THIRD ST #900TULSA OK 74103

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 460-0238

MCALESTER REGIONAL HEALTH CENTER

Affiliated With: WATERSTONE BENEFIT ADMINISTRATORS #962501227

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

DIRECT CARE AMERICA(800) 266-5896

CHECK BENEFIT CARDMCARE HMOAffiliated With: THE CHANDLER GROUP 1352

Fund No:PlanType: Group Health

DIRECT CARE AMERICA(800) 266-5896

DIRECT CARE AMERICAPO Box 2090 CSTOW OH 44224

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-347• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 348: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GLOBALCARE(678) 341-1811

CHECK BENEFIT CARDMCARE HMO - GLOBALCARE WRAP

Affiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005

THE KEMPTON GROUP(405) 521-1711

CHECK BENEFIT CARDMCBRIDE CLINIC INCAffiliated With: THE KEMPTON GROUP INC

Fund No:PlanType: Group Health

THE KEMPTON GROUP(405) 521-1711

THE KEMPTON GROUPPO Box 54889OKLAHOMA CITY OK 73154

FISERV HEALTH INC(800) 235-7160

CHECK BENEFIT CARDMCCALL PATTERN COMPANYAffiliated With: FISERVE HEALTH KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH INC(800) 235-7160

FISERV HEALTH INCPO Box 520Pueblo CO 81002-0520

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

CHECK BENEFIT CARDMCCORMICK TRUCKINGAffiliated With: FCE BENEFIT ADMINISTRATORS #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

Benefit Planners(800) 292-5386

CHECK BENEFIT CARDMCCOY'S CORPORATIONAffiliated With: BENEFIT PLANNERS

*

Fund No:PlanType: Group Health

Benefit Planners(800) 292-5386

Benefit PlannersPO Box 690450SAN ANTONIO TX 78269

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-348• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 349: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBC(800) 342-1407

CHECK BENEFIT CARDMCCRACKEN COUNTY JAIL - INMATES

Affiliated With: EMPLOYEE BENEFIT CONSULTANTS

Term Effective: 8/31/2007Fund No:PlanType: Group Health

EBC(800) 342-1407

EBCPO Box 1639APPLETON WI 54912

Professional Benefit Administrators, Inc.(800) 435-5694

CHECK BENEFIT CARDMCDANIEL FIRE SYSTEMSAffiliated With: PROFESSIONAL BENEFIT ADMINISTRATORS, ILLINOIS

Fund No:PlanType: Group Health

Professional Benefit Administrators, Inc.(800) 435-5694

PROFESSIONAL BENEFIT ADMINISTRATORS, INC. C/O CCN900 Jorie Blvd Ste 250Oakbrook IL 60523

Employee Benefit Management Corp (EBMC)(800) 552-0455

First Health(800) 613-7721

McGean

Fund No:PlanType: Group Health

Employee Benefit Management Corp (EBMC)(800) 552-0455

Employee Benefit Management Corp (EBMC)4789 Rings RdDublin OH 43017-1599

THE LOOMIS COMPANY(800) 367-3721

CHECK BENEFIT CARDMCGUIRE BEARINGS, INC.Affiliated With: LOOMIS BENEFITS WEST

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(800) 367-3721

THE LOOMIS COMPANYPO Box 13906READING PA 19612

CONTACT EMPLOYER CONTACT EMPLOYERMCO Advantage - EDIAffiliated With: MCO Advantage / PBM Corporation

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-349• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 350: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERMCO Advantage - PaperAffiliated With: MCO Advantage / PBM Corporation

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

STAR HEALTHCARE NETWORK(212) 581-8228

CHECK BENEFIT CARDMD ABROADAffiliated With: STAR HEALTHCARE NETWORK INC

*

Fund No:PlanType: Group Health

STAR HEALTHCARE NETWORK(212) 581-8228

STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019

WINTERBROOK/CCN(405) 843-9551 Ext 106

CHECK BENEFIT CARDMD BUILDING PRODUCTSAffiliated With: MD BUILDING PRODUCTS

Fund No:PlanType: Group Health

WINTERBROOK/CCN(405) 843-9551 Ext 106

WINTERBROOK/CCNPO Box 568800OKLAHOMA CITY OK 73156-8800

MENNONITE MUTUAL AID & ASSOC & MMA INSURANCE(574) 533-9515

MENNONITE MUTUAL AID C/O CCN(800) 348-7468

MEBP - EASTERN MENNONITE UNIVERSITY

Affiliated With: MENNONITE MUTUAL AID ASSOC AND MMA INSURANCE CO

Fund No:PlanType: Group Health

MENNONITE MUTUAL AID & ASSOC & MMA INSURANCE(574) 533-9515

MENNONITE MUTUAL AID & ASSOC & MMA INSURANCEPO Box 483GOSHEN IN 46527

STAR HEALTHCARE NETWORK(212) 581-8228

CHECK BENEFIT CARDMEDAIREAffiliated With: STAR HEALTHCARE NETWORK INC

*

Fund No:PlanType: Group Health

STAR HEALTHCARE NETWORK(212) 581-8228

STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-350• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 351: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8009723025

CHECK BENEFIT CARDMEDCATH INCAffiliated With: HEALTHSCOPE BENEFITS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8009723025

CHECK BENEFIT CARD

NHBC(888) 621-7900

CHECK BENEFIT CARDMEDCOST BENEFIT SERVICESAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

EBPA(800) 578-3272

CHECK BENEFIT CARDMEDICAL CARE DEVELOPMENTAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

EBPA(800) 578-3272

CHECK BENEFIT CARDMEDICAL CARE DEVELOPMENT JMS

Affiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-351• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 352: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBPA(800) 578-3272

CHECK BENEFIT CARDMEDICAL CARE DEVELOPMENT WRAP % JMS

Affiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

NHBC(888) 621-7900

CHECK BENEFIT CARDMEDICAL CLAIMS MANAGEMENTAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEMEDICAL COLLEGE OF GA UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDMEDICAL COLLEGE OF GEORGIA AIH0058367

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

Medical Consultants Network(631) 454-8399

Medical Consultants Network(631) 454-8399

Medical Consultants Network

Fund No:PlanType: Workers' Compensation

Medical Consultants Network(631) 454-8399

Medical Consultants Network3 Huntington QuadMelville NY 11747

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-352• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 353: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BENESIGHT INC(800) 476-5832

BENESIGHT MEDICAL MANAGEMENT(800) 476-5832

MEDICAL DATA SYSTEMS INCAffiliated With: BENESIGHT INC

Fund No:PlanType: Group Health

BENESIGHT INC(800) 476-5832

BENESIGHT INCPO Box 360Pueblo CO 81002-0360

CHECK BENEFIT CARD CHECK BENEFIT CARDMEDICAL MUTUAL OF OHIO - CCN RESIDENT

Affiliated With: MEDICAL MUTUAL OF OHIO

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDMEDICAL MUTUAL OF OHIO - CCN TRAVEL

Affiliated With: MEDICAL MUTUAL OF OHIO

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDMEDICAL UNIVERSITY OF SOUTH CAROLINA

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437

MEDICOR UM NOT APPLICABLEMEDICOR AUTOAffiliated With: MEDICOR

Fund No:PlanType: Auto

MEDICOR MEDICOR1745 N Brown Rd Ste 400Lawrenceville GA 30043

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-353• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 354: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERMedicor Managed CareAffiliated With: Medicor

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

MEDICOR UM NOT APPLICABLEMediCor-DOAS_MedataAffiliated With: Medicor Managed Care LLC

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

MEDICOR MEDICOR1745 N Brown Rd Ste 400Lawrenceville GA 30043

CHECK BENEFIT CARD CHECK BENEFIT CARDMEDIPAC INTERNATIONAL INCAffiliated With: MEDIPAC INTERNATIONAL

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

MEDSAVE(516) 622-1700

CHECK BENEFIT CARDMEDSAVE, INCAffiliated With: MEDSAVE, INC

Fund No:PlanType: Group Health

MEDSAVE(516) 622-1700

MEDSAVE390 Rabro RdHauppauge NY 11788

STAR HEALTHCARE NETWORK(212) 581-8228

CHECK BENEFIT CARDMEGA ASSISTANCEAffiliated With: STAR HEALTHCARE NETWORK INC

*

Fund No:PlanType: Group Health

STAR HEALTHCARE NETWORK(212) 581-8228

STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-354• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 355: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDMEGA LIFE AND HEALTH INC CO CDHP INDIVIDUAL

Affiliated With: MEGA LIFE & INSURANCE COMPANY

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

HEALTHMARKETS(866) 855-5542

CHECK BENEFIT CARDMEGA LIFE AND HEALTH INSURANCE COMPANY - CDHP

Affiliated With: MEGA LIFE & HEALTH INSURANCE COMPANY - CDHP

Fund No:PlanType: Group Health

HEALTHMARKETS8004515998

HEALTHMARKETSPO Box 982009NORTH RICHLAND HILLS TX 76182

CHECK BENEFIT CARD CHECK BENEFIT CARDMELALEUCA INCAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDMELITTA NORTH AMERICAAffiliated With: SELF INSURED BENEFIT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDMELO INTERNATIONALAffiliated With: BENEFIT SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-355• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 356: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERMemco Barge Line IncAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

CHECK BENEFIT CARDMEMORIAL HOSPITAL THE JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

HEALTHCOMP TPA(800) 442-7247

CHECK BENEFIT CARDMEMORIAL HOSPITALS ASSOCIATION

Affiliated With: HEALTHCOMP THIRD PARTY ADMINISTRATORS

Fund No:PlanType: Group Health

HEALTHCOMP TPA(800) 442-7247

HEALTHCOMP TPAPO Box 45018Fresno CA 93718

MEMPHIS VA MEDICAL CENTER

CHECK BENEFIT CARDMEMPHIS VA MEDICAL CENTER 3148

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MEMPHIS VA MEDICAL CENTER

MEMPHIS VA MEDICAL CENTER

1030 JEFFERSON AVEMEMPHIS TN 38104

Attn: FEE BASIS (136G)

CHECK BENEFIT CARD CHECK BENEFIT CARDMENNONITE CHURCH USAAffiliated With: MENNONITE MUTUAL AID ASSOC AND MMA INS CO MMA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-356• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 357: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDMENTOR GRAPHICS CORPAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

MERCER TRANSPORTATIONAffiliated With: MERCER ADMINISTRATION

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(502) 992-4535

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDMERCER UNIVERSITY - DOMESTIC AMH9033306

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 722-1668

PEARCE ADMINISTRATIONPO Box 2439Florence SC 29503

CHECK BENEFIT CARD CHECK BENEFIT CARDMERCURY INSURANCEAffiliated With: MITCHELL MEDICAL

Fund No:PlanType: Auto

Mercury: Administered by Mitchell MedicalExclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)

CHECK BENEFIT CARD CHECK BENEFIT CARD

WAUSAU BENEFITS, INC.(715) 841-7802

CHECK BENEFIT CARDMERIAL LIMITEDAffiliated With: WAUSAU BENEFITS INC

Fund No:PlanType: Group Health

WAUSAU BENEFITS, INC.(715) 841-7802

WAUSAU BENEFITS, INC.

PO Box 8046WAUSAU WI 54401-8046

Attn: LeAnn Fichtner

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-357• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 358: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MCMC LLC(888) 350-1150 Ext 228

MCMC LLC(888) 350-1150 Ext 228

MERIT AUTOAffiliated With: MCMC LLC

Fund No:PlanType: Auto

MCMC LLC(888) 350-1150 Ext 228

MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317

MIDWEST SECURITY ADMINISTRATORS, INC.

MIDWEST SECURITY ADMINISTRATORS, INC.

MESABA AVIATION, INC.Affiliated With: HEALTHCOMP ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

MIDWEST SECURITY ADMINISTRATORS, INC.

MIDWEST SECURITY ADMINISTRATORS, INC.2700 Midwest Dr.ONALASKA WI 54650

CHECK BENEFIT CARD CHECK BENEFIT CARDMESILLA VALLEY TRANSPORTATION

Affiliated With: BOON CHAPMAN BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

MERITAIN HEALTH(800) 828-6922

MERITAIN HEALTH(800) 828-6922

Met America Mortgage Bankers Inc.Affiliated With: MERITAIN HEALTH

Fund No:PlanType: Group Health

MERITAIN HEALTH(800) 828-6922

MERITAIN HEALTH300 CORPORATE PKWYAMHERST NY 14226

CHECK BENEFIT CARD CHECK BENEFIT CARDMetLife Insurance (Auto)Affiliated With: Mitchell Medical

Fund No:PlanType: Auto

Metlife: Administered by Mitchell Medical

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-358• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERMetro Group 90Affiliated With: New York State Insurance Fund

*

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER New York State Insurance Fund199 Church StNew York NY 10007

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDMETROPOLITAN LIBRARY SYSTEM

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

CONTACT EMPLOYER CONTACT EMPLOYERMetropolitan LifeAffiliated With: Mitchell Medical div. of Thompson Publishing Corp

Fund No:PlanType: Auto

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CHECK BENEFIT CARD CHECK BENEFIT CARDMETROPOLITAN STATE COLLEGE OF DENVER

Affiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Metro MetroMetropolitan Transit AuthorityAffiliated With: Metropolitan Transit Authority

Fund No:PlanType: Workers' Compensation

Metro Metro

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-359• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 360: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

METSCH HOURLYAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

METSCH SALARYAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

ADVANCED BENEFIT SOLUTIONS LLC(888) 419-1094

ARIZONA FOUNDATION FOR MEDICAL CARE(800) 852-8001

MEYER TRUCKING INC.Affiliated With: MEYER TRUCKING INC.

Fund No:PlanType: Group Health

ADVANCED BENEFIT SOLUTIONS LLC(888) 419-1094

ADVANCED BENEFIT SOLUTIONS LLCPO Box 71490PHOENIX AZ 85050

GALLAGHER BENEFIT ADMINISTRATORS INC(630) 493-3511

GALLAGHER BENEFIT ADMINISTRATORS INC(630) 493-3845

MFIAAffiliated With: GALLAGHER BENEFIT ADMINISTRATORS INC

Fund No:PlanType: Group Health

GALLAGHER BENEFIT ADMINISTRATORS INC(630) 493-3511

GALLAGHER BENEFIT ADMINISTRATORS INC750 WARRENVILLE RD STE 200LISLE IL 60532

MIAMI VAMC CHECK BENEFIT CARDMIAMI VAMC 3140Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MIAMI VAMC MIAMI VAMC

1201 NW 16TH STMIAMI FL 33125

Attn: FEE BASIS - 136B

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-360• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 361: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDMICAAffiliated With: GROUP ADMINISTRATORS, LTD

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Mountain States Administrative Services(520) 722-7133

Hines and Associates(847) 214-2780

MICROCHIPAffiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

Mountain States Administrative Services(520) 722-7133

Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710

HEALTH PLAN INC(508) 752-2480

CMS(866) 325-1550

MICROGROUP INCAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDMID AMERICAN ENERGY HOLDINGS COMPANY

Affiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

MAKSIN MANAGEMENT CORP(800) 220-1123

UM NOT APPLICABLEMID CONTINENT UNIVERSITYAffiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

MAKSIN MANAGEMENT CORP(800) 220-1123

MAKSIN MANAGEMENT CORP2500 McClellan AvePennsauken NJ 08109

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-361• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDMIDDLE GEORGIA COLLEGE AIH0058377

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEMIDDLE GEORGIA COLLEGE UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

CHECK BENEFIT CARD CHECK BENEFIT CARDMIDDLEBURY COLLEGEAffiliated With: KLAIS AND COMPANY

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

KLAIS & COMPANY INC(330) 867-8443

CHECK BENEFIT CARDMIDDLEBURY COLLEGEAffiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(330) 867-8443

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

EBPA(800) 578-3272

CHECK BENEFIT CARDMIDDLEBURY COLLEGE - JMSAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATION

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-362• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 363: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Deborah Storey(405) 767-1760

Deborah Storey(405) 767-1760

Midlands Injury ManagementAffiliated With: Midlands Injury Management

Fund No:PlanType: Workers' Compensation

Deborah Storey(405) 767-1760

Deborah StoreyPO Box 238804Oklahoma City OK 73116

BENEFIT ADMINISTRATIVE SYSTEMS(800) 523-0582

CHECK BENEFIT CARDMIDWEST PRODUCTS CO. INCAffiliated With: BENEFIT ADMINISTRATORS SYSTEMS

Fund No:PlanType: Group Health

BENEFIT ADMINISTRATIVE SYSTEMS(800) 523-0582

BENEFIT ADMINISTRATIVE SYSTEMS7 JOVANNA DR STE 1BHOMEWOOD IL 60430

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDMIDWEST TROPHY MANUFACTURING CO, INC.

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

SISCO(800) 547-4726

CHECK BENEFIT CARDMIKE BROOKS, INCAffiliated With: SISCO/Cottingham & Butler

Fund No:PlanType: Group Health

SISCO(800) 786-7930

SISCOPO Box 389DUBUQUE IA 52004-0389

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

MILES KIMBALL COMPANYAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-363• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 364: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BAC(800) 521-2654

BAC(614) 863-8780

MILES MCCLELLAN CONSTRUCTION CO

Affiliated With: BUSINESS ADMINISTRATORS & CONSULTANTS

Fund No:PlanType: Group Health

BAC(800) 521-2654

BACPO Box 107REYNOLDSBURG OH 43068

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

MANAGED CARE STRATEGIES(800) 283-4927

MILITARY DELI AND BAKERYAffiliated With: HEALTH AND WELFARE BENEFIT SYSTEMS INC

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

CONTACT EMPLOYER CONTACT EMPLOYERMillennium Risk ManagersAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

BENEFIT SYSTEMS & SERVICES, INC.(630) 203-5124

CHECK BENEFIT CARDMILLER AND COMPANYAffiliated With: BENEFIT SYSTEMS & SERVICES

Fund No:PlanType: Group Health

BENEFIT SYSTEMS & SERVICES, INC.(630) 203-5124

BENEFIT SYSTEMS & SERVICES, INC.760 Pasquinelli Dr. STE 320WESTMONT IL 60559

BRMS(888) 326-2555

BRMS(800) 368-0767

MILLS PENINSULA HEALTH SYSTEMS

Affiliated With: BENEFIT & RISK MANAGEMENT SERVICES

Fund No:PlanType: Group Health

BRMS(888) 326-2555

BRMSPO Box 2650RANCHO CORDOVA CA 98401

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-364• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 365: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MILWAUKEE VA MEDICAL CENTER

CHECK BENEFIT CARDMILWAUKEE VAMC (CLEMENT J ZABLOCKI VAMC)

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MILWAUKEE VA MEDICAL CENTER

MILWAUKEE VA MEDICAL CENTER

5000 W NATIONAL AVEMILWAUKEE WI 53295

Attn: FEE BASIS MIS-136E

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDMINERAL TECHNOLOGIES INCAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

AMERICA'S CHOICE HEALTHPLANS, LLC(877) 224-3627

AMERICAN HEALTH HOLDINGS INC(888) 578-1812

MINI SYSTEMS INCAffiliated With: AMERICA'S CHOICE HEALTHPLANS, LLC

Fund No:PlanType: Group Health

AMERICA'S CHOICE HEALTHPLANS, LLC(877) 224-3627

AMERICA'S CHOICE HEALTHPLANS, LLC13111 Northwest Fwy, Ste 510Houston TX 77040

GISC TOTALCARE(800) 242-4472

GISC TOTALCARE(800) 242-4472

MINI-SYSTEMS, INCAffiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

GISC TOTALCARE(800) 242-4472

GISC TOTALCARE20 WINTER STPEMBROKE MA 02359

MINNEAPOLIS VA MEDICAL CENTER

CHECK BENEFIT CARDMINNEAPOLIS VA MEDICAL CENTER 3703

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MINNEAPOLIS VA MEDICAL CENTER

MINNEAPOLIS VA MEDICAL CENTER

ONE VETERANS DRMINNEAPOLIS MN 55417

Attn: FEE BASIS 17A2

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-365• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 366: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

THE EPOCH GROUP(800) 255-6065

SHPS(888) 645-1380

MIRAMAR BOBCAT, INC ET.AL.Affiliated With: THE EPOCH GROUP #10469

Fund No:PlanType: Group Health

THE EPOCH GROUP(800) 255-6065

THE EPOCH GROUPPO Box 12170OVERLAND PARK KS 66282

CORESOURCE CORESOURCE(800) 480-6658

MISSION AVIATION FELLOWSHIPAffiliated With: CORESOURCE

Fund No:PlanType: Group Health

CORESOURCE CORESOURCEPO Box 2920CLINTON OH 52733-2920

WAUSAU BENEFITS, INC.(715) 841-7802

CHECK BENEFIT CARDMISSION LINEN SUPPLYAffiliated With: WAUSAU BENEFITS INC

Fund No:PlanType: Group Health

WAUSAU BENEFITS, INC.(715) 841-7802

WAUSAU BENEFITS, INC.

PO Box 8046WAUSAU WI 54401-8046

Attn: LeAnn Fichtner

INSURANCE CLAIMS SERVICES INC(800) 931-3439

CHECK BENEFIT CARDMISSION TO THE WORLD (PCA) INC

Affiliated With: ALTERNATIVE INSURANCE RESOURCES, INC.

Fund No:PlanType: Group Health

INSURANCE CLAIMS SERVICES INC(800) 931-3439

INSURANCE CLAIMS SERVICES INCPO Box 660787BIRMINGHAM AL 35266

STUDENT ASSURANCE SERVICES6514397098

CHECK BENEFIT CARDMISSOURI CONSORTIUM - NORTHWEST STATE UNIVERSITY

Affiliated With: STUDENT ASSURANCE SERVICES

Fund No:PlanType: Group Health

STUDENT ASSURANCE SERVICES6514397098

STUDENT ASSURANCE SERVICES333 N. MAIN STREETSTILLWATER MN 55082

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-366• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 367: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDMISSOURI CONSORTIUM - SOUTHEAST STATE UNIVERSITY

Affiliated With: STUDENT ASSURANCE SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

STUDENT ASSURANCE SERVICES6514397098

CHECK BENEFIT CARDMISSOURI CONSORTIUM - SOUTHERN STATE UNIVERSITY

Affiliated With: STUDENT ASSURANCE SERVICES

Fund No:PlanType: Group Health

STUDENT ASSURANCE SERVICES6514397098

STUDENT ASSURANCE SERVICES333 N. MAIN STREETSTILLWATER MN 55082

STUDENT ASSURANCE SERVICES6514397098

CHECK BENEFIT CARDMISSOURI CONSORTIUM - TRUMAN STATE UNIVERSITY

Affiliated With: STUDENT ASSURANCE SERVICES

Fund No:PlanType: Group Health

STUDENT ASSURANCE SERVICES6514397098

STUDENT ASSURANCE SERVICES333 N. MAIN STREETSTILLWATER MN 55082

TRUSTEED PLANS SERVICE GROUP

CHECK BENEFIT CARDMMI PLANSAffiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE GROUP

TRUSTEED PLANS SERVICE GROUPPO Box 1894TACOMA WA 98406-1705

Medical Mutual of Ohio(216) 736-2522

CHECK BENEFIT CARDMMO Indemnity TravelAffiliated With: Medical Mutual of Ohio

Fund No:PlanType: Group Health

Medical Mutual of Ohio(216) 736-2522

Medical Mutual of Ohio

2060 E 9th StCleveland OH 44115

Attn: Barb Hufgard

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-367• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 368: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLEMODERN FACILITIESAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

CNIC HEALTH SOLUTIONS(800) 426-7453

CNIC HEALTH SOLUTIONS(800) 426-7453

MODERN LUXURYAffiliated With: CNIC HEALTH SOLUTIONS

Fund No:PlanType: Group Health

CNIC HEALTH SOLUTIONS(800) 426-7453

CNIC HEALTH SOLUTIONSPO Box 3559ENGLEWOOD CO 80155-3559

CHECK BENEFIT CARD CHECK BENEFIT CARDMOHON INTERNATIONAL INCAffiliated With: CAPITOL ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

FLORIDA HEALTH ADMINISTRATORS(954) 366-0111

CORVEL CORPORATION(954) 340-8990

MONROE COUNTY SCHOOL BOARD

Affiliated With: FLORIDA HEALTH ADMINISTRATORS DBA FHA - TPA

Fund No:PlanType: Group Health

FLORIDA HEALTH ADMINISTRATORS(954) 366-0111

FLORIDA HEALTH ADMINISTRATORSPO Box 327810Fort Lauderdale FL 33332

DIRECT CARE AMERICA(800) 266-5896

CHECK BENEFIT CARDMONROE PLUMBERS & PIPEFITTERS

Affiliated With: THE CHANDLER GROUP #13352

Fund No:PlanType: Group Health

DIRECT CARE AMERICA(800) 266-5896

DIRECT CARE AMERICAPO Box 2090 CSTOW OH 44224

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-368• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 369: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MONTANA HEALTH CARE SYSTEM

CHECK BENEFIT CARDMONTANA HEALTH CARE SYSTEM 3534

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MONTANA HEALTH CARE SYSTEM

MONTANA HEALTH CARE SYSTEM

WILLIAM ST off HWY 12 WESTFORT HARRISON MT 59636

Attn: FEE BASIS

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

MONTEBELLO PACAKAGING INCAffiliated With: PREFERRED HEALTH PLAN INC 962550088

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(502) 992-4535

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

SMITH ADMINISTRATORS, INC.(817) 335-2582

SERVICE ADVOCATES(801) 261-5511

MONTEX DRILLINGAffiliated With: SMITH ADMINISTRATORS INC

Fund No:PlanType: Group Health

SMITH ADMINISTRATORS, INC.(817) 335-2582

SMITH ADMINISTRATORS, INC.3800 SANDSHELL DR STE 260FT. WORTH TX 76134

CHECK BENEFIT CARD CHECK BENEFIT CARDMONTGOMERY ESCALATOR ELEVATOR INC

Affiliated With: INTEGRITY HEALTH SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERMontgomery Insurance Company Auto CO

Affiliated With: RAM

Fund No:PlanType: Auto

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-369• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 370: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERMontgomery Insurance Company WC

Affiliated With: RAM

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

MONTGOMERY VAMC CHECK BENEFIT CARDMONTGOMERY VAMC 3543Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MONTGOMERY VAMC MONTGOMERY VAMC

215 PERRY HILL RDMONTGOMERY AL 36109

Attn: FEE BASIS SECTION

CONTACT EMPLOYER CONTACT EMPLOYERMontlake Insurance HoldingsAffiliated With: GENEX Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

PATIENT ADVOCATES LLC(207) 657-7733

CHECK BENEFIT CARDMOOSEHEAD MANUFACTURING COMPANY

Affiliated With: PATIENT ADVOCATE LLC

Fund No:PlanType: Group Health

PATIENT ADVOCATES LLC(207) 657-7733

PATIENT ADVOCATES LLCPO Box 1959Gray ME 04039

BENEFIT MANAGEMENT INC.(800) 290-1368

CHECK BENEFIT CARDMORIDGE MANUFACTURING, INCAffiliated With: BENEFIT MANAGEMENT INC

Fund No:PlanType: Group Health

BENEFIT MANAGEMENT INC.(800) 290-1368

BENEFIT MANAGEMENT INC.PO Box 1090GREAT BEND KS 67530

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-370• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 371: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDMORRIS COLLEGEAffiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437

CHECK BENEFIT CARD CHECK BENEFIT CARDMORRIS INDUSTRIALAffiliated With: CAROLINA BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

MORRIS TRANSFER, INC.Affiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.(800) 673-5222

MORTON WELDING COMPANY INC

Affiliated With: OSF HEALTHPLANS INC

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(309) 677-8356

OSF HealthPlans, Inc.PO Box 5128PEORIA IL 61601-5128

BENEFIT SUPPORT(800) 777-4782

CHECK BENEFIT CARDMOSLEY HOLDINGSAffiliated With: HEALTHDATAINSIGHTS DBA MVPPO

Fund No:PlanType: Group Health

BENEFIT SUPPORT(800) 777-4782

BENEFIT SUPPORT305 GREEN STGAINSVILLE GA 30501

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-371• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BENEFIT MANAGEMENT INC.

MedWatch(800) 432-8421

MOSSBERG SANITATIONAffiliated With: BENEFIT MANAGEMENT INC

Fund No:PlanType: Group Health

BENEFIT MANAGEMENT INC.

BENEFIT MANAGEMENT INC.

CORESOURCE(800) 624-7143

CORESOURCE(800) 480-6658

Motel Hotel Associates, IncAffiliated With: CORESOURCE INC

Fund No:PlanType: Group Health

CORESOURCE(800) 624-7143

CORESOURCEPO Box 2920CLINTON OH 52733-2920

PIONEER MANAGEMENT SYSTEMS(877) 868-9060

CHECK BENEFIT CARDMOUNT HOLYOKE COLLEGEAffiliated With: PIONEER MANAGEMENT SYSTEMS

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(877) 868-9060

PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01090

MOUNTAIN HOME VA MEDICAL CENTER

CHECK BENEFIT CARDMOUNTAIN HOME VA MEDICAL CENTER 3146

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MOUNTAIN HOME VA MEDICAL CENTER

MOUNTAIN HOME VA MEDICAL CENTER

MOUNTAIN HOME VAMCMOUNTAIN HOME TN 37684

Attn: 04F

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

MOUNTAIN VIEW HOSPITALAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-372• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8882954864

CHECK BENEFIT CARDMOUNTVILLE MILLS INCAffiliated With: JSL ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8882954864

CHECK BENEFIT CARD

ACORDIA NATIONAL(888) 685-7774

CHECK BENEFIT CARDMPD INCAffiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR

*

Fund No:PlanType: Group Health

ACORDIA NATIONAL(888) 685-7774

ACORDIA NATIONAL

THE LOOMIS COMPANY(800) 346-1223

UM NOT APPLICABLEMPR ASSOCIATES INCAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(800) 346-1223

THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011

BENESYS INC(248) 813-9800

HINES & ASSOCIATES(847) 214-2780

MRCC EMPLOYEE BENEFITS FUND/RETIREES

Affiliated With: MRCC EMPLOYEE BENEFITS FUND

Fund No:PlanType: Group Health

BENESYS INC(248) 813-9800

BENESYS INC700 TOWER DRTROY MI 48098

BENESYS INC(248) 813-9800

HINES & ASSOCIATES(847) 214-2780

MRCC EMPLOYEE BENEFITS FUND/TRAVEL

Affiliated With: MRCC EMPLOYEE BENEFITS FUND

Fund No:PlanType: Group Health

BENESYS INC(248) 813-9800

BENESYS INC700 TOWER DRTROY MI 48098

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-373• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 374: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850

AMERICAN HEALTH HOLDING(888) 877-7994

MTS - INTRANSIT, INCAffiliated With: TRUSTEED PLANS SERVICE GROUP

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850

TRUSTEED PLANS SERVICE CORPORATIONPO Box 1894TACOMA WA 98406-1705

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDMUELLER INDUSTRIES INCAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

CHECK BENEFIT CARD CHECK BENEFIT CARDMULLER MARTINI CORPORATIONAffiliated With: HEALTHDATAINSIGHTS / DBA MVPPO

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850

AMERICAN HEALTH HOLDING(888) 877-7994

MULVANNY G2 ARCHITECTUREAffiliated With: TRUSTEED PALNS SERVICE CORPORATION

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850

TRUSTEED PLANS SERVICE CORPORATIONPO Box 1984NASHVILLE TN 37202

MURFREESBORO VA MEDICAL CENTER

CHECK BENEFIT CARDMURFREESBORO VA MEDICAL CENTER 3151

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MURFREESBORO VA MEDICAL CENTER

MURFREESBORO VA MEDICAL CENTER

3400 LEBANON PIKEMURFREESBORO TN 37129

Attn: FEE BASIS (136)

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-374• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 375: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FISERV HEALTH KANSAS(800) 235-7160

AVIDYN HEALTH(866) 802-1328

MURRAY BROS CADDY SHACKAffiliated With: FISERV HEALTH - KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

MUSKOGEE VAMC CHECK BENEFIT CARDMUSKOGEE VAMC 3105Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

MUSKOGEE VAMC MUSKOGEE VAMC

1011 HONOR HEIGHTS DRMUSKOGEE OK 74401

Attn: 161A

EQUITABLE PLAN SERVICES(800) 749-2631

CHECK BENEFIT CARDMUSTANG MACHINERY COMPANY LTD

Affiliated With: EQUITABLE PLAN SERVICES

Fund No:PlanType: Group Health

EQUITABLE PLAN SERVICES(800) 749-2631

EQUITABLE PLAN SERVICESPO Box 720460OKLAHOMA CITY OK 73172

CHECK BENEFIT CARD CHECK BENEFIT CARDMUTUAL FIRE ASSOC THE PROVIDENCE MUTUAL FIRE

Affiliated With: GALLAGHER BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

GALLAGHER BENEFIT ADMINISTRATORS INC(630) 493-3516

GALLAGHER BENEFIT ADMINISTRATORS INC(630) 493-3845

MUTUAL FIRE INSURANCE OF NEW ENGLAND

Affiliated With: GALLAGHER BENEFIT ADMINISTRATORS INC

Fund No:PlanType: Group Health

GALLAGHER BENEFIT ADMINISTRATORS INC(630) 493-3516

GALLAGHER BENEFIT ADMINISTRATORS INC750 WARRENVILLE RD STE 200LISLE IL 60532

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-375• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 376: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PREFERRED CARE, INC.(215) 639-6208

CHECK BENEFIT CARDMUTUAL OF OMAHA - SPECIAL RISK STUDENT ATHLETIC PROGRAM

Affiliated With: PREFERRED CARE INC

Fund No:PlanType: Group Health

PREFERRED CARE, INC.(215) 639-6208

PREFERRED CARE, INC.1300 VIRGINIA DR STE 315FT. WASHINGTON PA 19034

THE LOOMIS COMPANY(800) 498-6250

HINES & ASSOCIATES(888) 826-5769

MVM INC.Affiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(800) 498-6250

THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

NORTH AMERICA ADMINISTRATORS, L.P.

MYERS LUMBERAffiliated With: NORTH AMERICA ADMINISTRATORS, L.P.-TENNESSEE

Fund No:PlanType: Group Health

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

HEALTH NET FEDERAL SERVICES(214) 387-3232

CHECK BENEFIT CARDN LITTLE ROCK VA MEDICAL CENTER 3109

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(214) 387-3232

HEALTH NET FEDERAL SERVICES

2200 FORT ROOTS DRN LITTLE ROCK AR 72114

Attn: FEE BASIS (136G)

ASSURECARE(800) 968-6616

CHECK BENEFIT CARDNACHI ROBOTICAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4050 HUNSACKER DR STE 110EAST LANSING MI 48823

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-376• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 377: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SUMMIT(888) 690-2020

UM NOT APPLICABLENA'NEELZHIIN JI OLTA TORREON DAY SCHOOL

Affiliated With: SUMMIT

Fund No:PlanType: Group Health

SUMMIT(888) 690-2020

SUMMITPO Box 25160SCOTTSDALE AZ 85255-0102

CONTACT EMPLOYER CONTACT EMPLOYERNassauAffiliated With: New York State Insurance Fund

*

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

CHECK BENEFIT CARDNATIONAL COLLEGE OF NATUROPATHIC MEDICINE

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376

PATIENT ADVOCATES LLC(207) 657-7733

PATIENT ADVOCATES LLC(207) 657-7733

NATIONAL DISTRIBUTORSAffiliated With: PATIENT ADVOCATES LLC

Fund No:PlanType: Group Health

PATIENT ADVOCATES LLC(207) 657-7733

PATIENT ADVOCATES LLCPO Box 1959Gray ME 04039

CONTACT EMPLOYER CONTACT EMPLOYERNational Grange Mutual Insurance Company

Affiliated With: Genex Services, Inc.

Fund No:PlanType: Auto

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-377• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERNational Grange Mutual Insurance Company

Affiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

NHBC(888) 321-7900

CHECK BENEFIT CARDNATIONAL HEALTH BENEFIT CORPORATION PEMP (NHBC)

Affiliated With: NATIONAL HEALTH BENEFIT CORPORATION (NHBC)

Fund No:PlanType: Group Health

DBA: SPENCER AND ASSOCIATES

NHBC(888) 321-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

PREMIER ACCESS(888) 463-4137

CHECK BENEFIT CARDNATIONAL HEALTH INSURANCEAffiliated With: PREMIER ACCESS

Fund No:PlanType: Group Health

PREMIER ACCESS(888) 463-4137

PREMIER ACCESSPO Box 150375Arlington TX 76015

SANUS HEALTH CORPORATION(305) 572-9756

SANUS HEALTH CORPORATION(305) 572-9756

NATIONAL INSURANCE BOARDAffiliated With: SANUS HEALTH

Fund No:PlanType: Group Health

SANUS HEALTH CORPORATION(305) 572-9756

SANUS HEALTH CORPORATION12501 KENDALL DR STE 2MIAMI FL 33186

CENBEN USA(614) 797-5204

CHECK BENEFIT CARDNATIONAL PEN CORPORATIONAffiliated With: CENBEN USA INC

Fund No:PlanType: Group Health

CENBEN USA(614) 797-5204

CENBEN USA

4079 Executive PkwyWesterville OH 43081

Attn: Melissa Joseph

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-378• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 379: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7345

NATIONAL SPORTS SERVICESAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

ECOM PPO ADVISORS, INC(800) 342-0719

CHECK BENEFIT CARDNATIONAL TELECOMMUNICATION COOPERATIVE ASSOCIATION

Affiliated With: ECOM PPO ADVISORS INC

Fund No:PlanType: Group Health

ECOM PPO ADVISORS, INC(800) 342-0719

ECOM PPO ADVISORS, INC

8350 N. CENTRAL EXPWY, STE 600DALLAS TX 75206

Attn: ACCOUNTING

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

National Title TravelAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CHECK BENEFIT CARD8774534201

First HealthNATIONAL WOOD PRODUCTSAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8774534201

CHECK BENEFIT CARD

NATIONWIDE HEALTH CLAIMS(800) 299-6080

NATIONWIDE BETTER HEALTH(866) 835-5328

NATIONWIDE HEALTH PLANS - CALIFORNIA FARM BUREAU

Affiliated With: NATIONWIDE HEALTH PLANS

Term Effective: 9/30/2007Fund No:PlanType: Group Health

NATIONWIDE HEALTH CLAIMS(800) 299-6080

NATIONWIDE HEALTH CLAIMSPO Box 182690COLUMBUS OH 43218

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-379• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 380: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

NATIONWIDE HEALTH PLANS(800) 331-4222

NATIONWIDE HEALTH PLANS(800) 331-4222

NATIONWIDE HEALTH PLANS - CALIFORNIA SMALL GROUP PRODUCT

Affiliated With: NATIONWIDE

Fund No:PlanType: Group Health

NATIONWIDE HEALTH PLANS(800) 331-4222

NATIONWIDE HEALTH PLANSPO Box 8026DUBLIN OH 43017

NATIONWIDE HEALTH CLAIMS(800) 299-6080

HEALTH & MEDICAL SOLUTIONS(866) 835-5328

NATIONWIDE HEALTH PLANS - OHIO FARM BUREAU PRIM

Affiliated With: NATIONWIDE HEALTH PLANS

Fund No:PlanType: Group Health

NATIONWIDE HEALTH CLAIMS(800) 299-6080

NATIONWIDE HEALTH CLAIMSPO Box 182690COLUMBUS OH 43218

NATIONWIDE HEALTH CLAIMS(800) 299-6080

NATIONWIDE BETTER HEALTH(866) 835-5328

NATIONWIDE HEALTH PLANS - OHIO FARM BUREAU WRAP

Affiliated With: NATIONWIDE HEALTH PLANS

Fund No:PlanType: Group Health

NATIONWIDE HEALTH CLAIMS(800) 299-6080

NATIONWIDE HEALTH CLAIMSPO Box 182690COLUMBUS OH 43218

NATIONWIDE HEALTH PLANS(800) 331-4222

NATIONWIDE HEALTH PLANS(800) 331-4222

NATIONWIDE HEALTH PLANS - OHIO WRAP

Affiliated With: NATIONWIDE HEALTH PLANS - OHIO WRAP

Fund No:PlanType: Group Health

NATIONWIDE HEALTH PLANS(800) 331-4222

NATIONWIDE HEALTH PLANSPO Box 182690COLUMBUS OH 43218

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-380• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 381: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

NATIONWIDE HEALTH PLANS(800) 331-4222

NATIONWIDE HEALTH PLANS(800) 331-4222

NATIONWIDE HEALTH PLANS OHIO PRIMES LIVES

Affiliated With: NATIONWIDE HEALTH PLANS OHIO PRIMES LIVES

Fund No:PlanType: Group Health

NATIONWIDE HEALTH PLANS(800) 331-4222

NATIONWIDE HEALTH PLANSPO Box 182690COLUMBUS OH 43218

PACIFIC LIFE & ANNUITY COMPANY(800) 542-6642

CHECK BENEFIT CARDNATURES REALMAffiliated With: PACIFIC LIFE & ANNUITY

Fund No:PlanType: Group Health

PACIFIC LIFE & ANNUITY COMPANY(800) 542-6642

PACIFIC LIFE & ANNUITY COMPANYPO Box 295Onalaska WI 54650

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

NAVAGENTE GROUP INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

SRT ADMINISTRATORS, INC.(888) 690-2020

SRT ADMINISTRATORS, INC.

NAVAJO MOUNTAIN COMMUNITY SCHOOL

Affiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS, INC.(888) 690-2020

SRT ADMINISTRATORS, INC.14646 N. Kierland Blvd. #200SCOTTSDALE AZ 85254

CONTACT EMPLOYER CONTACT EMPLOYERNavajo NationAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-381• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 382: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.

NAZLINI COMMUNITY SCHOOLAffiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.PO Box 25160SCOTTSDALE AZ 85255-0102

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 460-0238

NBM CORPORATION DBA THE BANK N A

Affiliated With: WATERSTONE BENEFITS ADMINISTRATORS

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

CHECK BENEFIT CARDNE CONSERVATORY MUSICAffiliated With: PIONEER MANAGEMENT SERVICES

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090

HEALTH NET FEDERAL SERVICES(916) 985-1259

UM NOT APPLICABLENebraska Western Iowa HCS - Grand Island 4006

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(916) 985-1259

CLAIMS MANAGER

2201 N Broadwell AveGrand Island NE 68803

Attn: Fee Basis 136F

NEBRASKA WESTERN IOWA HCS - LINCOLN

CHECK BENEFIT CARDNebraska Western Iowa HCS - Lincoln

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

NEBRASKA WESTERN IOWA HCS - LINCOLN

NEBRASKA WESTERN IOWA HCS - LINCOLN

600 S 70TH STLINCOLN NE 68510

Attn: FEE BASIS BLDG 1

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-382• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 383: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AMERICA'S CHOICE HEALTHPLANS, LLC(877) 224-3627

AMERICAN HEALTH HOLDINGS INC(888) 578-1812

NEI WPCCAffiliated With: AMERICA'S CHOICE HEALTHPLANS LLC

Fund No:PlanType: Group Health

AMERICA'S CHOICE HEALTHPLANS, LLC(877) 224-3627

AMERICA'S CHOICE HEALTHPLANS, LLC13111 Northwest Fwy, Ste 510Houston TX 77040

UNITED CLAIM SOLUTIONS(602) 393-4553

UM NOT APPLICABLENEIL HUFFMAN INCAffiliated With: UNITED CLAIMS SOLUTIONS

Fund No:PlanType: Group Health

UNITED CLAIM SOLUTIONS(602) 393-4553

UNITED CLAIM SOLUTIONS10835 N 25TH AVE STE 105PHOENIX AZ 85029

CHECK BENEFIT CARD CHECK BENEFIT CARDNELSON AND SONS INCAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

NELSON NUTRACEUTICALAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

CHECK BENEFIT CARD CHECK BENEFIT CARDNETCARE LIFE & HEALTH

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-383• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

NEVADA CANCER CENTER TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

NEVADA TITLE INSURANCE COMPANY

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

NEW COM INC PEPMAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

NEW COM INC.Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

CHECK BENEFIT CARD CHECK BENEFIT CARDNEW ENGLAND COLLEGE SPORTS

Affiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-384• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 385: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONSOLIDATED HEALTH PLANS INC(800) 633-7867

CHECK BENEFIT CARDNEW ENGLAND CULINARY INSTITUTE

Affiliated With: CONSOLIDATED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

CONSOLIDATED HEALTH PLANS INC(800) 633-7867

CONSOLIDATED HEALTH PLANS INC195 STAFFORD STSPRINGFIELD MA 01104

PATIENT ADVOCATES LLC(800) 290-8559

PATIENT ADVOCATES LLC(800) 290-8559

NEW ENGLAND HOMESAffiliated With: PATIENT ADVOCATES LLC

Fund No:PlanType: Group Health

PATIENT ADVOCATES LLC(800) 290-8559

PATIENT ADVOCATES LLCPO Box 1959Gray ME 04039

EBPA(800) 525-8788

CHECK BENEFIT CARDNEW ENGLAND PRECISION JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

ECOM PPO ADVISORS, INC(800) 552-7879

CHECK BENEFIT CARDNEW ERA LIFE INSURANCEAffiliated With: ECOM PPO ADVISORS INC

Fund No:PlanType: Group Health

ECOM PPO ADVISORS, INC(800) 552-7879

ECOM PPO ADVISORS, INC

8350 N. CENTRAL EXPWY, STE 600DALLAS TX 75206

Attn: ACCOUNTING

International Medical Group, Inc.(800) 628-4664 or (317) 655-4500

International Medical Group, Inc.(800) 628-4664 or (317) 655-4500

New Freedom CareAffiliated With: International Medical Group, Inc.

Fund No:PlanType: Group Health

International Medical Group, Inc.(800) 628-4664 or (317) 655-4500

International Medical Group, Inc.2960 N Meridian StIndianapolis IN 46208

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-385• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 386: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EMPLOYEE BENEFIT PLAN ADMINISTRATION(888) 877-6447

APS HEALTHCARE(262) 787-2200

NEW HAMPSHIRE HEALTH PLANAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATION

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT PLAN ADMINISTRATION(888) 877-6447

EMPLOYEE BENEFIT PLAN ADMINISTRATION37 INDUSTRIAL DREXETER NH 03833

NEW ORLEANS VA MEDICAL CENTER

CHECK BENEFIT CARDNEW ORLEANS VA MEDICAL CENTER 3106

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

NEW ORLEANS VA MEDICAL CENTER

NEW ORLEANS VA MEDICAL CENTER

400 VETERANS AVEBILOXI MS 39531

Attn: FEE BASIS 136F

GILSBAR, INC.(800) 445-7227

CHECK BENEFIT CARDNEW PARK RESOURCES INCAffiliated With: GILSBAR INC

Fund No:PlanType: Group Health

GILSBAR, INC.(800) 445-7227

GILSBAR, INC.PO Box 2947COVINGTON LA 70434-2947

CHECK BENEFIT CARD CHECK BENEFIT CARDNEW TRIBES MISSIONAffiliated With: NEW TRIBES MISSION

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SELF INSURED PLANS LLC(239) 403-7884

MedWatch(800) 432-8421

NEW TRIBES MISSION FLORIDAAffiliated With: NEW TRIBES MISSION

Fund No:PlanType: Group Health

SELF INSURED PLANS LLC(239) 403-7884

SELF INSURED PLANS LLC1016 COLLIER CENTER STE 200NAPLES FL 34103

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-386• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 387: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERNew York City DivisionAffiliated With: New York State Insurance Fund

*

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER New York State Insurance Fund199 Church StNew York NY 10007

CONTACT EMPLOYER CONTACT EMPLOYERNew York Special Funds Conservation

Affiliated With: New York Special Funds Conservation

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

HEALTH NET FEDERAL SERVICES(214) 387-3232

CHECK BENEFIT CARDNEW YORK VA MEDICAL CENTER 3522

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(214) 387-3232

HEALTH NET FEDERAL SERVICES5504 HILL HEAVEN CTFRISCO TX 75035

CHECK BENEFIT CARD CHECK BENEFIT CARDNEWBURY COLLEGE SPORTSAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AMERICA'S CHOICE HEALTHPLANS, LLC(877) 224-3627

AMERICAN HEALTH HOLDINGS INC(888) 578-1812

NEWBURY COMICS INCAffiliated With: AMERICA'S CHOICE HEALTHPLANS LLC

Fund No:PlanType: Group Health

AMERICA'S CHOICE HEALTHPLANS, LLC(877) 224-3627

AMERICA'S CHOICE HEALTHPLANS, LLC13111 Northwest Fwy, Ste 510Houston TX 77040

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-387• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 388: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Western Health(605) 719-4600 or (888) 341-1766

Western Health(605) 719-4640 or (800) 229-0892

Newkirk's Ace HardwareAffiliated With: Rapid City Regional Hospital DBA Western Health

Fund No:PlanType: Group Health

Western Health(605) 719-4600 or (888) 341-1766

Western Health529 Kansas City St Ste 200Rapid City SD 57701

C.L. FRATES AND COMPANY(405) 290-5696

CHECK BENEFIT CARDNEWMAN MEMORIAL HOSPITALAffiliated With: C L FRATES & COMPANY

Fund No:PlanType: Group Health

C.L. FRATES AND COMPANY(405) 290-5696

C.L. FRATES AND COMPANYPO Box 26967OKLAHOMA CITY OK 73126-0967

CBSA(800) 925-2272

PERFORMAX / GUIDED2HEALTH(866) 405-2021

NEWSPAPER FIRST INCAffiliated With: PERFORMAX CBSA

Fund No:PlanType: Group Health

CBSA(800) 925-2272

CBSAPO Box 27725MINNEAPOLIS MN 55427

NF SG VA MEDICAL CENTER

CHECK BENEFIT CARDNF SG VA MEDICAL CENTER 3143Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

NF SG VA MEDICAL CENTER

NF SG VA MEDICAL CENTER

619 S MARIONLAKE CITY FL 32025

Attn: BUSINESS OFFICE 04

Benefits/Eligibility(800) 843-3106

CHECK BENEFIT CARD(800) 522-2161

Nippon Life Insurance Company of America

Affiliated With: Insurers Administrative Corporation #962500302

Fund No:PlanType: Group Health

Benefits/Eligibility(800) 843-3106

Benefits/EligibilityPO Box 828Park Ridge IL 60068-0828

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-388• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 389: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

NOAHS COLLECTORS GALLERYAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

EBPA(802) 846-8060

CHECK BENEFIT CARDNOBLE HEALTH SYSTEMS INC WRAP JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272

COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272

NOBLE HEALTH SYSTEMS INC WRAP VST

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272

COMPREHENSIVE BENEFITS ADMINISTRATORS INCPO Box 2365SOUTH BURLINGTON VT 05407-2365

SRT ADMINISTRATORS, INC. C/O CCN

CHECK BENEFIT CARDNOOKSACK RIVER CASINOAffiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS, INC. C/O CCN

SRT ADMINISTRATORS, INC. C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-389• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 390: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTHSCOPE BENEFITS INC(877) 266-2054

CHECK BENEFIT CARDNORDENIA USA, INCAffiliated With: HEALTHSCOPE BENEFITS, INC.

Fund No:PlanType: Group Health

HEALTHSCOPE BENEFITS INC(877) 266-2054

HEALTHSCOPE BENEFITS INCPO Box 619055DALLAS TX 75261

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

CHECK BENEFIT CARDNORRIS SUCKER RODSAffiliated With: WATERSTONE BENEFITS ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

THE LOOMIS COMPANY(866) 239-7191

HINES & ASSOCIATES(888) 826-5769

NORTEL GOVERNMENT SOLUTIONS

Affiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(866) 239-7191

THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011

CHECK BENEFIT CARD CHECK BENEFIT CARDNORTH AMERICAN ADMINISTRATORS

Affiliated With: MERITAIN HEALTH

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

NORTH AMERICAN PREFERREDAffiliated With: NORTH AMERICAN ADMINISTRATORS - NY

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-390• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 391: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CompIQ Corporation(800) 293-3131

UM NOT APPLICABLENORTH AMERICAN RISK SERVICES (NARS)

Affiliated With: CompIQ #13910

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(800) 293-3131

CompIQ Corporation35 Tesla Way #100Irvine CA 92618

CompIQ Corporation(800) 293-3131

UM NOT APPLICABLENORTH AMERICAN RISK SERVICES (NARS) AUTO

Affiliated With: CompIQ #13910

Fund No:PlanType: Auto

CompIQ Corporation(800) 293-3131

CompIQ Corporation35 Tesla Way #100Irvine CA 92618

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

NORTH CARE CENTERAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS 20183

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(405) 607-2587

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDNORTH CAROLINA AT&T STATE UNIVERSITY

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDNORTH CAROLINA SCHOOL OF THE ARTS

Affiliated With: MAKSIN MANAGEMENT CORPORATION

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 722-1668

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-391• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 392: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDNORTH CAROLINA STATE UNIVERSITY

Affiliated With: MAKSIN MANAGEMENT CORPORATION

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 722-1668

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(800) 251-9665

UM NOT APPLICABLENORTH CAROLINA WESLEYAN COLLEGE

Affiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(800) 251-9665

TRUE CHOICEPO Box 700307DALLAS TX 75370

NORTH CHICAGO VA MEDICAL CENTER

CHECK BENEFIT CARDNORTH CHICAGO VA MEDICAL CENTER 3165

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

NORTH CHICAGO VA MEDICAL CENTER

NORTH CHICAGO VA MEDICAL CENTER

3001 GREE BAY RDNORTH CHICAGO IL 60064

Attn: FEE 136B

EBPA(802) 846-8060

CHECK BENEFIT CARDNORTH COUNTY HEALTH SYSTEMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATOR, INC.

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-392• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 393: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBPA(802) 846-8060

CHECK BENEFIT CARDNORTH COUNTY HEALTH SYSTEMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 7858Burbank CA 91510-7858

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDNORTH GEORGIA COLLEGE & STATE UNIV AIH0058397

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLENORTH GEORGIA COLLEGE & STATE UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PEARCE ADMINISTRATION(843) 622-6001

GALLAGHER BENEFIT ADMINISTRATORS INC

NORTH GREENVILLE UNIVERSITY - DOMESTIC

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-393• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 394: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TRUE CHOICE(800) 251-9665

UM NOT APPLICABLENORTH HARRIS MONTGOMERY CCD

Affiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 251-9665

TRUE CHOICEPO Box 700307DALLAS TX 75370

AMERIBEN SOLUTIONS CHECK BENEFIT CARDNORTH ORANGE COMMUNITY COLLEGE DISTRICT CYPRESS COLLEGE DISTRICT/CYPRESS COLLEGE

Affiliated With: AMERIBEN SOLUTIONS

Term Effective: 8/31/2007Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS AMERIBEN SOLUTIONSPO Box 6977BOISE ID 83707

HEALTH NET FEDERAL SERVICES(214) 387-3232

CHECK BENEFIT CARDNORTHAMPTON VA MEDICAL CENTER 3112

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(214) 387-3232

NORTHAMPTON VAMC

421 N MAIN STLEEDS MA 01053

Attn: FEE BASIS 001 FEE

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARDNORTHEAST KINGDOM HUMAN SERVICES

Affiliated With: COMPREHENSIVE BENEFITS ADMINISTRATOR

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05407

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-394• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 395: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARDNORTHEASTERN VERMONT REGIONAL HOSPITAL WRAP JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

BENESYS(248) 822-4200

HEALTH CARE EVALUATION(209) 951-6711

NORTHERN CA SHEET METAL WORKERS DBA "LOCAL 162" HEALTH CARE PLAN

Affiliated With: SHEET METAL WORKERS LOCAL 104 HEALTH CARE PLAN

Fund No:PlanType: Group Health

BENESYS(248) 822-4200

BENESYSPO Box 1138SAN RAMON CA 94583

NORTHERN CALIFORNIA HCS

CHECK BENEFIT CARDNORTHERN CALIFORNIA HCS 3184

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

NORTHERN CALIFORNIA HCS

NORTHERN CALIFORNIA HCS

201 WALNUT AVEVALLEJO CA 94592

Attn: FEE SERVICE (04F)

CHECK BENEFIT CARD CHECK BENEFIT CARDNORTHERN MAINE MEDICAL CENTER

Affiliated With: ULTRABENEFITS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-395• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 396: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

NORTHPORT VA MEDICAL CENTER

CHECK BENEFIT CARDNORTHPORT VA MEDICAL CENTER 3120

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

NORTHPORT VA MEDICAL CENTER

NORTHPORT VA MEDICAL CENTER

79 MIDDLEVILLE RDNORTHPORT NY 11768

Attn: FEE BASIS 136A

NORTHSTAR PROVIDERS, LLC(786) 507-1600

UM NOT APPLICABLENorthstar Providers LLCAffiliated With: COMP IQ

Fund No:PlanType: Auto

NORTHSTAR PROVIDERS, LLC(786) 507-1600

NORTHSTAR PROVIDERS, LLC8080 NW 155TH STMIAMI LAKES FL 33016

NORTHSTAR PROVIDERS, LLC(786) 507-1600

UM NOT APPLICABLENorthstar Providers LLCAffiliated With: COMP IQ

Fund No:PlanType: Workers' Compensation

NORTHSTAR PROVIDERS, LLC(786) 507-1600

NORTHSTAR PROVIDERS, LLC8080 NW 155TH STMIAMI LAKES FL 33016

CHECK BENEFIT CARD CHECK BENEFIT CARDNORTHWEST INDIANA PAINTERSAffiliated With: PAINTERS LOCAL 460

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

FISERV HEALTH KANSAS(800) 235-7160

AVIDYN HEALTH(866) 802-1328

NORTHWEST LIQUID FERTILIZER INC

Affiliated With: FISERV HEALTH - KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-396• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 397: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDNORTHWEST METAL PRODUCTS CO

Affiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

THE LOOMIS COMPANY(877) 634-9814

CHECK BENEFIT CARDNORTHWEST TEXTBOOKAffiliated With: LOOMIS BENEFITS WEST

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(877) 634-9814

THE LOOMIS COMPANYPO Box 7045WYOMISSING PA 19610

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDNORTHWESTERN MUTUAL LIFEAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

PIONEER MANAGEMENT SYSTEMS(413) 534-8658

UM NOT APPLICABLENorwich UniversityAffiliated With: PIONEER MANAGEMENT SYSTEMS

*

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(413) 534-8658

PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01089

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN(800) 388-3193

NOTRE DAME DE NAMURAffiliated With: AMERIBEN SOLUTIONS #15255

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-397• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

NOVA HEALTHCARE ADMINISTRATORS INC(800) 999-5703

CHECK BENEFIT CARDNOVA HEALTHCARE ADMINISTRATORS

Affiliated With: NOVA HEALTHCARE ADMINISTRATORS

Fund No:PlanType: Group Health

NOVA HEALTHCARE ADMINISTRATORS INC(716) 250-7302

NOVA HEALTHCARE ADMINISTRATORS INC250 ESSJAY RDBUFFALO NY 14221

CBA - COOPERATIVE BENEFITS CORPORATION(402) 483-9265

CHECK BENEFIT CARDNRECA - OUT OF AREA NATIONAL NETWORK (TRAVEL @ %)

Affiliated With: NRECA - National Rural Electric Cooperative

Fund No:PlanType: Group Health

CBA - COOPERATIVE BENEFITS CORPORATION(402) 483-9265

CBA - COOPERATIVE BENEFITS CORPORATIONPO Box 6249LINCOLN NE 68506-0249

EBPA(802) 846-8060

CHECK BENEFIT CARDNRF DISTRIBUTORS VSTAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

DIRECT CARE AMERICA(800) 266-5896

CHECK BENEFIT CARDNSB RETAIL SYSTEMAffiliated With: THE CHANDLER GROUP #13352

Fund No:PlanType: Group Health

DIRECT CARE AMERICA(800) 266-5896

DIRECT CARE AMERICAPO Box 2090 CSTOW OH 44224

MERITAIN HEALTH(812) 429-2747

CHECK BENEFIT CARDNUNN MILLINGAffiliated With: NORTH AMERICAN

Fund No:PlanType: Group Health

MERITAIN HEALTH(812) 429-2747

MERITAIN HEALTHPO Box 1090GREAT BEND KS 67530

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-398• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDNW DOORAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

MSAG(800) 486-4068

MSAG(800) 486-4068

NYK LOGISTICS (AMERICAS) NUWDC DIVISION

Affiliated With: MID SOUTH ADMINISTRATIVE GROUP

Fund No:PlanType: Group Health

MSAG(800) 486-4068

MSAG1180 Vickery LaneCordova TN 38016

CHECK BENEFIT CARD8007159414

CHECK BENEFIT CARDO C TANNERAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8007159414

CHECK BENEFIT CARD

ENTRUST INC(281) 368-7878

UM NOT APPLICABLEOAK HOTELS GROUPAffiliated With: ENTRUST INC

Fund No:PlanType: Group Health

ENTRUST INC(281) 368-7878

ENTRUST INC14701 ST MARY'S LN STE 150HOUSTON TX 77079

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDOAKTREE CAPITAL MANAGEMENT

Affiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-399• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

OSF HealthPlans, Inc.(309) 677-8356

CHECK BENEFIT CARDO'BRIEN STEELAffiliated With: OSF HEALTHPLANS, INC.

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(309) 677-8356

OSF HealthPlans, Inc.PO Box 5128PEORIA IL 61601-5128

CHECK BENEFIT CARD SELF INSURED PLANS LLC

OCEAN PROPERTIES LTDAffiliated With: SELF INSURED PLANS LLC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

HealthComp(800) 442-7247

HealthComp(800) 755-7247

OCEANSIDE AUTO COUNTRYAffiliated With: HEALTHCOMP TPA

Fund No:PlanType: Group Health

HealthComp(800) 442-7247

HealthCompPO Box 45018Fresno CA 93718

STAR HEALTHCARE NETWORK

UM NOT APPLICABLEOCS-EAJ RICHMONDAffiliated With: STAR HEALTHCARE NETWORK 19313

*

Fund No:PlanType: Group Health

STAR HEALTHCARE NETWORK

STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019

Octagon Risk Services, Inc - Rancho Cordova(866) 672-9296

Octagon Risk Services, Inc - Rancho Cordova(866) 672-9296

Octagon Risk Services, IncAffiliated With: CompManagement, Inc. (CMI)

Fund No:PlanType: Workers' Compensation

Octagon Risk Services, Inc - Rancho Cordova(866) 672-9296

CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-400• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PROFESSIONAL BENEFIT ADMINISTRATORS(800) 435-5694

CHECK BENEFIT CARDODLE MCGUIRE AND SHOOKAffiliated With: PROFESSIONAL BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

PROFESSIONAL BENEFIT ADMINISTRATORS(800) 435-5694

PROFESSIONAL BENEFIT ADMINISTRATORS900 Jorie Blvd Ste 250Oakbrook IL 60523

CONTACT EMPLOYER CONTACT EMPLOYEROhio CasualtyAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYEROhio Casualty Group AUTOAffiliated With: GENEX Services, Inc.

Fund No:PlanType: Auto

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

FISERV HEALTH KANSAS(800) 235-7160

AVIDYN HEALTH(866) 802-1328

OKLAHOMA BANKERS ASSOCIATION

Affiliated With: FISERV HEALTH KANSAS - 11297

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

TRUE CHOICE(800) 251-9665

UM NOT APPLICABLEOKLAHOMA BAPTIST UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 251-9665

TRUE CHOICEPO Box 700307DALLAS TX 75370

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-401• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDOKLAHOMA BLOOD INSTITUTEAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDOKLAHOMA CARDIOVASCULAR ASSOCIATES

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDOKLAHOMA CHRISTIAN UNIVERSITY

Affiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

CI(817) 479-2115

CI(817) 479-2115

OKLAHOMA CITY UNIVERSITY DOMESTIC

Affiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 785-2446

TRUE CHOICEPO Box 700307DALLAS TX 75370

OKLAHOMA CITY VAMC CHECK BENEFIT CARDOKLAHOMA CITY VAMC 3107Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

OKLAHOMA CITY VAMC OKLAHOMA CITY VAMC

921 NE 13THOKLAHOMA CITY OK 73104

Attn: FEE SERVICES (136A-2)

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-402• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 403: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDOKLAHOMA CITY ZOOAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

THE KEMPTON GROUP(405) 521-1711

CHECK BENEFIT CARDOKLAHOMA CONFERENCE OF UNITED METHODIST CHURCHES

Affiliated With: THE KEMPTON GROUP INC

Fund No:PlanType: Group Health

THE KEMPTON GROUP(405) 521-1711

THE KEMPTON GROUPPO Box 54889OKLAHOMA CITY OK 73154

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDOKLAHOMA COUNTY COMMISSIONERS RETIREES

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

THE KEMPTON GROUP(405) 521-1711

CHECK BENEFIT CARDOKLAHOMA ELECTRIC COOPERATIVE

Affiliated With: THE KEMPTON GROUP INC

Fund No:PlanType: Group Health

THE KEMPTON GROUP(405) 521-1711

THE KEMPTON GROUPPO Box 54889OKLAHOMA CITY OK 73154

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDOKLAHOMA FOUNDATION FOR CARDIOVASCULAR RESEARCH

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-403• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDOKLAHOMA HEALTH INSURANCE HIGH RISK

Affiliated With: THE EPOCH GROUP #10469

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADVANTAGE(800) 825-3540

OKLAHOMA HEART HOSPITAL LLC

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS #20183

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(405) 607-2624

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

AMERICA'S CHOICE HEALTHPLANS, LLC

MANAGED CARE CONCEPTS(409) 886-2723

OKLAHOMA LEATHER PRODUCTS INC

Affiliated With: AMERICAS CHOICE HEALTH PLAN

Fund No:PlanType: Group Health

AMERICA'S CHOICE HEALTHPLANS, LLC

AMERICA'S CHOICE HEALTHPLANS, LLCPO Box 922043HOUSTON TX 77292

C.L. FRATES AND COMPANY(405) 290-5696

CHECK BENEFIT CARDOKLAHOMA LUMBERMANS ASSOCIATION

Affiliated With: C L FRATES & COMPANY

Fund No:PlanType: Group Health

C.L. FRATES AND COMPANY(405) 290-5696

C.L. FRATES AND COMPANYPO Box 26967OKLAHOMA CITY OK 73126-0967

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-404• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDOKLAHOMA MED RESEARCH FOUNDATION

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDOKLAHOMA MUNICIPAL ASSURANCE GROUP

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

UM NOT APPLICABLEOKLAHOMA PRESS ASSOCIATION/MEMBERS EMPLOYEES BENEFIT TRUST

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORS3121 QUAIL SPRINGS PKWYOKLAHOMA CITY OK 73134

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDOKLAHOMA STATE UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-405• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CI(817) 479-2115

CI(817) 479-2115

OKLAHOMA UNIVERSITY INTERNATIONAL STUDENTS

Affiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 785-2446

TRUE CHOICEPO Box 700307DALLAS TX 75370

STAR HEALTHCARE NETWORK(212) 581-8228

CHECK BENEFIT CARDON CALL INTERNATIONALAffiliated With: STAR HEALTHCARE NETWORK INC

*

Fund No:PlanType: Group Health

STAR HEALTHCARE NETWORK(212) 581-8228

STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019

THE LOOMIS COMPANY(800) 875-2364

HINES & ASSOCIATES(888) 826-5769

ON SITE E-DISCOVERYAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(800) 875-2364

THE LOOMIS COMPANY3220 East 26th StreetLos Angeles CA 90023

CHECK BENEFIT CARD CHECK BENEFIT CARDOne BeaconAffiliated With: Mitchell Medical

Fund No:PlanType: Auto

One Beacon: Administered by Mitchell MedicalExclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)

CHECK BENEFIT CARD CHECK BENEFIT CARD

INSURANCE ADMINISTRATORS OF AMERICA INC

HEALTHCARE STRATEGIES INC8885991515

OPEX CORPORATIONAffiliated With: INSURANCE ADMINISTRATORS OF AMERICA (IAA)

Fund No:PlanType: Group Health

INSURANCE ADMINISTRATORS OF AMERICA INC

INSURANCE ADMINISTRATORS OF AMERICA INC1934 OLNEY AVE STE 200CHERRY HILL NJ 08003

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-406• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 407: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PROFESSIONAL BUSINESS SERVICES(800) 732-3412

CHECK BENEFIT CARDOPPORTUNITIES ENTERPRISESAffiliated With: UNITED CLAIMS SOLUTIONS

Fund No:PlanType: Group Health

PROFESSIONAL BUSINESS SERVICES(800) 732-3412

PROFESSIONAL BUSINESS SERVICES2959 LUCERNE DRGRAND RAPIDS MI 48546

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(619) 574-1685

OPPORTUNITY RESOURCESAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

Benefit Planners(866) 868-8230

FISERV HEALTH INC(866) 868-8230

OPTIMUS CORPORATIONAffiliated With: FISERV BENEFIT PLANNERS

*

Fund No:PlanType: Group Health

Benefit Planners(866) 868-8230

Benefit PlannersPO Box 690450SAN ANTONIO TX 78269

STUDENT RESOURCES(800) 237-0903 Ext 6352

CHECK BENEFIT CARDORAL ROBERTS UNIVERSITYAffiliated With: UnitedHealthcare StudentResources #11689

Fund No:PlanType: Group Health

STUDENT RESOURCES(800) 237-0903 Ext 6352

STUDENT RESOURCES2301 W. PLANO PKWY #300PLANO TX 75075

GUARANTEE TRUST LIFE INSURANCE CO8006221993

GUARANTEE TRUST LIFE INSURANCE CO

ORAL ROBERTS UNIVERSITY

Fund No:PlanType: Group Health

GUARANTEE TRUST LIFE INSURANCE CO8006221993

GUARANTEE TRUST LIFE INSURANCE CO. C/O CCNPO Box 3000SCOTTSDALE AZ 85271

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-407• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 408: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TRUSTEED PLANS SERVICE CORPORATION(800) 426-9786

AMERICAN HEALTH HOLDING(888) 877-7994

ORCHARD RITE LTDAffiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE CORPORATION(800) 426-9786

TRUSTEED PLANS SERVICE CORPORATIONPO Box 1894TACOMA WA 98401-1894

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDOREGON COLLEGE OF ARTS AND CRAFTS

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 700-7153

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 869-7093

OREGON GLASS COMPANYAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS, INC

Fund No:PlanType: Group Health

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 700-7153

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.220 120TH Ave NE Bldg DBellevue WA 98005

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

OREGON INSTITUTE OF TECHNOLOGY INTERNATIONAL & DOMESTIC

Affiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-408• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 409: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDORION MARIN GROUPAffiliated With: BUSINESS ADMINISTRATORS AND CONSULTANTS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

ASSURECARE(800) 759-1311

Careline UR(763) 383-4800

ORLAND SCHOOL #135Affiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 759-1311

ASSURECARE340 Quadrangle DrBolingbrook IL 60440

AFFORDABLE BENEFIT ADMINISTRATORS INC(818) 842-0147

CHECK BENEFIT CARDORTHOPAEDIC CENTER OF THE ROCKIES

Affiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC. (ABA)

Fund No:PlanType: Group Health

AFFORDABLE BENEFIT ADMINISTRATORS INC(818) 842-0147

AFFORDABLE BENEFIT ADMINISTRATORS INCPO Box 10787BURBANK CA 91510-0787

OSF HealthPlans, Inc.(877) 677-8222

CHECK BENEFIT CARDOSF-H S I PARTNERSHIPAffiliated With: OSF HEALTHPLANS INC

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(877) 677-8222

OSF HealthPlans, Inc.PO Box 5128PEORIA IL 61601-5128

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.(800) 284-2273

OSFHPAffiliated With: OSF HEALTHPLANS, INC.

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-409• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MERITAIN HEALTH(800) 842-3216

UM NOT APPLICABLEOSLER INSTITUTEAffiliated With: MERITAIN HEALTH

Fund No:PlanType: Group Health

MERITAIN HEALTH(800) 842-3216

MERITAIN HEALTH9245 N Meridian St Ste 100Indianapolis IN 46260

C.L. FRATES AND COMPANY(405) 290-5696

CHECK BENEFIT CARDOSMA HEALTH NETWORKAffiliated With: C L FRATES & COMPANY

Fund No:PlanType: Group Health

C.L. FRATES AND COMPANY(405) 290-5696

C.L. FRATES AND COMPANYPO Box 26967OKLAHOMA CITY OK 73126-0967

CENBEN USA(614) 797-5204

CHECK BENEFIT CARDOTAY WATER DISTRICTAffiliated With: CENBEN USA INC

Fund No:PlanType: Group Health

CENBEN USA(614) 797-5204

CENBEN USA

4079 Executive PkwyWesterville OH 43081

Attn: Melissa Joseph

TRUE CHOICE(800) 251-9665

UM NOT APPLICABLEOUR LADY OF THE LAKE UNIVERSITY

Affiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 251-9665

TRUE CHOICEPO Box 700307DALLAS TX 75370

CHECK BENEFIT CARD8014742555

CHECK BENEFIT CARDOVERLAND WEST INCAffiliated With: P5 HEALTH PLAN SOLUTIONS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8014742555

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-410• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYEROwens IllinoisAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

MERITAIN HEALTH(800) 455-1938

CHECK BENEFIT CARDOWENSBORO MEDICAL HEALTH SYSTEM

Affiliated With: MERITAIN HEALTH

Fund No:PlanType: Group Health

MERITAIN HEALTH(800) 455-1938

MERITAIN HEALTH111 SE THIRD ST STE 404EVANSVILLE IN 47708

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

PACE - TEC, INC.Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

CHECK BENEFIT CARD8004269786

CHECK BENEFIT CARDPACIFIC CATARACT AND LASER INSTITUTE

Affiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8004269786

CHECK BENEFIT CARD

CHECK BENEFIT CARD8004427247

CHECK BENEFIT CARDPACIFIC COAST FEATHER NORTHWEST FRAMING

Affiliated With: HEALTHCOMP ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8004427247

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-411• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

PACIFIC COAST STEEL TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Pacific Gas & Electric Company(415) 973-3350

Pacific Gas & Electric Company(415) 973-3350

Pacific Gas and ElectricAffiliated With: Pacific Gas and Electric

Fund No:PlanType: Workers' Compensation

Pacific Gas & Electric Company(415) 973-3350

Pacific Gas & Electric Company77 Beale St., 28th FloorSan Francisco CA 94105

CHECK BENEFIT CARD6102939229

CHECK BENEFIT CARDPACIFIC LUTHERAN UNIVERSITYAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD6102939229

CHECK BENEFIT CARD

CHECK BENEFIT CARD8009922322

CHECK BENEFIT CARDPACIFIC MARITIME ASSOCIATIONAffiliated With: PACIFIC MARITIME ASSOCIATION

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8009922322

CHECK BENEFIT CARD

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDPACIFIC NORTHWEST COLLEGE OF ART

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-412• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HELLER ASSOCIATES(714) 549-7052

HELLER ASSOCIATESPACIFIC SOUTHWEST INSTRUMENTS

Affiliated With: HELLER ASSOCIATES

Fund No:PlanType: Group Health

HELLER ASSOCIATES(714) 549-7052

HELLER ASSOCIATES2755 BRISTOLCOSTA MESA CA 92626

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDPACIFIC UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

PacificSource Customer Service(800) 624-6052

First Health(800) 449-9905

PacificSource Health PlansAffiliated With: PacificSource Health Plans

Fund No:PlanType: Group Health

PacificSource Health Plans(800) 624-6052

PacificSource Health PlansPO Box 7068Eugene OR 97401-0068

PacificSource(800) 624-6052

PacificSource Medical Affairs(800) 624-6052

PacificSource Travel BenefitAffiliated With: PacificSource Health Plans

Fund No:PlanType: Group Health

Previously listed under PacificSource Health Plans

PacificSource Health Plans(800) 624-6052

PacificSource Health Plans250 Country Club RdEugene OR 97401

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

PACKAGING UNLIMITEDAffiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-413• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SISCO(800) 547-4726

CHECK BENEFIT CARDPACKERS HOLDING, LLCAffiliated With: SISCO/Cottingham & Butler

Fund No:PlanType: Group Health

SISCO(800) 786-7930

SISCOPO Box 389DUBUQUE IA 52004-0389

BUTLER BENEFIT SERVICES(563) 327-2240

CHECK BENEFIT CARDPACKING TECHNOLOGIESAffiliated With: SISCO/Cottingham & Butler

Fund No:PlanType: Group Health

BUTLER BENEFIT SERVICES(563) 327-2240

BUTLER BENEFIT SERVICES215 N MAIN ST STE 800DAVENPORT IA 52801

CHECK BENEFIT CARD CHECK BENEFIT CARDPAINTERS ASSOCIATED TRADES

Affiliated With: PAINTERS ASSOCIATED TRADES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

HEALTH PLAN INC(800) 532-7575

CARE MANAGEMENT SERVICES(866) 325-1550

PAK 2000 INCAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

CENBEN USA(614) 797-5204

CHECK BENEFIT CARDPALA BAND OF MISSION INDIANSAffiliated With: CENBEN USA INC

Fund No:PlanType: Group Health

CENBEN USA(614) 797-5204

CENBEN USA

4079 Executive PkwyWesterville OH 43081

Attn: Melissa Joseph

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-414• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PIONEER MANAGEMENT SYSTEMS(413) 534-8658

UM NOT APPLICABLEPalm Beach Atlantic CollegeAffiliated With: PIONEER MANAGEMENT SYSTEMS

*

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(413) 534-8658

PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01089

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDPALM BEACH COMMUNITY COLLEGE

Affiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

APA Partners Inc(800) 833-3650

APA Partners Inc(800) 833-3650

PALM BEACH COUNTY FIREFIGHTERS

Affiliated With: APA PARTNERS INC

Fund No:PlanType: Group Health

APA Partners Inc(800) 833-3650

APA Partners IncPO Box 1506Latham NY 12110

PALO ALTO HCS CHECK BENEFIT CARDPALO ALTO HCS 3185Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

PALO ALTO HCS PALO ALTO HCS

3801 MIRANDA AVEPALO ALTO CA 94304

Attn: FEE DEPT 640/136C

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

PALOMAR COLLEGEAffiliated With: AMERIBEN SOLUTIONS

Term Effective: 8/31/2007Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-415• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURECARE(800) 968-6616

CARELINE(763) 383-4800

PAM TRANSPORTAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

PAN WESTERN TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

EBA&M(714) 668-8920

HINES & ASSOCIATES(800) 528-2498

PANDOL & SONSAffiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)

Fund No:PlanType: Group Health

EBA&M(714) 668-8920

EBA&MPO Box 5079WESTLAKE VILLAGE CA 91359

CHECK BENEFIT CARD CHECK BENEFIT CARDPAPER PRODUCTSAffiliated With: CAROLINA BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERParadigm Health Systems AutoAffiliated With: Paradigm Health Systems

Fund No:PlanType: Auto

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-416• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Paradigm Health (David Vargas)(925) 677-4719

Paradigm Health (David Vargas)(925) 677-4719

Paradigm Management Services, LLC

Affiliated With: Paradigm Management Services, LLC

Fund No:PlanType: Workers' Compensation

Paradigm Health (David Vargas)(925) 677-4719

Paradigm Health Claims Department1001 Galaxy Way Ste 300Concord CA 94520

ADVENTIST HEALTH SYSTEM WEST

CHECK BENEFIT CARDPARADISE VALLEY HOSPITAL - PPO

Affiliated With: ADVENTIST HEALTH SYSTEM/WEST

Term Effective: 12/31/2007Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM WEST

ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002

CHECK BENEFIT CARD CHECK BENEFIT CARDPARAMETRIXAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

CHECK BENEFIT CARDPARKVIEW HOSPITALAffiliated With: WATERSTONE BENEFITS ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.(800) 673-5222

Parsons CompanyAffiliated With: OSF Healthplans Inc

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(309) 677-8356

OSF HealthPlans, Inc.PO Box 5128PEORIA IL 61601-5128

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-417• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 418: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDPASO ROBLES JOINT UNIFIED SCHOOL DISTRICT

Affiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

PASSION PARTIESAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

PAT CLARK ENTERPRISES TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

MARSH ADVANTAGE AMERICA(800) 394-6888

CHECK BENEFIT CARDPATE CONSRUCTION CO. INC.Affiliated With: MARSH ADVANTAGE AMERICA

Fund No:PlanType: Group Health

MARSH ADVANTAGE AMERICA(800) 394-6888

MARSH ADVANTAGE AMERICA501 N BROADWAY STE 500ST. LOUIS MO 63102

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDPATRICK INDUSTRIES, INC.Affiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-418• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 419: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBPA(800) 578-3272

CHECK BENEFIT CARDPATRIOT HEALTHCARE - JMSAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATOR

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

BENEFIT ADMINISTRATIVE SYSTEMS(708) 799-7400

CHECK BENEFIT CARDPATRIOT HOMES, INCAffiliated With: BENEFIT ADMINISTRATIVE SYSTEM

Fund No:PlanType: Group Health

BENEFIT ADMINISTRATIVE SYSTEMS(708) 799-7400

BENEFIT ADMINISTRATIVE SYSTEMS17475 JOVANNA DRHOMEWOOD IL 60430

Patriot Risk Services Patriot Risk ServicesPatriot Risk ServicesAffiliated With: TIMCO/Guarantee Insurance Co

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

Patriot Risk Services Patriot Risk Services1061 521 Corporate Center Dr Ste 140Fort Mill SC 29715

FISERV HEALTH KANSAS(800) 235-7160

CHECK BENEFIT CARDPAUL FISHER OIL COMPANYAffiliated With: FISERV HEALTH KANSAS - 11297

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

HEALTH PLAN INC CARE MANAGEMENT SERVICES(866) 325-1550

PAUL G WHITE TILE COMPANY-PEPM

Affiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INCPO Box 5199WESTBOROUGH MA 01581

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-419• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 420: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

PAWN SHOP MANAGEMENTAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CONTACT EMPLOYER CONTACT EMPLOYERPBM Corp - EDIAffiliated With: MCO Advantage / PBM Corporation

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERPBM Corp - PaperAffiliated With: MCO Advantage / PBM Corporation

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

CHECK BENEFIT CARDPeace Corps VolunteersAffiliated With: International Medical Group, Inc.

Fund No:PlanType: Group Health

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684

CHECK BENEFIT CARD8002822460

CHECK BENEFIT CARDPEACE RIVER CENTER FOR PERSONAL DEVELOPMENT INC

Affiliated With: HERITAGE CONSULTANTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8002822460

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-420• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 421: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Benefit Planners(800) 292-5386

CHECK BENEFIT CARDPEARCE INDUSTRIESAffiliated With: BENEFIT PLANNERS

*

Fund No:PlanType: Group Health

Benefit Planners(800) 292-5386

Benefit PlannersPO Box 690450SAN ANTONIO TX 78269

GLOBALCARE(678) 341-1922

UM NOT APPLICABLEPEDDINGHAUS CORPORATIONAffiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1922

GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005

CONTACT EMPLOYER CONTACT EMPLOYERPeerless Insurance Company Auto CO

Fund No:PlanType: Auto

AVMA Group Health and Life Insurance Trust

CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERPeerless Insurance Company WCAffiliated With: RAM

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

PEGGY LAWTON KITCHENS, INC.Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-421• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 422: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850

AMERICAN HEALTH HOLDING(888) 877-7994

PELTRAM PLUMBING INCAffiliated With: TRUSTED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850

TRUSTEED PLANS SERVICE CORPORATIONPO Box 1984TACOMA WA 98406

J SMITH LANIER & CO(910) 480-3100

DOCTORS DIRECT HEALTHCARE(910) 480-3100

PENDER MEMORIAL HOSPITALAffiliated With: J SMITH LANIER & COMPANY

Fund No:PlanType: Group Health

J SMITH LANIER & CO(910) 480-3100

J SMITH LANIER & CO201 HAY STREET, STE 302FAYETTEVILLE NC 28301

CHECK BENEFIT CARD CHECK BENEFIT CARDPENMORE LITHOGRAPHERS - PEPM

Affiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

GLOBALCARE, INC.(678) 341-1922

UM NOT APPLICABLEPENN WESTERN - NEW POSEIDON ENTERPRISES

Affiliated With: GLOBALCARE INC

Fund No:PlanType: Group Health

GLOBALCARE, INC.(678) 341-1922

GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005

GLOBALCARE(678) 341-1922

MEDCOST(800) 722-2157

PENN WESTERN -AMSOLAffiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1922

GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-422• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 423: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GLOBALCARE(678) 341-1922

UM NOT APPLICABLEPENN WESTERN -AMSOL TRAVEL NETWORK GEORGIA

Affiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1922

GLOBALCARE6875 Shiloh Rd EALPHARETTA GA 30005

CHECK BENEFIT CARD CHECK BENEFIT CARDPENSACOLA CHRISTIAN COLLEGE

Affiliated With: AMERICAN HEALTHCARE ALLIANCE

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD7753526901

CHECK BENEFIT CARDPEPPERMILL HOTEL AND CASINOAffiliated With: CDS GROUP HEALTH

Fund No:PlanType: Group Health

CHECK BENEFIT CARD7753526901

CHECK BENEFIT CARD

HOMETOWN HEALTH PROVIDERS INSURANCE(775) 982-3039

HOMETOWN HEALTH PROVIDERS INSURANCE(775) 982-3039

PEPPERMILL HOTEL CASINOAffiliated With: PEPPERMILL HOTEL CASINO

Fund No:PlanType: Group Health

HOMETOWN HEALTH PROVIDERS INSURANCE(775) 982-3039

HOMETOWN HEALTH PROVIDERS INSURANCE830 HARVARD WAYRENO NV 89502

American Administrative Group(800) 323-1726

CHECK BENEFIT CARDPerformance BankersAffiliated With: American Administrative Group

Fund No:PlanType: Group Health

American Administrative Group(800) 323-1726

American Administrative GroupPO Box 5227Lisle IL 60532-5227ECS Payor ID 37283

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-423• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 424: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INC

PERFORMANCE CONTRACTORSAffiliated With: PREFERRED BENEFIT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INCPO Box 916188LONGWOOD FL 32791-6188

CHECK BENEFIT CARD8002779476

CHECK BENEFIT CARDPERFORMANCE FRICTIONAffiliated With: CORPORATE BENEFITS SERVICE INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8002779476

CHECK BENEFIT CARD

NHBC(888) 621-7900

CHECK BENEFIT CARDPERFORMANCE HEALTH (PHA)Affiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

Benefit Planners(800) 292-5386

CHECK BENEFIT CARDPERMIAN MUD SERVICES INCAffiliated With: BENEFIT PLANNERS

*

Fund No:PlanType: Group Health

(800) 292-5386 Benefit PlannersPO Box 690450SAN ANTONIO TX 78269

PERRY POINT / BALTIMORE VA MEDICAL CENTER

CHECK BENEFIT CARDPERRY POINT/BALTIMORE VA MEDICAL CENTER 3131

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

PERRY POINT / BALTIMORE VA MEDICAL CENTER

PERRY POINT / BALTIMORE VA MEDICAL CENTER

BLDG G 4H, RM 120PERRY POINT MD 21902

Attn: MAS/FEE SERVICES - 136

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-424• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 425: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Employee Benefit Management Corp (EBMC)(614) 766-5800

CHECK BENEFIT CARDPERRYSBURG SCHOOLAffiliated With: EMPLOYEE BENEFIT MANAGEMENT CORP

Fund No:PlanType: Group Health

Employee Benefit Management Corp (EBMC)(614) 766-5800

Employee Benefit Management Corp (EBMC)4789 Rings RdDublin OH 43017-1599

PERSONALCARE(800) 562-5792

PERSONALCARE(800) 562-5792

PersonalCare Freedom PPOAffiliated With: Coventry Health Care

Fund No:PlanType: Group Health

PERSONALCARE(800) 562-5792

PERSONALCAREPO Box 7141LONDON KY 40742-7141

Peter Chang Enterprises(248) 455-8972

Peter Chang Enterprises(248) 455-8972

Peter Chang EnterprisesAffiliated With: Peter Chang Enterprises

Fund No:PlanType: Workers' Compensation

Peter Chang Enterprises(248) 455-8972

Peter Chang Enterprises28530 Orchard Lake Rd Ste 101Farmington Hills MI 48334

CHECK BENEFIT CARD CHECK BENEFIT CARDPETERSON TRACTOR COMPANYAffiliated With: CAPITOL ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7345

PHC OF NEVADAAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-425• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 426: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PHILADELPHIA VAMC CHECK BENEFIT CARDPHILADELPHIA VAMC 3127Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

PHILADELPHIA VAMC PHILADELPHIA VAMC

UNIVERSITY & WOODLANDS AVEPHILADELPHIA PA 19104

Attn: FEE BASIS 04F

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

PHILCOR TV & ELECTRONIC TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CORESOURCE(866) 280-4120

CORESOURCE(866) 794-0770

PHOENIX CEMENT COMPANYAffiliated With: CORESOURCE

Fund No:PlanType: Group Health

CORESOURCE(866) 280-4120

CORESOURCEPO Box 2920CLINTON OH 52733-2920

BENEFIT CONCEPTS, INC.(610) 337-2600

CHECK BENEFIT CARDPHOENIX COLOR CORPORATIONAffiliated With: BROKERAGE CONCEPTS BENEFIT CONCEPTS

Fund No:PlanType: Group Health

BENEFIT CONCEPTS, INC.(610) 337-2600

BENEFIT CONCEPTS, INC.1021 W. 8TH AVE STE 200KING OF PRUSSIA PA 19406

PHOENIX VAMC CHECK BENEFIT CARDPHOENIX VAMC 3173Affiliated With: HEALTH NET FEDERAL SERVICES

*

Fund No:PlanType: Group Health

PHOENIX VAMC PHOENIX VAMC

620 E INDIAN SCHOOL RDPHOENIX AZ 85012

Attn: FEE BASIS 136E5

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-426• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 427: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GLOBALCARE, INC.8008601111

PHP Management(800) 982-6257

PHP OF NORTHERN INDIANA ASOAffiliated With: GLOBALCARE, INC.

Fund No:PlanType: Group Health

GLOBALCARE, INC.6783411722

GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

PHP SMALL GROUPAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

GLOBALCARE(678) 341-1811

UM NOT APPLICABLEPHYSICIANS HEALTH PLAN OF MID-MICHIGAN

Affiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005

CHECK BENEFIT CARD6783411722

CHECK BENEFIT CARDPHYSICIANS HEALTH PLAN OF NORTHERN INDIANA

Affiliated With: GLOBALCARE

Fund No:PlanType: Group Health

CHECK BENEFIT CARD6783411722

CHECK BENEFIT CARD

GILSBAR(985) 871-1863

CHECK BENEFIT CARDPHYSICIANS MUTUAL INSURANCE COMPANY-CARRIER

Affiliated With: GILSBAR INC

Fund No:PlanType: Group Health

GILSBAR(985) 871-1863

GILSBAR2100 COVINGTON CENTRECOVINGTON LA 70433

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-427• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GILSBAR(985) 871-1863

CHECK BENEFIT CARDPHYSICIANS MUTUAL INSURANCE COMPANY-MEICARE SELECT

Affiliated With: GILSBAR INC

Fund No:PlanType: Group Health

GILSBAR(985) 871-1863

GILSBAR2100 COVINGTON CENTRECOVINGTON LA 70433

Benesight(800) 752-3473

CHECK BENEFIT CARDPiccadilly Cafeterias, Inc.Affiliated With: Benesight

Fund No:PlanType: Group Health

Benesight(800) 752-3473

Piccadilly Cafeterias, Inc.PO Box 2467Baton Rouge LA 70821

GROUP ADMINISTRATORS, LTD.(847) 519-1880

CHECK BENEFIT CARDPIERCE, COUCN, HENDRICKSON, BAYSINGER & GREEN, LLP

Affiliated With: GROUP ADMINISTRATORS, LTD.

Fund No:PlanType: Group Health

GROUP ADMINISTRATORS, LTD.(847) 519-1880

GROUP ADMINISTRATORS, LTD.450 E Remington RdSchaumburg IL 60173

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

Piercy Bowler Taylor & Kern TravelAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

EBPA(800) 578-3272

CHECK BENEFIT CARDPINE STATE TRADING COMPANY - JMS

Affiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-428• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 429: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Western Health(605) 719-4600 or (888) 341-1766

Western Health(605) 719-4640 or (800) 229-0892

Pioneer ManorAffiliated With: Rapid City Regional Hospital DBA Western Health

Fund No:PlanType: Group Health

Western Health Western Health529 Kansas City St Ste 200Rapid City SD 57701

CHECK BENEFIT CARD CHECK BENEFIT CARDPIONEER TELEPHONEAffiliated With: PIONEER TELEPHONE

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

Pipe Maintenance TravelAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

*

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

PITTSBURGH VA MEDICAL CENTER

CHECK BENEFIT CARDPITTSBURGH VA MEDICAL CENTER 3130

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

PITTSBURGH VA MEDICAL CENTER

PITTSBURGH VA MEDICAL CENTER

7180 HIGHLAND DRPITTSBURGH PA 15206

Attn: FEE BASIS 04D4-H

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

PIZZA HUT OF IDAHOAffiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS-NY(800) 397-2122

NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-429• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 430: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CENBEN USA(888) 633-7879

CENTRAL BENEFITS(800) 882-9889

PLAN HANDLERS INCAffiliated With: HEALTHSCOPE BENEFITS INC #11491

Fund No:PlanType: Group Health

CENBEN USA(888) 633-7879

CENBEN USAPO Box 612900DALLAS TX 75261-2900

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

PLAYLV GAMING OPERATION, LLC

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDPLEASANT VALLEY JT UNION ELEMENTARY

Affiliated With: K-12 STUDENT INSURANCE, A DIVISION OF UICI

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

PLUMB HOUSE INC.Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-430• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8887412673

CHECK BENEFIT CARDPLUMBERS PIPEFITTERS LOCAL 421 HEALTH WELFARE FUND

Affiliated With: CORE MANAGEMENT RESOURCES GROUP INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8887412673

CHECK BENEFIT CARD

LEO A. RILEY(307) 266-2877

HEALTH SERVICES ADVISORY GROUP(602) 264-6382

PLUMBERS AND PIPEFITTERS H AND S FUND

Affiliated With: PLUMBERS AND PIPEFITTERS H AND S FUND

Fund No:PlanType: Group Health

LEO A. RILEY(307) 266-2877

LEO A. RILEY141 S CENTER STE 200CASPER WY 82601

CONTACT EMPLOYER PMA Insurance Group The - CPC(888) 476-2669

PMA Insurance Group TheAffiliated With: PMA Insurance Group

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

PMA Insurance Group The - CPC(888) 476-2669

PMA Insurance Group The - CPCPO Box 25249Lehigh Valley PA 18002-5249

GROUP & PENSION ADMINISTRATORS(800) 827-7223

CHECK BENEFIT CARDPointBank (TRAVEL)Affiliated With: GROUP & PENSION ADMINISTRATORS

*

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-431• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

POMPANOOSUC MILLS CORPORATION

Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

POPLAR BLUFF VA MEDICAL CNTER

CHECK BENEFIT CARDPOPLAR BLUFF VA MEDICAL CENTER 3527

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

POPLAR BLUFF VA MEDICAL CNTER

POPLAR BLUFF VA MEDICAL CNTER

1500 N WESTWOOD BLVDPOPLAR BLUFF MO 63901

Attn: FEE BASIS 04

ASSURECARE(800) 759-1311

Careline UR(763) 383-4800

POPULATION REFERENCE BUREAU (PRB)

Affiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 759-1311

ASSURECARE340 Quadrangle DrBolingbrook IL 60440

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(425) 482-1000

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(425) 482-1000

PORT TOWNSEND PAPERAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS

Fund No:PlanType: Group Health

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(425) 482-1000

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.220 120th Ave Ste D200Bellevue WA 98005

CHECK BENEFIT CARD CHECK BENEFIT CARDPORTAGE ENVIRONMENTAL INCAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-432• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 433: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PROFESSIONAL BUSINESS SERVICES(800) 732-3412

CHECK BENEFIT CARDPORTAGE SCHOOLS TEACHERS AND ADMINISTRATORS

Affiliated With: UNITED CLAIMS SOLUTIONS

Fund No:PlanType: Group Health

PROFESSIONAL BUSINESS SERVICES(800) 732-3412

PROFESSIONAL BUSINESS SERVICES2959 LUCERNE DRGRAND RAPIDS MI 48546

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

PORTLAND STATE UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

PORTLAND STATE UNIVERSITY INTERNATIONAL

Affiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

PORTLAND VAMC CHECK BENEFIT CARDPORTLAND VAMC 3178Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

PORTLAND VAMC PORTLAND VAMC

3710 SW US VETERANS HOSPITAL RDPORTLAND OR 97239

Attn: FEE BASIS 136F

FISERV HEALTH INC FISERV HEALTH INCPORTOLA PLAZA HOTEL AT MONTEREY BAY

Affiliated With: BENESIGHT, INC.

Fund No:PlanType: Group Health

FISERV HEALTH INC FISERV HEALTH INCPO Box 375PUEBLO CO 81002

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-433• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 434: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.(800) 284-2273

POSAffiliated With: OSF HEALTHPLANS, INC.

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128

CHECK BENEFIT CARD CHECK BENEFIT CARDPOST REGISTERAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

MERCER ADMINISTRATION(800) 394-6888

CHECK BENEFIT CARDPOTANDON PRODUCEAffiliated With: MERCER ADMINISTRATION

Fund No:PlanType: Group Health

MEDILLUME III(800) 394-6888

MERCER ADMINISTRATION701 Market St Ste 1350St Louis MO 63101

CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295

CHECK BENEFIT CARDPOWER HOUSE GYMAffiliated With: CAROLINA BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295

CAROLINA BENEFIT ADMINISTRATORS333 SOUTH PINE STSPARTANBURG SC 29302

GISC, INC(800) 242-4472

CHECK BENEFIT CARDPOWER SHOT UTILITY CONSTRUCTION SERVICES, LLC

Affiliated With: GROUP INSURANCE SERVICE CENTER INC

Fund No:PlanType: Group Health

GISC, INC(800) 242-4472

GISC, INC20 WINTER STPEMBROKE MA 02359

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-434• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 435: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

POWERWORKS INDUSTRIES, INCAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

EBS EMPLOYEE BENEFIT SERVICES INC.

EBS EMPLOYEE BENEFIT SERVICES INC.

PPDG/PROFESSIONAL PERFORMANCE DEVELOPMENTAL GROUP

Affiliated With: EBS EMPLOYEE BENEFIT SERVICES INC

Fund No:PlanType: Group Health

EBS EMPLOYEE BENEFIT SERVICES INC.

EBS EMPLOYEE BENEFIT SERVICES INC.4318 WOODCREEKSAN ANTONIO TX 78228

UNITED BENEFITS(386) 239-4350

CHECK BENEFIT CARDPPI MOTORSPORTS LLCAffiliated With: UNITED BENEFITS DIVISION

Fund No:PlanType: Group Health

UNITED BENEFITS(386) 239-4350

UNITED BENEFITSPO Box 2480DAYTONA BEACH FL 32115-2480

EPOCH GROUP LC THE(800) 255-6065

UM NOT APPLICABLEPRATT FEEDERS/BUFFALO FEEDERS

Affiliated With: THE EPOCH GROUP

Fund No:PlanType: Group Health

EPOCH GROUP LC THE(800) 255-6065

THE EPOCH GROUP, LCPO Box 12170OVERLAND PARK KS 66282

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-435• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 436: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 816-6049

WATERSTONE UTILIZATION MANAGEMENT(800) 460-0238

PRATT REGIONAL MEDICAL CENTER

Affiliated With: WATERSTONE BENEFIT ADMINISTRATORS #962501227

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 816-6049

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

Preferred Plus of Kansas, Inc(316) 609-2308

PREFERRED HEALTH SYSTEMS(800) 289-0345

PREFERRED BENEFIT ADMINISTRATORS

Affiliated With: PREFERRED PLUS OF KANSAS INC

Fund No:PlanType: Group Health

Preferred Plus of Kansas, Inc(316) 609-2308

Preferred Plus of Kansas, Inc8535 E 21st St NorthWichita KS 67206

Preferred Plus of Kansas, Inc(316) 609-2308

PREFERRED HEALTH SYSTEMS(800) 424-0345

PREFERRED PLUS OF KANSAS INC

Affiliated With: PREFERRED PLUS OF KANSAS INC / AHA

Fund No:PlanType: Group Health

Preferred Plus of Kansas, Inc(316) 609-2308

Preferred Plus of Kansas, Inc8535 E 21st St NorthWichita KS 67206

MERITAIN HEALTH(800) 824-8316

CHECK BENEFIT CARDPREFERRED SOURCINGAffiliated With: NORTH AMERICAN

Fund No:PlanType: Group Health

MERITAIN HEALTH(800) 824-8316

MERITAIN HEALTHPO Box 80884Indianapolis IN 46280

PREMIER ACCESS(888) 463-4137

CHECK BENEFIT CARDPREMIER ACCESS (OUT OF AREA)

Affiliated With: PREMIER ACCESS

Fund No:PlanType: Group Health

PREMIER ACCESS(888) 463-4137

PREMIER ACCESSPO Box 150275ARLINGTON TX 76015

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-436• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 437: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MBA OF MARYLAND(410) 505-0507

STRATEGIC HEALTH DEVELOPMENT

PREMIER CLUB BENEFITS DBA BALD CREEK COLONY CLUB

Affiliated With: MBA OF MARYLAND

Fund No:PlanType: Group Health

MBA OF MARYLAND(410) 505-0507

MBA OF MARYLAND3103 EMMORTON RDABINGDON MD 21009

MBA OF MARYLAND(410) 505-0507

STRATEGIC HEALTH DEVELOPMENT

PREMIER CLUB BENEFITS DBA BOCA LAGO COUNTRY CLUB, INC.

Affiliated With: MBA OF MARYLAND

Fund No:PlanType: Group Health

MBA OF MARYLAND(410) 505-0507

MBA OF MARYLAND3103 EMMORTON RDABINGDON MD 21009

CONTACT EMPLOYER CONTACT EMPLOYERPremier Control ServicesAffiliated With: GENEX Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

PREMIER LABORATORY LLCAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

CHECK BENEFIT CARD CHECK BENEFIT CARDPREMIER RESORTS INTERNATIONAL INC

Affiliated With: CNIC HEALTH SOLUTIONS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-437• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 438: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDPREMIUM BEERS OF OKLAHOMAAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

FMH BENEFIT SERVICES INC(800) 990-9058

HCM(800) 990-9058

PREMIUM STANDARD FARMSAffiliated With: FMH BENEFIT SERVICES, INC. A DIVISION OF CORESOURC

Fund No:PlanType: Group Health

FMH BENEFIT SERVICES INC(800) 990-9058

FMH BENEFIT SERVICES INCPO Box 25946OVERLAND PARK KS 66225-5946

PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882

PHYSICIAN CARE OF CALIFORNIA(714) 540-5882

PRESBYTERIAN INTERCOMMUNITY HOSPITAL

Affiliated With: PHYSICIANS CARE INSURANCE SERVICES

Fund No:PlanType: Group Health

PHYSICIANS CARE INSURANCE SERVICES, INC.(714) 540-5882

PHYSICIANS CARE INSURANCE SERVICES, INC.PO Box 15165SANTA ANA CA 92735

PRESCOTT VAMC CHECK BENEFIT CARDPRESCOTT VAMC (N ARIZONA) 3175

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

PRESCOTT VAMC PRESCOTT VAMC

500 HWY 89 NORTHPRESCOTT AZ 86313

Attn: FEE - 144BF

ASSURECARE(800) 968-6616

CARELINE(763) 383-4800

PRESS SEAL GASKETAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-438• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 439: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDPRETIUM PACKAGING LLCAffiliated With: THE EPOCH GROUP L C

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

EQUITABLE PLAN SERVICES(405) 755-2929

CHECK BENEFIT CARDPRICE EDWARDS, HENDERSON & CO

Affiliated With: EQUITABLE PLAN SERVICES

Fund No:PlanType: Group Health

EQUITABLE PLAN SERVICES(405) 755-2929

EQUITABLE PLAN SERVICESPO Box 720460OKLAHOMA CITY OK 73172

America's TPA(952) 896-1255

CHECK BENEFIT CARDPRIDEAffiliated With: AMERICAS TPA

Fund No:PlanType: Group Health

America's TPA(952) 896-1255

America's TPAPO Box 398220Bloomington MN 55439

KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711

CHECK BENEFIT CARDPRIDE FEEDERS I LTD COMPANYAffiliated With: THE KEMPTON GROUP INC

Fund No:PlanType: Group Health

KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711

KEMPTON GROUP ADMINISTRATORS INCPO Box 54889OKLAHOMA CITY OK 73154

PRIMARY PROVIDER MANAGEMENT COMPANY, INC.(619) 742-3223

PRIMARY PROVIDER MANAGEMENT COMPANY, INC.(909) 778-6118

PRIMARY PROVIDER MANAGEMENT COMPANY, INC.

Affiliated With: PRIMARY PROVIDER MANAGEMENT COMPANY, INC.

Fund No:PlanType: Group Health

PRIMARY PROVIDER MANAGEMENT COMPANY, INC.(619) 742-3223

PRIMARY PROVIDER MANAGEMENT COMPANY, INC.2525 Camino del Rio South Ste 300San Diego CA 92108

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-439• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 440: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MSO, INC. OF SOUTHERN CALIFORNIA(626) 656-2370

CHECK BENEFIT CARDPRIMERA HEALTHCARE SERVICES, INC

Fund No:PlanType: Group Health

MSO, INC. OF SOUTHERN CALIFORNIA(626) 656-2370

MSO, INC. OF SOUTHERN CALIFORNIAPO Box 10355Scottsdale AZ 85271-0355

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDPRINCIPAL FINANCIAL GROUPAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

NORTHWEST ADMINISTRATORS, INC(206) 726-3259

UNICARE(800) 762-3029

PRINTING SPEC. & PAPER PRODS. JOINT EMP/UNION HLTH & WEL

Affiliated With: PRINTING SPEC. & PAPER PRODS. JOINT EMP/UNION HLTH

Fund No:PlanType: Group Health

NORTHWEST ADMINISTRATORS, INC(206) 726-3259

NORTHWEST ADMINISTRATORS, INC2323 Eastlake Avenue EastSeattle WA 98102

CONTACT EMPLOYER CONTACT EMPLOYERProcura

Fund No:PlanType: Workers' Compensation

Procura(610) 290-7202

Procura2435 Blvd of the Generals Ste 201Norristown PA 19403

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

PRODUCTION METAL FORMING, INC.

Affiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-440• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 441: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH PLAN INC(508) 752-2480

CMS(866) 325-1550

PROFESIONAL ELECTRICAL CONTRACTORS OF CT, INC.

Affiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

MERCER ADMINISTRATION(800) 394-6888

CHECK BENEFIT CARDPROFESSIONAL OFFICE SERVICES, INC.

Affiliated With: MERCER ADMINISTRATOR

Fund No:PlanType: Group Health

MERCER ADMINISTRATION(800) 394-6888

MERCER ADMINISTRATION701 Market St Ste 1350St Louis MO 63101

RESOURCEONE ADMINSTRATORS(800) 967-2077

MEDCAREONE CORP(800) 816-1206

Professional Performance Development Corporation

Affiliated With: RESOURCEONE ADMINISTRATORS

*

Fund No:PlanType: Group Health

RESOURCEONE ADMINSTRATORS(918) 967-2077

RESOURCEONE ADMINSTRATORS

PO Box 489BUCKEYSTOWN MD 21717

Attn: Mary Shepherd

CHECK BENEFIT CARD CHECK BENEFIT CARDProgressive Insurance (Auto)Affiliated With: Mitchell Medical

Fund No:PlanType: Auto

Progressive: Administered by Mitchell Medical

CHECK BENEFIT CARD CHECK BENEFIT CARD

Accordia National(800) 428-1291

Accordia National(800) 428-1291

Progressive Insurance CompanyAffiliated With: Progressive Insurance Company

Fund No:PlanType: Group Health

Accordia National(800) 428-1291

Accordia NationalPO Box 3262CHARLESTON WV 25332

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-441• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 442: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDPROGRESSIVE INSURANCE COMPANY AUTO

Affiliated With: MITCHELL MEDICAL

Fund No:PlanType: Auto

Progressive: Administered by Mitchell MedicalExclude Physical Therapists, Chiropractors & Behavioral Health providers (OCN ONLY)

CHECK BENEFIT CARD CHECK BENEFIT CARD

BUSINESS ADMINISTRATORS & CONSULTANTS INC(800) 521-2654

CHECK BENEFIT CARDPROGRESSIVE MEDICAL INCAffiliated With: HEALTHSCOPE BENEFITS INC

Fund No:PlanType: Group Health

BUSINESS ADMINISTRATORS & CONSULTANTS INC(800) 521-2654

BUSINESS ADMINISTRATORS & CONSULTANTS INC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068

HEALTH PLAN INC(508) 752-2480

CARE MANAGEMENT SERVICES(866) 325-1550

PROJECT ADVENTURESAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

ASSURECARE(800) 759-1311

Careline UR(763) 383-4800

PROLOG SERVICESAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 759-1311

ASSURECARE340 Quadrangle DrBolingbrook IL 60440

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

PROVIDENCE AND WORCESTER RAILROAD

Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-442• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 443: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PROVIDENCE VA MEDICAL CENTER

CHECK BENEFIT CARDPROVIDENCE VA MEDICAL CENTER 3114

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

PROVIDENCE VA MEDICAL CENTER

PROVIDENCE VA MEDICAL CENTER5504 HILL HEAVEN CTFRISCO TX 75035

CONTACT EMPLOYER CONTACT EMPLOYERProvidence WashingtonAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

PROVIDER NETWORKS OF AMERICA, INC(817) 417-2839

CHECK BENEFIT CARDPROVIDER NETWORKS OF AMERICA - PEPM

Affiliated With: PROVIDER NETWORKS OF AMERICA

Fund No:PlanType: Group Health

PROVIDER NETWORKS OF AMERICA, INC(817) 417-2839

PROVIDER NETWORKS OF AMERICA, INCPO Box 850778RICHARDSON TX 75085

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 869-7093 Ext 117

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 869-7093 Ext 117

PUGET SOUND FREIGHT LINESAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 869-7093 Ext 117

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.PO Box 85008BELLEVUE WA 98015

PUGET SOUND VA HCS - AMIRICAN LAKE DIVISION

CHECK BENEFIT CARDPUGET SOUND VA HCS AMERICAN LAKE DIVISION 3179

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

PUGET SOUND VA HCS - AMIRICAN LAKE DIVISION

PUGET SOUND VA HCS - AMIRICAN LAKE DIVISION

9600 VETERANS DRTACOMA WA 98493

Attn: A-136-FEE

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-443• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 444: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FISERV HEALTH TENNESSEE

INTRACORP(800) 866-8899

PULLEN AND ASSOCIATESAffiliated With: FISERV HEALTH TENNESSEE

Fund No:PlanType: Group Health

FISERV HEALTH TENNESSEE(800) 255-8109

FISERV HEALTH TENNESSEEPO Box 530PUEBLO CO 81002-0530

CHECK BENEFIT CARD8884191094

ADVANCED BENEFITS SOLUTIONS

PULMONARY ASSOCIATESAffiliated With: ADVANCED BENEFIT SOLUTIONS LLC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8884191094

CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDPYROMATION, INC.Affiliated With: NORTH AMERICAN ADMINISTRATOR - NY

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

QUAIL MOUNTAIN PEPSI COLAAffiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

DELTA HEALTH SYSTEMS(209) 939-3992

ARIZONA FOUNDATION FOR MEDICAL CARE(602) 417-2337

QUALITY PROJECT MANAGEMENT

Affiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(209) 939-3992

DELTA HEALTH SYSTEMSPO Box 495Stockton CA 95201

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-444• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 445: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

QUALITY WOOD PRODUCTSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Gallagher Benefit Administrators Inc(800) 323-1726

IntraCorp(800) 535-5222

Quanta Services GroupAffiliated With: Gallagher Benefit Administrators, Inc.

Fund No:PlanType: Group Health

Gallagher Benefit Administrators Inc(800) 323-1726

Gallagher Benefit Administrators IncPO Box 34297San Antonio TX 78265

BAC(614) 863-8780

BAC(614) 863-8780

QUANTUM SERVICESAffiliated With: BUSINESS ADMINISTRATORS AND CONSULTANTS

Fund No:PlanType: Group Health

BAC(614) 863-8780

BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068

SRT ADMINISTRATORS(888) 690-2020

Action HealthCare(800) 433-6915

QUECHAN TRIBE - PARADISE CASINOS

Affiliated With: SRT ADMINISTRATORS

Fund No:PlanType: Group Health

SRT ADMINISTRATORS(888) 690-2020

SRT ADMINISTRATORSPO Box 25160SCOTTSDALE AZ 85255-0102

GROUP & PENSION ADMINISTRATORS(800) 827-7223

HEALTH WATCH(972) 238-7900

QUICKSILVER RESOURCES, INCAffiliated With: GROUP & PENSIONS ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223 Ext 2325

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-445• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 446: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EQUITABLE PLAN SERVICES(405) 755-2929

CHECK BENEFIT CARDQUIK PRINT/DOCUMARTAffiliated With: EQUITABLE PLAN SERVICES

Fund No:PlanType: Group Health

EQUITABLE PLAN SERVICES(405) 755-2929

EQUITABLE PLAN SERVICESPO Box 720460OKLAHOMA CITY OK 73172

CHECK BENEFIT CARD8002556065

CHECK BENEFIT CARDQUINCY COMPRESSOR DIVISION SALES UNIT

Affiliated With: THE EPOCH GROUP L C

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8002556065

CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDQUINNIPIAC COLLEGE SPORTSAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

American Administrative Group Inc.(800) 323-1726

American Administrative Group Inc.(800) 538-5222

Quixote CorporationAffiliated With: American Administrative Group

Fund No:PlanType: Group Health

American Administrative Group Inc.(800) 323-1726

American Administrative Group Inc.PO Box 5227LISLE IL 60532

FISERV HEALTH KANSAS(800) 235-7160

AVIDYN HEALTH(866) 802-1328

R & B EXPRESSAffiliated With: FISERV HEALTH - KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-446• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 447: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDR AND O CONSTRUCTIONAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD3129068080

CHECK BENEFIT CARDR G RAY CORPORATIONAffiliated With: ALLIED BENEFIT SYSTEMS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD3129068080

CHECK BENEFIT CARD

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

RADIO FREQUENCY COMPANYAffiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

CHECK BENEFIT CARD CHECK BENEFIT CARDRAIN FOR RENTAffiliated With: BENEFIT PLANNERS LTD

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERRAMAffiliated With: Liberty

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-447• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 448: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HCH ADMINISTRATION INC(800) 447-3227

CHECK BENEFIT CARDRAMAHA NAVAJO CHAPTERAffiliated With: EMPLOYEE BENEFIT CONSULTANTS INC

Fund No:PlanType: Group Health

HCH ADMINISTRATION INC(309) 673-7330

HCH ADMINISTRATION INCPO Box 285PEORIA IL 61650

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

RAMPART RESORT MANAGEMENT

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

THE EPOCH GROUP(800) 255-6065

THE EPOCH GROUP(800) 255-6065

RAMSEY INDUSTRIES, INCAffiliated With: THE EPOCH GROUP

Fund No:PlanType: Group Health

THE EPOCH GROUP(800) 255-6065

THE EPOCH GROUP6717 SHAWNEE MISSION PARKWAYOVERLAND PARK KS 66202

Western Health(605) 719-4600 or (888) 341-1766

Western Health(605) 719-4640 or (800) 229-0892

Rapid ChevroletAffiliated With: Rapid City Regional Hospital DBA Western Health

Fund No:PlanType: Group Health

Western Health(605) 719-4600 or (888) 341-1766

Western Health529 Kansas City St Ste 200Rapid City SD 57701

NHBC(888) 621-7900

CHECK BENEFIT CARDRCIAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-448• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 449: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Mountain States Administrative Services(520) 722-7133

Hines and Associates(847) 214-2780

RDT EMPLOYEE BENEFIT TRUSTAffiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

Mountain States Administrative Services(520) 722-7133

Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

MED-CERTREAL SERVICESAffiliated With: NORTH AMERICA ADMINISTRATORS

Fund No:PlanType: Group Health

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

SMITH ADMINISTRATORS(801) 261-5511

SERVICE ADVOCATES(877) 261-5511

RED INCAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

SMITH ADMINISTRATORS(801) 261-5511

SMITH ADMINISTRATORS428 E WINCHESTER ST, STE 200SALT LAKE CITY UT 84107

SRT ADMINISTRATORS, INC.(480) 505-0424

HINES AND ASSOCIATES(800) 528-2498

RED MESA UNIFIED SCHOOL DISTRICT - PEPM

Affiliated With: SRT ADMINISTRATORS, INC

Fund No:PlanType: Group Health

SRT ADMINISTRATORS, INC.(480) 505-0424

SRT ADMINISTRATORS, INC.14646 N. Kierland BlvdScottsdale AZ 85255-0102

ADVENTIST HEALTH SYSTEM/WEST C/O CCN

CHECK BENEFIT CARDREDBUD COMMUNITY HOSPITALAffiliated With: ADVENTIST HEALTH SYSTEM/WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM/WEST C/O CCN

ADVENTIST HEALTH SYSTEM/WEST C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-449• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 450: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 525-8788

CHECK BENEFIT CARDREDGINTON-FAIRVIEW GENERAL HOSPITAL

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC.

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR(800) 525-8788

COMPREHENSIVE BENEFITS ADMINISTRATORPO Box 2365SOUTH BURLINGTON VT 05407

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDREED COLLEGEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

Western Health(605) 719-4600 or (888) 341-1766

Western Health(605) 719-4640 or (800) 229-0892

Regional HealthAffiliated With: Western Health

Fund No:PlanType: Group Health

Western Health(605) 719-4600 or (888) 341-1766

Western Health529 Kansas City St Ste 200Rapid City SD 57701

GLOBALCARE, INC.8008601111

GLOBALCARE8008601111

REGIONAL MEDICAL ADMINISTRATORS

Affiliated With: GLOBALCARE, INC.

Fund No:PlanType: Group Health

GLOBALCARE, INC.6783411722

GLOBALCARE, INC.6875 Shiloh Rd EALPHARETTA GA 30005

STUDENT RESOURCES(800) 237-0903 Ext 6352

CHECK BENEFIT CARDREGIS COLLEGEAffiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT RESOURCES(800) 237-0903 Ext 6352

STUDENT RESOURCES2301 W. PLANO PKWY #300PLANO TX 75075

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-450• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 451: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

CHECK BENEFIT CARDRELIEF ENTERPRISE, INC.Affiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDRELIGIOUS COMP TRUST/HMSR-CHRISTIAN BROTHER SERVICES

Affiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

EBA&M(800) 776-1545

CHECK BENEFIT CARDREMECAffiliated With: EBA&M

Fund No:PlanType: Group Health

EBA&M(800) 776-1545

EBA&MPO Box 5079WESTLAKE VILLAGE CA 91359

Accordia National(888) 685-7774

CHECK BENEFIT CARDREMINGTON ARMS COMPANY INCAffiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR

*

Fund No:PlanType: Group Health

Accordia National(888) 685-7774

Accordia NationalPO Box 3262CHARLESTON WV 25332

RENO VAMC CHECK BENEFIT CARDRENO VAMC 3186Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

RENO VAMC RENO VAMC

1000 LOCUST STRENO NV 89502

Attn: FEE BASIS 04FB

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-451• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 452: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CompIQ Corporation(800) 293-3131

CONTACT EMPLOYERRENY CompanyAffiliated With: CompIQ

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(800) 293-3131

CompIQ Corporation2 South PointeLake Forest CA 92630

RENY Company The(972) 250-0189

RENY Company The(972) 250-0189

RENY Company TheAffiliated With: RENY Company The

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

RENY Company The(972) 250-0189

RENY Company The16610 Dallas Parkway Ste 2400Dallas TX 75248

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

REPUBLIC MORTGAGE TRAVEL PLAN

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

REPUBLIC MORTGAGE, LLCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

DIRECT CARE AMERICA(800) 266-5896

CHECK BENEFIT CARDREPUBLIC STORAGE SYSTEMSAffiliated With: THE CHANDLER GROUP 13352

Fund No:PlanType: Group Health

DIRECT CARE AMERICA(800) 266-5896

DIRECT CARE AMERICAPO Box 2090 CSTOW OH 44224

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-452• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 453: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARDRESOURCE MANAGEMENT INCAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERResource Management Systems IncAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

APPALACHIAN BENEFITS(828) 926-4040

CHECK BENEFIT CARDRESTAURANT CONCEPTS INCAffiliated With: PPALACHAIN BENEFITS

Fund No:PlanType: Group Health

APPALACHIAN BENEFITS(828) 926-4040

APPALACHIAN BENEFITSPO Box 780STOCKTON CA 94565

CENBEN USA(614) 797-5204

CHECK BENEFIT CARDRETALIX USAAffiliated With: CENBEN USA INC / HEALTHSCOPE

Fund No:PlanType: Group Health

CENBEN USA(614) 797-5204

CENBEN USA

4079 Executive PkwyWesterville OH 43081

Attn: Melissa Joseph

Review Med(214) 696-3855

CHECK BENEFIT CARDREVIEW MED L.P.Affiliated With: CompIQ

Fund No:PlanType: Group Health

Review Med(214) 696-3855

Review Med10300 N Central Expressway Ste 450Dallas TX 75231

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-453• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 454: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDReview Works AUTOAffiliated With: Review Works

Fund No:PlanType: Auto

CHECK BENEFIT CARD

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDRGIS INVENTORY SPECIALAffiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

THE LOOMIS COMPANY(800) 346-1223

HINES & ASSOCIATES(888) 826-5769

RHODE & SCHWARZ, INCAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(800) 346-1223

THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011

CHECK BENEFIT CARD CHECK BENEFIT CARDRHODE ISLAND COLLEGE SPORTS

Affiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

KLAIS & COMPANY INC(330) 867-8443

CHECK BENEFIT CARDRHODE ISLAND SCHOOL OF DESIGN

Affiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(330) 867-8443

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-454• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 455: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EVEREST ADMINISTRATORS, INC.(800) 286-4160

CHECK BENEFIT CARDRHODES INTERNATIONAL INCAffiliated With: EVEREST ADMINISTRATORS INC

Fund No:PlanType: Group Health

EVEREST ADMINISTRATORS, INC.(800) 286-4160

EVEREST ADMINISTRATORS, INC.PO Box 19002PROVO UT 84605-9002

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN(800) 249-8440

HINES & ASSOCIATES(800) 528-2498

RHYTHM & HUES, INC.Affiliated With: EMPLOYEE BENEFIT ADMINISTRATION & MGMT. (EBA&M)

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCN(800) 249-8440

EMPLOYEE BENEFIT ADMIN. & MGMT. (EBA&M) C/O CCNPO Box 3000SCOTTSDALE AZ 85271-3000

RICHMOND (H HOLMES MCGUIRE) VA

CHECK BENEFIT CARDRICHMOND (H HOLMES MCGUIRE) VA 3137

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

RICHMOND (H HOLMES MCGUIRE) VA

1201 BROAD ROCK BLVDRICHMOND VA 23249

Attn: FEE 04A

SMITH ADMINISTRATORS, INC.(801) 261-5511

SERVICE ADVOCATES(801) 261-5511

RIDLEYS SUPERMARKETS INCAffiliated With: SMITH ADMINISTRATORS INC

Fund No:PlanType: Group Health

SMITH ADMINISTRATORS, INC.(801) 261-5511

SMITH ADMINISTRATORS, INC.3761 S 700 E SUITE 202SALT LAKE CITY UT 84106

CONTACT EMPLOYER CONTACT EMPLOYERRIMCOAffiliated With: STRATACARE

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-455• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 456: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDRINGLING SCHOOL OF ART AND DESIGN - AMH9076276

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 722-1668

PEARCE ADMINISTRATIONPO Box 2438Florence SC 29503

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDRIO ALGOM MINING CORPORATION

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

CONTACT EMPLOYER CONTACT EMPLOYERRisk Administration Services IncAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Risk Administration Services, Inc.(605) 361-5701

CHECK BENEFIT CARDRisk Administration Services, Inc.Affiliated With: STRATACARE

Fund No:PlanType: Workers' Compensation

Risk Administration Services, Inc.(605) 361-5701

Risk Administration Services, Inc.3900 W 53rd StSioux Falls SD 57109-1008

CONTACT EMPLOYER CONTACT EMPLOYERRisk Enterprise ManagementAffiliated With: Risk Enterprise Management

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-456• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 457: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

NHBC(888) 621-7900

CHECK BENEFIT CARDRISK REDUCTIONAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798

AHH/EBC REVIEWRITE HITE HOLDING CORPORATION

Affiliated With: EMPLOYEE BENEFIT CONSULTANTS

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT CONSULTANTS(800) 558-7798

EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839

THE EPOCH GROUP, LC(800) 255-6065

UM NOT APPLICABLERITEMADE PAPER CONVERTERSAffiliated With: THE EPOCH GROUP

Fund No:PlanType: Group Health

THE EPOCH GROUP, LC(800) 255-6065

THE EPOCH GROUP, LCPO Box 12170OVERLAND PARK KS 66282

UNDERWRITERS SAFETY & CLAIMS(800) 678-1536

UNDERWRITERS SAFETY & CLAIMS

RITTAL CORP.Affiliated With: UNDERWRITERS SAFETY & CLAIMS, INC.

Fund No:PlanType: Group Health

UNDERWRITERS SAFETY & CLAIMS(800) 678-1536

UNDERWRITERS SAFETY & CLAIMSPO Box 23507LOUISVILLE KY 40223

SELECT BENEFIT ADMINISTRATORS OF AMERICA(916) 226-2020

CHECK BENEFIT CARDRIVERSIDE GENERAL HOSPITALAffiliated With: PHYSICIAN CHOICE NETWORK LLC

Fund No:PlanType: Group Health

SELECT BENEFIT ADMINISTRATORS OF AMERICA(916) 226-2020

SELECT BENEFIT ADMINISTRATORS OF AMERICALaguna Springs Dr Ste 320Elk Grove CA 95758

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-457• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 458: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDRIVERSIDE SAN BERNARDINO CNTY INDIAN HEALTH INC

Affiliated With: RIVERSIDE SAN BERNARDINO CNTY INDIAN HEALTH CLINIC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

ACCESS HEALTH DIRECT(858) 467-7630

ACCESS HEALTH DIRECT(951) 778-6118

RIVERSIDE-SAN BERNARDINO COUNTY INDIAN HEALTH, INC.

Affiliated With: PRIMARY PROVIDER MANAGEMENT COMPANY

Fund No:PlanType: Group Health

ACCESS HEALTH DIRECT(858) 467-7630

ACCESS HEALTH DIRECT9275 SKY PARK CT STE 400SAN DIEGO CA 92123

RMSCO INC(315) 448-9000

RMSCO INC(315) 448-9000

RMSCOAffiliated With: RMSCO INC

Fund No:PlanType: Workers' Compensation

RMSCO INC(315) 448-9000

RMSCO INC115 CONTINUUM DRLIVEPOOL NY 13088

CHECK BENEFIT CARD8639674139

CHECK BENEFIT CARDRO MAC LUMBER SUPPLY INCAffiliated With: HERITAGE CONSULTANTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8639674139

CHECK BENEFIT CARD

GLOBALCARE(678) 341-1811

CHECK BENEFIT CARDROBERT C BOUK-MERCANTILE BANCORP, INC

Affiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-458• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 459: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8003216607

CHECK BENEFIT CARDROBERT F KENNEDY MEDICAL PLAN

Affiliated With: ROBERT F KENNEDY MEDICAL PLAN

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8003216607

CHECK BENEFIT CARD

CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295

CHECK BENEFIT CARDROBERTS BROTHERS REALTORSAffiliated With: CAROLINA BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

CAROLINA BENEFIT ADMINISTRATORS(800) 476-2295

CAROLINA BENEFIT ADMINISTRATORS333 SOUTH PINE STSPARTANBURG SC 29302

CONTACT EMPLOYER CONTACT EMPLOYERRochesterAffiliated With: New York State Insurance Fund

*

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

AMERIBEN SOLUTIONS(800) 953-1801

CHECK BENEFIT CARDROCKHURST UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 953-1801

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

ROCKWAY INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-459• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 460: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDROCKY MOUNTAIN CAREAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

WAUSAU BENEFITS, INC.(715) 841-7802

CHECK BENEFIT CARDROCKY MOUNTAIN CHOCOLATE FACTORY, INC.

Affiliated With: WAUSAU BENEFITS

Fund No:PlanType: Group Health

WAUSAU BENEFITS, INC.(715) 841-7802

WAUSAU BENEFITS, INC.

PO Box 8046WAUSAU WI 54401-8046

Attn: LeAnn Fichtner

CHECK BENEFIT CARD CHECK BENEFIT CARDROCKY MOUNTAIN THERAPYAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERRocor InternationalAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

GROUP & PENSION ADMINISTRATORS INC(800) 827-7223

HEALTH WATCH(972) 238-7900

RODMAN COMPANIESAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS INC(972) 238-7900

GROUP & PENSION ADMINISTRATORS INC12770 MERIT DR STE 200DALLAS TX 75251

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-460• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 461: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONSOLIDATED HEALTH PLANS(800) 633-7867

CHECK BENEFIT CARDROGER WILLIAMS UNIVERSITYAffiliated With: CONSOLIDATED HEALTH PLANS

Fund No:PlanType: Group Health

CONSOLIDATED HEALTH PLANS(800) 633-7867

CONSOLIDATED HEALTH PLANS195 STAFFORD STSPRINGFIELD MA 01104

BENEFIT SERVICES, INC.8003673762

Med-Valu(800) 349-8587

ROHRER CORPORATIONAffiliated With: BENEFIT SERVICES INC

Fund No:PlanType: Group Health

BENEFIT SERVICES, INC.8003673762

BENEFIT SERVICES, INC.3636 COPLEY RDAKRON OH 44216

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

RONNOCO SPECIALTY COFFEEAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

COMMERCIAL TRAVELERS(800) 756-3702

CHECK BENEFIT CARDROSE HULMAN - DOMESTICAffiliated With: COMMERCIAL TRAVELERS MUTUAL INSURANCE COMPANY

Fund No:PlanType: Group Health

COMMERCIAL TRAVELERS(800) 756-3702

COMMERCIAL TRAVELERS70 GENESEE STUTICA NY 13502

COMMERCIAL TRAVELERS(800) 756-3702

CHECK BENEFIT CARDROSE HULMAN - INTERNATIONALAffiliated With: COMMERCIAL TRAVELERS MUTUAL INSURANCE COMPANY

Fund No:PlanType: Group Health

COMMERCIAL TRAVELERS(800) 756-3702

COMMERCIAL TRAVELERS70 GENESEE STUTICA NY 13502

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-461• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 462: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

COMMERCIAL TRAVELERS(800) 756-3702

CHECK BENEFIT CARDROSE HULMAN - SPORTSAffiliated With: COMMERCIAL TRAVELERS MUTUAL INSURANCE COMPANY

Fund No:PlanType: Group Health

COMMERCIAL TRAVELERS(800) 756-3702

COMMERCIAL TRAVELERS70 GENESEE STUTICA NY 13502

HEALTH NET FEDERAL SERVICES(916) 985-1259

CHECK BENEFIT CARDROSEBURG VA HCS 3180Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(916) 985-1259

HEALTH NET FEDERAL SERVICES2025 AEROJET RDRANCHO CORDOVA CA 95742

SISCO(800) 457-4726

CHECK BENEFIT CARDROSENS DIVERSIFIED, INCAffiliated With: SELF INSURED SERVICES COMPANY SISCO

Fund No:PlanType: Group Health

SISCO(800) 457-4726

SISCOPO Box 389DUBUQUE IA 52004-0389

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDROSENSTEIN FIST AND RINGOLDAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

BENEFIT SERVICES, INC.(800) 367-3762

CHECK BENEFIT CARDROTATIONAL MOLDING TECHNOLOGIES

Affiliated With: BENEFITS SERVICES, INC.

Fund No:PlanType: Group Health

BENEFIT SERVICES, INC.(800) 367-3762

BENEFIT SERVICES, INC.3636 Copley RdAkron OH 44321

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-462• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 463: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BENEFIT PLAN MANAGEMENT(781) 753-7559

CHECK BENEFIT CARDROYAL INSTITUTIONAL SERVICES PAWTUCKET ANGELICA

Affiliated With: BENEFIT PLAN MANAGEMENT

Fund No:PlanType: Group Health

BENEFIT PLAN MANAGEMENT(781) 753-7559

BENEFIT PLAN MANAGEMENTPO Box 536ROCKLAND MA 02370

GROUP & PENSION ADMINISTRATORS(800) 827-7223

HEALTH WATCHROYAL OAKSAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

BAC(614) 863-8780

BAC(614) 863-8780

RPM MANAGEMENT, INCAffiliated With: BUSINESS ADMINISTRATORS AND CONSULTANTS

Fund No:PlanType: Group Health

BAC(614) 863-8780

BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

CHECK BENEFIT CARDRS STAFFINGAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLERS STAFFINGAffiliated With: FCE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-463• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 464: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERRSKCO Cunningham and Lindsey Channeling

Affiliated With: RSKCO Cunningham and Lindsey

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

RSVP TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CHECK BENEFIT CARD CHECK BENEFIT CARDRUIZ FOOD PRODUCTSAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

JOHN RILEY INSURANCE(800) 541-1101

HINES AND ASSOCIATES(800) 246-4127

RUSH UNIVERSITYAffiliated With: JOHN RILEY INSURANCE

Fund No:PlanType: Group Health

JOHN RILEY INSURANCE(800) 541-1101

JOHN RILEY INSURANCE

PO Box 356WEST BOYLSTON MA 01453

Attn: SUSAN RINDFLEISCH

EQUITABLE PLAN SERVICES(405) 755-2929

CHECK BENEFIT CARDRUSTIN CONCRETEAffiliated With: EQUITABLE PLAN SERVICES

Fund No:PlanType: Group Health

EQUITABLE PLAN SERVICES(405) 755-2929

EQUITABLE PLAN SERVICESPO Box 720460OKLAHOMA CITY OK 73172

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-464• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 465: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

CHECK BENEFIT CARDRYAN BUILDING GROUPAffiliated With: ALLIED BENEFIT SYSTEMS, INC.

Fund No:PlanType: Group Health

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

ALLIED BENEFIT SYSTEMS, INC208 S LASALLE ST STE 1300CHICAGO IL 60604

CHECK BENEFIT CARD CHECK BENEFIT CARDSABROSO COMPANYAffiliated With: ASSOCIATED ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

ASSURECARE(800) 968-6616

CARELINE(763) 383-4800

SAC FINANCEAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDSADDLEBACK COLLEGEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

CHECK BENEFIT CARD8004427247 8005287936

CHECK BENEFIT CARDSADDLEBACK VALLEY COMMUNITY CHURCH

Affiliated With: HEALTHCOMP ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8004427247 8005287936

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-465• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 466: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERSafety Group Office 1Affiliated With: New York State Insurance Fund

*

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER New York State Insurance Fund199 Church StNew York NY 10007

CONTACT EMPLOYER CONTACT EMPLOYERSafety Group Office 2Affiliated With: New York State Insurance Fund

*

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER New York State Insurance Fund199 Church StNew York NY 10007

MERITAIN HEALTH(877) 801-1500

CHECK BENEFIT CARDSAFYAffiliated With: MERITAIN HEALTH

Fund No:PlanType: Group Health

MERITAIN HEALTH(877) 801-1500

MERITAIN HEALTH19800 Detroit Rd.ROCKY RIVER OH 44116

CONTACT EMPLOYER CONTACT EMPLOYERSagamore Insurance CompanyAffiliated With: GENEX Services, Inc

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

HEALTHCOMP TPA(800) 442-7247

HEALTHCOMP TPA(800) 755-7247

SAGE PUBLICATIONSAffiliated With: HEALTHCOMP THIRD PARTY ADMOINISTRATORS

Fund No:PlanType: Group Health

HEALTHCOMP TPA(800) 442-7247

HEALTHCOMP TPAPO Box 45018Fresno CA 93718

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-466• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 467: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

SAGEBRUSH - RHODES HOMESAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

SAGEBRUSH-TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

SAGINAW VA MEDICAL CENTER

CHECK BENEFIT CARDSAGINAW VA MEDICAL CENTER 3158

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

SAGINAW VA MEDICAL CENTER

SAGINAW VA MEDICAL CENTER

1500 WEISS STSAGINAW MI 48602

Attn: FEE BASIS 136F

ACORDIA NATIONAL(888) 685-7774

CHECK BENEFIT CARDSAIA BURGES AUTOMOTIVE CURATORS

Affiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR

*

Fund No:PlanType: Group Health

ACORDIA NATIONAL(888) 685-7774

ACORDIA NATIONAL

ADMINISTRATIVE CONCEPTS INC(888) 293-9229

UM NOT APPLICABLESAINT FRANCIS UNIVERSITYAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS INC(888) 293-9229

ADMINISTRATIVE CONCEPTS INC

997 Old Eagle School Rd. #215WAYNE PA 19087-1706

Attn: Customer Service Dept

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-467• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 468: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SALEM VAMC CHECK BENEFIT CARDSALEM VAMC 3138Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

SALEM VAMC SALEM VAMC

1970 ROANOKE BLVDSALEM VA 24153

Attn: FEE BASIS 04H

GROUP & PENSION ADMINISTRATORS(800) 827-7223

CHECK BENEFIT CARDSales Partners Southwest (TRAVEL)Affiliated With: GROUP & PENSION ADMINISTRATORS

*

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

KEY BENEFIT ADMINISTRATORS(866) 387-0489

Health Care Management(317) 284-7650

SALINAS GOLF & COUNTRY CLUBAffiliated With: KEY BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

KEY BENEFIT ADMINISTRATORS(866) 387-0489

KEY BENEFIT ADMINISTRATORSPO Box 1239FORT MILL SC 29716

COASTAL TPA, INC.(800) 564-7475

SVMH(831) 757-4333

SALINAS VALLEY MEMORIAL HOSP (NON-WRAP)

Affiliated With: COASTAL TPA, INC.

Fund No:PlanType: Group Health

COASTAL TPA, INC.(800) 564-7475

COASTAL TPA, INC.PO Box 80308SALINAS CA 93912

COASTAL TPA, INC.(831) 455-1833

SALINAS VALLEY MEMORIAL HOSPITAL(831) 757-4333

SALINAS VALLEY MEMORIAL HOSPITAL

Affiliated With: COASTAL TPA INC

Fund No:PlanType: Group Health

COASTAL TPA, INC.(831) 455-1833

COASTAL TPA, INC.PO Box 80308SALINAS CA 93912

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-468• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 469: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SALISBURY VAMC CHECK BENEFIT CARDSALISBURY VAMC 3139Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

SALISBURY VAMC SALISBURY VAMC

1601 BRENNER RDSALISBURY NC 28144

Attn: FEE BASIS (04J)

SALT LAKE CITY VAMC CHECK BENEFIT CARDSALT LAKE CITY VAMC 3535Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

SALT LAKE CITY VAMC SALT LAKE CITY VAMC500 FOOTHILL DRSALT LAKE CITY UT 84148

CHECK BENEFIT CARD CHECK BENEFIT CARDSALT LAKE ORTHOPAEDIC CLINICAffiliated With: SMITH ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CORESOURCE(866) 280-4120

CORESOURCE(866) 794-0770

SALT RIVER SAND & ROCKAffiliated With: CORESOURCE

Fund No:PlanType: Group Health

CORESOURCE(866) 280-4120

CORESOURCEPO Box 2920CLINTON OH 52733-2920

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

CHECK BENEFIT CARDSALVE REGINA UNIVERSITYAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-469• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 470: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDSAM HOUSTON STATE UNIVERSITY

Affiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

NHBC(888) 621-7900

CHECK BENEFIT CARDSAMARITAN HEALTH PLANSAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.(800) 284-2273

SAMCAffiliated With: OSF HEALTHPLANS, INC.

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128

TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850

AMERICAN HEALTH HOLDING(888) 877-7994

SAMMON TRUCKING, INC.Affiliated With: TRUSTEED PLANS SERVICE GROUP

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE CORPORATION(253) 564-5850

TRUSTEED PLANS SERVICE CORPORATIONPO Box 1894TACOMA WA 98406-1705

GROUP & PENSION ADMINISTRATORS INC(800) 827-7223

HEALTH WATCH(972) 238-7900

SAN ANTONIO AEROSPACE - TRAVEL

Affiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS INC(972) 238-7900

GROUP & PENSION ADMINISTRATORS INC12770 MERIT DR STE 200DALLAS TX 75251

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-470• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 471: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTHCOMP THIRD PARTY ADMINISTRATORS INC(800) 442-7247

CHECK BENEFIT CARDSAN BENITO HEALTH CARE DISTRICT

Affiliated With: HEALTHCOMP THIRD PARTY ADMINISTRATORS

Fund No:PlanType: Group Health

HEALTHCOMP THIRD PARTY ADMINISTRATORS INC(800) 442-7247

HEALTHCOMP THIRD PARTY ADMINISTRATORS INCPO Box 45018Fresno CA 93718

SAN DIEGO HCS CHECK BENEFIT CARDSAN DIEGO HCS 3192Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

SAN DIEGO HCS SAN DIEGO HCS

3350 LA JOLLA VILLAGE DRSAN DIEGO CA 92161

Attn: FEE BASIS 136B-SV

SAN FRANSISCO VAMC CHECK BENEFIT CARDSAN FRANCISCO VAMC 3187Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

SAN FRANSISCO VAMC SAN FRANSISCO VAMC

4150 CLEMENT ST BLDG 6SAN FRANSISCO CA 94121

Attn: FEE BASIS 04F

ADVENTIST HEALTH SYSTEM WEST

CHECK BENEFIT CARDSAN JOAQUIN COMMUNITY HOSPITAL

Affiliated With: ADVENTIST HEALTH SYSTEM/WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM WEST

ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002

ADVENTIST HEALTH SYSTEMS/WEST

CHECK BENEFIT CARDSAN JOAQUIN COMMUNITY HOSPITAL EXCLUSIVE

Affiliated With: ADVENTIST HEALTH SYSTEM/WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEMS/WEST

ADVENTIST HEALTH SYSTEMS/WESTPO Box 619031ROSEVILLE CA 95661-9002

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-471• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDSAN JUAN IPAAffiliated With: NATIONAL HEALTH BENEFIT CORPORATION (NHBC)

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SAN JUAN VA MEDICAL CENTER

CHECK BENEFIT CARDSAN JUAN VA MEDICAL CENTER 3145

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

SAN JUAN VA MEDICAL CENTER

SAN JUAN VA MEDICAL CENTER

10 CASIA STSAN JUAN PR 00921

Attn: 672-B01D

CHECK BENEFIT CARD CHECK BENEFIT CARDSANDVIKAffiliated With: ALLIED BENEFIT SYSTEMS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

ASSOCIATED ADMINISTRATORS, INC.(800) 770-6672

CHECK BENEFIT CARDSANTA CLARA UNIVERSITYAffiliated With: ASSOCIATED ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

ASSOCIATED ADMINISTRATORS, INC.(800) 770-6672

ASSOCIATED ADMINISTRATORS, INC.PO Box 5096PORTLAND OR 97208

CHECK BENEFIT CARD CHECK BENEFIT CARDSANTA CRUZ MEDICAL CLINICAffiliated With: CAPITOL ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-472• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 473: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDSANTA MONICA COLLEGEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

STAR HEALTHCARE NETWORK(212) 581-8228

CHECK BENEFIT CARDSANUS HEALTHAffiliated With: STAR HEALTHCARE NETWORK INC

*

Fund No:PlanType: Group Health

STAR HEALTHCARE NETWORK(212) 581-8228

STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019

SANUS HEALTH CORPORATION(469) 417-1755

SANUS HEALTH CORPORATION(469) 417-1755

SANUS HEALTHAffiliated With: SANUS HEALTH CORPORATION

Fund No:PlanType: Group Health

SANUS HEALTH CORPORATION(469) 417-1755

SANUS HEALTH CORPORATION12501 KENDALL DR STE 2MIAMI FL 33186

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

SAPAUGH MOTORS, INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

EBPA(802) 846-8060

CHECK BENEFIT CARDSARGENT CORP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-473• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 474: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDSAVANNAH STATE UNIV AIH0058417

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLESAVANNAH STATE UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

CHECK BENEFIT CARDSAYRE MEMORIAL HOSPITALAffiliated With: WATERSTONE BENEFITS ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

CONTACT EMPLOYER CONTACT EMPLOYERSCA Claims ManagementAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CHECK BENEFIT CARD CHECK BENEFIT CARDSCC INDUSTRIESAffiliated With: CORESOURCE

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-474• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 475: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERSCHAFFER COMPANIES GHAffiliated With: STRATACARE

Fund No:PlanType: Group Health

CONTACT EMPLOYER CONTACT EMPLOYER

CONTACT EMPLOYER CONTACT EMPLOYERSCHAFFER COMPANIES WCAffiliated With: STRATACARE

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

SCHALER ANDERSON HEALTHCARE(602) 659-1403

CHECK BENEFIT CARDSCHALLER ANDERSON BEHAVIORAL HEALTH OF CALIFORNIA ADMINISTRATORS

Affiliated With: SCHALLER ANDERSON HEALTHCARE

Fund No:PlanType: Group Health

SCHALER ANDERSON HEALTHCARE(602) 659-1403

SCHALER ANDERSON HEALTHCARE4645 E. COTTON CENTER BLVD BLDG 1 #200PHOENIX AZ 85040

NORTH AMERICA ADMINISTRATORS, L.P.(615) 255-6654

MED-CERT(800) 356-7126

SCHMIEDESKAMP, ROBERTSON, NEW & MITCHELL

Affiliated With: NORTH AMERICAN ADMINISTRATORS

Fund No:PlanType: Group Health

(615) 255-6654 NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

(800) 220-2600 CHECK BENEFIT CARDSCHMITT, SUSSMAN, ENTERPRISES dba PFP

Affiliated With: BROKERAGE CONCEPTS INC

Fund No:PlanType: Group Health

CLAIMS MANAGER(610) 337-2600

CLAIMS MANAGERPO Box 61553KING OF PRUSSIA PA 19406

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-475• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PROFESSIONAL CLAIMS MGMT(800) 590-6500

CHECK BENEFIT CARDSCHOOL CITY OF EAST CHICAGOAffiliated With: PROFESIONAL CLAIMS MANAGEMENT

Fund No:PlanType: Group Health

PROFESSIONAL CLAIMS MGMT(800) 590-6500

PROFESSIONAL CLAIMS MGMT16 W 455 S FRONTGATE RD STE 216BURR RIDGE IL 60527

NGS AMERICAN, INC.8005211555

UM NOT APPLICABLESCHWARZ PARTNERS-PACKAGING

Affiliated With: NGS AMERICAN INC

Fund No:PlanType: Group Health

NGS AMERICAN, INC.8005211555

NGS AMERICAN, INC.PO Box 7676DETROIT MI 48080

CHECK BENEFIT CARD CHECK BENEFIT CARDSCICOM INCAffiliated With: MAYO MANAGEMENT SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD7753526959

CHECK BENEFIT CARDSCOLARI S FOOD DRUGAffiliated With: CDS GROUP HEALTH

Fund No:PlanType: Group Health

CHECK BENEFIT CARD7753526959

CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDSCOTIABANKAffiliated With: COLONIAL GROUP INTERNATIONAL LTD

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-476• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 477: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

SCOTLAND YARD SECURITY SERVICES LTD

Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

SCHALLER ANDERSON HEALTHCARE LLC(888) 897-4988

SCHALLER ANDERSON HEALTHCARE LLC

SCRIPPS HEALTH INC EPOAffiliated With: SCHALLER ANDERSON HEALTHCARE LLC

Fund No:PlanType: Group Health

SCHALLER ANDERSON HEALTHCARE LLC(888) 897-4988

SCHALLER ANDERSON HEALTHCARE LLCPO Box 63065PHOENIX AZ 85082-3065

SCHALLER ANDERSON HEALTHCARE LLC

SCHALLER ANDERSON HEALTHCARE LLC

SCRIPPS HEALTH INC PPO AND OUT OF AREA

Affiliated With: SCHALLER ANDERSON HEALTHCARE LLC

Fund No:PlanType: Group Health

SCHALLER ANDERSON HEALTHCARE LLC

SCHALLER ANDERSON HEALTHCARE LLCPO Box 63065PHOENIX AZ 85082-3065

ALLIED ADMINISTRATORS(619) 297-8235

CHECK BENEFIT CARDSD CEMENT MASONS TRUSTAffiliated With: SD CEMENT MASONS TRUST

Fund No:PlanType: Group Health

ALLIED ADMINISTRATORS(619) 297-8235

ALLIED ADMINISTRATORS2831 Camino del Rio S STE 311SAN DIEGO CA 92108

ALLIED ADMINISTRATORS(619) 297-8235

CHECK BENEFIT CARDSD COUNTY TEAMSTER TRUSTAffiliated With: SD COUNTY TEAMSTER TRUST

Fund No:PlanType: Group Health

ALLIED ADMINISTRATORS(619) 297-8235

ALLIED ADMINISTRATORS2831 Camino del Rio S STE 311SAN DIEGO CA 92108

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-477• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CBA(800) 525-8788

UM NOT APPLICABLESD IRELAND CONCRETEAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

CBA(800) 525-8788

CBAPO Box 2365SOUTH BURLINGTON VT 05407

ENTRUST INC(281) 368-7878

MEDICAL HELPLINE(877) 463-3435

SEABOARD INTERNATIONALAffiliated With: ENTRUST INC

Fund No:PlanType: Group Health

ENTRUST INC(281) 368-7878

ENTRUST INC14701 ST MARY'S LN STE 150HOUSTON TX 77079

CHECK BENEFIT CARD CHECK BENEFIT CARDSEALMASTER EPT HOURLYAffiliated With: SEALMASTER EPT HOURLY

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

America's TPA(952) 896-1255

CHECK BENEFIT CARDSEASONAL CONCEPTS INCAffiliated With: AMERICAS TPA

Fund No:PlanType: Group Health

America's TPA(952) 896-1255

America's TPAPO Box 398220Bloomington MN 55439

CONTACT EMPLOYER CONTACT EMPLOYERSeaton CorporationAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-478• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 479: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBMS(800) 777-3575

CHECK BENEFIT CARDSEATTLE FINANCIAL GROUPAffiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES, INC.

Fund No:PlanType: Group Health

EBMS(800) 777-3575

EBMSPO Box 21367BILLINGS MT 59104-1367

CHECK BENEFIT CARD CHECK BENEFIT CARDSEATTLE PACIFIC INDUSTRIESAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDSEATTLE TACOMA BOX COAffiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

HEALTH PLAN INC(508) 752-2480

CARE MANAGEMENT SERVICES(866) 325-1550

SECURE CARE PRODUCTS INCAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INCPO Box 5199WESTBOROUGH MA 01581

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

CHECK BENEFIT CARDSECURIGUARDAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-479• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDSECURITIES AMERICA FINANCIAL CORPORATION

Affiliated With: AMERICAN HEALTHCARE ALLIANCE

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

KHS(800) 822-1274

UM NOT APPLICABLESecurity ForcesAffiliated With: KANAWHA HEALTHCARE

*

Fund No:PlanType: Group Health

KHS(800) 822-1274

KHSPO Box 1000LANCASTER SC 29720

CONTACT EMPLOYER CONTACT EMPLOYERSedgwick Claims Management Services

Affiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Selective Insurance Agency(973) 948-1638

CHECK BENEFIT CARDSelective Insurance AgencyAffiliated With: Fair Isaac Corporation

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

Selective Insurance Agency(973) 948-1638

Selective Insurance Agency40 Wantage AveBranchville NJ 07890

HEALTHCOMP ADMINISTRATORS INC(800) 755-7247

HEALTHCOMP ADMINISTRATORS INC(800) 755-7247

SENECA CENTERAffiliated With: HEALTHCOMP

Fund No:PlanType: Group Health

HEALTHCOMP ADMINISTRATORS INC(800) 755-7247

HEALTHCOMP ADMINISTRATORS INC621 SANTA FEFRESNO CA 93703

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-480• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 481: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

JEANNE SHIMODA(800) 442-7247

CHECK BENEFIT CARDSENENET, INCAffiliated With: HEALTHCOMP TPA #10473

Fund No:PlanType: Group Health

JEANNE SHIMODA(800) 442-7247

JEANNE SHIMODAPO Box 45018FRESNO CA 93721

QUALIFIED BENEFIT SERVICES LLC(800) 853-3234

UM NOT APPLICABLE(801) 269-8723

SENIOR MANAGEMENT CONCEPTS

Affiliated With: QUALIFIED BENEFIT SERVICES

Fund No:PlanType: Group Health

QUALIFIED BENEFIT SERVICES LLC(800) 853-3234

QUALIFIED BENEFIT SERVICES LLC75 S 500 WBOUNTIFUL UT 84010

Sentry Insurance(800) 426-7234

Sentry Insurance(800) 488-4790

Sentry Employee Medical PlanAffiliated With: Sentry Insurance

Fund No:PlanType: Group Health

The First Health® Network is not used for Chiropractic services.

Sentry Insurance(800) 426-7234

Sentry InsurancePO Box 8025Stevens Point WI 54481

CONTACT EMPLOYER CONTACT EMPLOYERSentry InsuranceAffiliated With: Sentry Insurance A Mutual Company

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

THE LOOMIS COMPANY(866) 425-7244

HINES & ASSOCIATES(888) 826-5769

SEQUEL YOUTH AND FAMILYAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(866) 425-7244

THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-481• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 482: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH NETWORK AMERICA(888) 200-8537

HEALTH NETWORK AMERICA(732) 676-2637

SEQUEL YOUTH SERVICES - CLARINDA ACADEMY

Affiliated With: HEALTH NETWORK AMERICA

Fund No:PlanType: Group Health

HEALTH NETWORK AMERICA(888) 200-8537

HEALTH NETWORK AMERICAPO Box 607W LONG BRANCH NJ 07764

CONTACT EMPLOYER CONTACT EMPLOYERService Corporation International (SCI Management)

Affiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

CHECK BENEFIT CARDSERVICE SOURCE EMPLOYMENT SERVICES, INC.

Affiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.(800) 284-2273

SFIAffiliated With: OSF HEALTHPLANS, INC.

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.(800) 284-2273

SFMCAffiliated With: OSF HEALTHPLANS, INC.

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-482• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 483: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BAC(800) 521-2654

UM NOT APPLICABLESHAMROCK MANAGEMENT LLCAffiliated With: BUSINESS ADMINISTRATORS & CONSULTANTS, INC.

Fund No:PlanType: Group Health

BAC(614) 863-2120 Ext 3102

BACPO Box 107REYNOLDSBURG OH 43068

CHECK BENEFIT CARD CHECK BENEFIT CARDSHARE BUILDERSAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PROFESSIONAL BENEFIT ADMINISTRATORS, INC.(630) 655-3755

CHECK BENEFIT CARDSHARE CORPORATIONAffiliated With: PROFESSIONAL BENEFIT ADMINISTRATORS INC (PBA)

Fund No:PlanType: Group Health

PROFESSIONAL BENEFIT ADMINISTRATORS, INC.(630) 655-3755

PROFESSIONAL BENEFIT ADMINISTRATORS, INC.900 Jorie Blvd Ste 250Oakbrook IL 60523

C.L. FRATES AND COMPANY(405) 290-5696

CHECK BENEFIT CARDSHARE MEDICAL CENTERAffiliated With: C L FRATES & COMPANY

Fund No:PlanType: Group Health

C.L. FRATES AND COMPANY(405) 290-5696

C.L. FRATES AND COMPANYPO Box 26967OKLAHOMA CITY OK 73126-0967

MCA ADMINISTRATORS INC(800) 922-4966

CHECK BENEFIT CARDSHARON HOSPITALAffiliated With: MCA ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

MCA ADMINISTRATORS INC(800) 922-4966

MCA ADMINISTRATORS INC820 PARISH STPITTSBURGH PA 15220

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-483• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 484: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

CHECK BENEFIT CARDSHAWNEE MEDICAL CENTER CLINIC - 001

Affiliated With: WATERSTONE BENEFITS ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711

QUANTUM CARE(866) 412-8252

SHEBESTER-BECHTELAffiliated With: THE KEMPTON GROUP INC

Fund No:PlanType: Group Health

KEMPTON GROUP ADMINISTRATORS INC(405) 521-1711

KEMPTON GROUP ADMINISTRATORS INCPO Box 54889OKLAHOMA CITY OK 73154

BENESYS(248) 822-4200

HEALTH CARE EVALUATION(209) 951-6711

SHEET METAL WORKERS DBA"LOCAL 104" HEALTH CARE PLAN

Affiliated With: SHEET METAL WORKERS LOCAL 104 HEALTH CARE PLAN

Fund No:PlanType: Group Health

BENESYS(248) 822-4200

BENESYSPO Box 1618SAN RAMON CA 94583

CHECK BENEFIT CARD CHECK BENEFIT CARDSHEET METAL WORKERS' HEALTH AND WELFARE FUND OF NORTHERN CAROLINA

Affiliated With: SOUTHERN BENEFIT ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-484• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 485: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7345

SHELBY AUTOMOTIVEAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

CONTACT EMPLOYER CONTACT EMPLOYERShell Oil CompanyAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

AMERICA'S CHOICE HEALTHPLANS, LLC(877) 224-3627

AMERICAN HEALTH HOLDINGS INC(888) 578-1812

SHEPLEY WOOD PRODUCTS INCAffiliated With: BENEFIRST LLC

Fund No:PlanType: Group Health

AMERICA'S CHOICE HEALTHPLANS, LLC(877) 224-3627

AMERICA'S CHOICE HEALTHPLANS, LLC13111 Northwest Fwy, Ste 510Houston TX 77040

SHERIDAN VAMC CHECK BENEFIT CARDSHERIDAN VAMC 3536Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

SHERIDAN VAMC SHERIDAN VAMC1898 FORT RDSHERIDAN WY 82801

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

MED-CERT(800) 356-7126

SHIPPERS RENTAL COMPANYAffiliated With: NORTH AMERICAN ADMINISTRATORS LLC

Fund No:PlanType: Group Health

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-485• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 486: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.

SHIPROCK ALTERNATIVE SCHOOLS

Affiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.PO Box 25160SCOTTSDALE AZ 85255-0102

JSL ADMINISTRATORS, INC.(910) 480-3100

DOCTORS DIRECT(800) 443-9178

SHOOK BUILDER SUPPLY COAffiliated With: JSL ADMINISTRATORS, INC

Fund No:PlanType: Group Health

JSL ADMINISTRATORS, INC.(910) 480-3100

JSL ADMINISTRATORS, INC.201 HAY STREET, STE 302FAYETTEVILLE NC 28301

SHREVEPORTVAMC CHECK BENEFIT CARDSHREVEPORT VAMC 3108Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

SHREVEPORTVAMC SHREVEPORTVAMC

510 E ESTONER AVESHREVEPORT LA 71101

Attn: FEE 136C2

AMERIBEN SOLUTIONS AMERIBEN SOLUTIONSSIERRA COLLEGEAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

SIERRA HEALTH SERVICESAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-486• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 487: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Sierra Heatlh Services(818) 846-5297

Sierra Heatlh Services(800) 373-3054

Sierra Health Services

Fund No:PlanType: Workers' Compensation

Sierra Heatlh Services(818) 846-5297

Sierra Heatlh ServicesPO Box 7858Burbank CA 91510-7858

CHECK BENEFIT CARD CHECK BENEFIT CARDSIGMA CORPORATIONAffiliated With: BROKERAGE CONCEPTS INC BENEFIT CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

SIGNATURE LABELAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

SILVER STATE BANKAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

SILVER STATE FORD-TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-487• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 488: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

SILVERTON CASINO LLCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

ADVENTIST HEALTH SYSTEM WEST

CHECK BENEFIT CARDSIMI VALLEY HOSPITAL - EPOAffiliated With: ADVENTIST HEALTH SYSTEM/WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM WEST

ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002

NORTH AMERICAN ADMINISTRATORS(800) 397-2122

NORTH AMERICAN ADMINISTRATORS(800) 397-2122

SIMPSON NORTON CORPORATION

Affiliated With: NORTH AMERICAN ADMINISTRATORS - NEW YORK

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS(800) 397-2122

NORTH AMERICAN ADMINISTRATORSPO Box 1065AMHERST NY 14226

HEALTHCOMP TPA(800) 442-7247

CHECK BENEFIT CARDSIMPSON UNIVERSITYAffiliated With: HEALTHCOMP TPA #10473

Fund No:PlanType: Group Health

HEALTHCOMP TPA(800) 442-7247

HEALTHCOMP TPAPO Box 45018Fresno CA 93718

SIOUX FALLS VA MEDICAL CENTER

CHECK BENEFIT CARDSIOUX FALLS VA MEDICAL CENTER 3711

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

SIOUX FALLS VA MEDICAL CENTER

SIOUX FALLS VA MEDICAL CENTER

2501 W 22ND STREETSIOUX FALLS SD 57117

Attn: FEE 00143G

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-488• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 489: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GROUP BENEFIT SERVICES, INC.(800) 995-3569

GROUP BENEFIT SERVICES, INC.(800) 995-3569

SIOUX MANUFACTURINGAffiliated With: GROUP BENEFIT SERVICES, INC

Fund No:PlanType: Group Health

GROUP BENEFIT SERVICES, INC.(800) 995-3569

GROUP BENEFIT SERVICES, INC.1736 E. Sunshine Ste 200Springfield MO 65804

NHBC(888) 621-7900

CHECK BENEFIT CARDSIS IMPERIAL PALACEAffiliated With: NATIONAL HEALTH BENEFITS CORPORATION (NHBC)

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

MED-CERT(800) 356-7126

SISBRO INCAffiliated With: NORTH AMERICAN ADMINISTRATORS LLC

Fund No:PlanType: Group Health

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

SISCO(800) 457-4726

SISCO(800) 457-4726

SISCOAffiliated With: SISCO/Cottingham & Butler

Fund No:PlanType: Group Health

SISCO(800) 457-4726

SISCOPO Box 389DUBUQUE IA 52004-0389

CHECK BENEFIT CARD CHECK BENEFIT CARDSIZEMORE INCAffiliated With: NATIONAL CLAIMS ADMINISTRATIVE SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-489• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 490: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.(800) 284-2273

SJHAffiliated With: OSF HEALTHPLANS, INC.

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128

OSF HealthPlans, Inc. OSF HealthPlans, Inc.SJMCAffiliated With: OSF HEALTHPLANS, INC.

Fund No:PlanType: Group Health

OSF HealthPlans, Inc. OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

CHECK BENEFIT CARDSKF USA INCAffiliated With: ALLIED BENEFITS SYSTEMS

Fund No:PlanType: Group Health

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

ALLIED BENEFIT SYSTEMS, INCPO Box 909786CHICAGO IL 606090

THE LOOMIS COMPANY(800) 782-0392

CHECK BENEFIT CARDSKF USA INCORPORATEDAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(800) 782-0392

THE LOOMIS COMPANY850 N PARK RDWYOMISSING PA 19610

RISK REDUCTION INC GENEX SERVICES, INC.(800) 477-3502

SKILSTAF INCAffiliated With: SKILSTAF INC

Fund No:PlanType: Group Health

RISK REDUCTION INC RISK REDUCTION INCPO Box 729ALEXANDER CITY AL 35011

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-490• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 491: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

SKY RIVER MANAGEMENT, LLC TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

GISC, INC(800) 242-4472

TOTALCARE W / APS HEALTHCARE(866) 598-3973

Smart Management IncAffiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

GISC, INC(800) 242-4472

GISC, INCPO Box 9120MARSHFIELD MA 02050

PIONEER MANAGEMENT SYSTEMS(877) 868-9060

CHECK BENEFIT CARDSMITH COLLEGEAffiliated With: PIONEER MANAGEMENT SYSTEMS

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(877) 868-9060

PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01090

CHECK BENEFIT CARD CHECK BENEFIT CARDSMITH COLLEGE SPORTSAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDSMITH DETROIT DIESEL ALLISONAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-491• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 492: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TOWER LIFE INSURANCE(888) 830-4927

CHECK BENEFIT CARDSMITH INTERNATIONALAffiliated With: TOWER LIFE

Fund No:PlanType: Group Health

TOWER LIFE INSURANCE(888) 830-4927

TOWER LIFE INSURANCE310 S. ST. MARY'S STREET #400SAN ANTONIO TX 78205-3164

CORESOURCE INC(800) 624-7143

CORESOURCE INC(800) 480-6658

SMITH MEDIAAffiliated With: CORESOURCE, INC.

Fund No:PlanType: Group Health

CORESOURCE INC(800) 624-7143

CORESOURCE INCPO Box 2920CLINTON OH 52733-2920

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.(800) 284-2273

SMMCAffiliated With: OSF HEALTHPLANS, INC.

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128

HARRINGTON BENEFITS, DIV OF FISERV(602) 906-5042

FISERV HEALTH CARE MANAGEMENT(877) 294-7839

SNELL & WILMER, LLCAffiliated With: HARRINGTON BENEFIT SERVICES INC

Fund No:PlanType: Group Health

HARRINGTON BENEFITS, DIV OF FISERV(602) 906-5042

HARRINGTON BENEFITS, DIV OF FISERVPO Box 845PUEBLO CO 81002

SUPERIEN HEALTH NETWORK(800) 266-5896

CHECK BENEFIT CARDSO CAL BAKER & CONFECTIONARY UNION & INDUSTRY WELFARE FUND

Affiliated With: SUPERIEN HEALTH NETWORK #18373

Fund No:PlanType: Group Health

SUPERIEN HEALTH NETWORK(800) 266-5896

SUPERIEN HEALTH NETWORK

PO Box 2388 CSTOW OH 44224

Attn: Supervisor of the Claims Dept

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-492• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 493: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

CHECK BENEFIT CARDSODEXHO MANAGEMENTAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

CHECK BENEFIT CARD ADVANCED BENEFIT SOLUTIONS

SOLAR INDUSTRIESAffiliated With: ADVANCED BENEFIT SOLUTIONS LLC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERSolin USA

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(800) 293-3131

Solin USA520 N Semoran Blvd Ste 220Orlando FL 32807

CHECK BENEFIT CARD CHECK BENEFIT CARDSolo Voyager PlanAffiliated With: Cambridge Life Insurance Company

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERSOLUTIONS 4Affiliated With: MCMC LLC

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

MCMC LLC(888) 350-1150 Ext 228

MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-493• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 494: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MCMC LLC(888) 350-1150 Ext 228

MCMC LLC(888) 350-1150 Ext 228

Solutions4 - Nashvile AutoAffiliated With: MCMC LLC

Fund No:PlanType: Auto

MCMC LLC(888) 350-1150 Ext 228

MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317

CHECK BENEFIT CARD CHECK BENEFIT CARDSOLUTIONS4 AUTOAffiliated With: MCMC LLC

Fund No:PlanType: Auto

CHECK BENEFIT CARD MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDSOMA - STUDENT OSTEOPATHIC MEDICAL ASSOC 1

Affiliated With: UnitedHealthcare StudentResources #11689

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDSOMA - STUDENT OSTEOPATHIC MEDICAL ASSOC 2

Affiliated With: UnitedHealthcare StudentResources #11689

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDSOMA HIGH DEDUCTIBLE PLANAffiliated With: UnitedHealthcare StudentResources #11689

Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-494• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 495: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

American Administrative Group

IntraCorp(800) 538-5222

SONIC INDUSTRIES INCAffiliated With: AMERICAN ADMINISTRATIVE GROUP

Fund No:PlanType: Group Health

American Administrative Group

American Administrative GroupPO Box 93670LUBBOCK TX 79493-3670

ADVENTIST HEALTH SYSTEM WEST

CHECK BENEFIT CARDSONORA COMMUNITY HOSPITALAffiliated With: ADVENTIST HEALTH SYSTEM/WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM WEST

ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002

FISERV HEALTH INC(800) 235-7160

AVIDYN HEALTH(214) 647-6194

SOONER PHARMACY OF TISHOMINGO, INC

Affiliated With: FISERV HEALTH KANSAS - 11297

Fund No:PlanType: Group Health

FISERV HEALTH INC(800) 235-7160

FISERV HEALTH INCPO Box 520Pueblo CO 81002-0520

KLAIS & COMPANY INC(330) 867-8443

CHECK BENEFIT CARDSOPREMA, INCAffiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(330) 867-8443

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

CNIC HEALTH SOLUTIONS(800) 426-7453

CNIC HEALTH SOLUTIONS(800) 426-7453

SOS STAFFING SERVICES, INC. (COLORADE EEs-TRAVEL)

Affiliated With: CNIC HEALTH SOLUTIONS

Fund No:PlanType: Group Health

CNIC HEALTH SOLUTIONS(800) 426-7453

CNIC HEALTH SOLUTIONSPO Box 3559ENGLEWOOD CO 80155-3559

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-495• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 496: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ADVENTIST HEALTH SYSTEM WEST(800) 441-2524

CHECK BENEFIT CARDSOUTH COAST MEDICAL CENTERAffiliated With: ADVENTIST HEALTH SYSTEM WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM WEST(800) 441-2524

ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDSOUTH GEORGIA COLLEGE AIH0058437

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDSOUTH GEORGIA COLLEGE AIH0058447

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLESOUTH GEORGIA COLLEGE UNDERGRAD UNIVERSITY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

PIONEER MANAGEMENT SYSTEMS(413) 534-8658

UM NOT APPLICABLESouth Maine Community CollegeAffiliated With: PIONEER MANAGEMENT SYSTEMS

*

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(413) 534-8658

PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01089

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-496• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 497: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ADMINISTRATIVE CONCEPTS, INC.(610) 293-9229

CHECK BENEFIT CARDSOUTH UNIVERSITYAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS, INC.(610) 293-9229

ADMINISTRATIVE CONCEPTS, INC.

997 Old Eagle School Rd. #215WAYNE PA 19087-1706

Attn: Customer Service Dept

ADMINISTRATIVE CONCEPTS, INC.(610) 293-9229

CHECK BENEFIT CARDSOUTH UNIVERSITYAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS, INC.(610) 293-9229

ADMINISTRATIVE CONCEPTS, INC.

997 Old Eagle School Rd. #215WAYNE PA 19087-1706

Attn: Customer Service Dept

ADMINISTRATIVE CONCEPTS INC(610) 293-9229

UM NOT APPLICABLESOUTH UNIVERSITYAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS INC(610) 293-9229

ADMINISTRATIVE CONCEPTS INC

997 Old Eagle School Rd. #215WAYNE PA 19087-1706

Attn: Customer Service Dept

ECOM PPO ADVISORS, INC(828) 281-9000

CHECK BENEFIT CARDSOUTH VALLEY BANKAffiliated With: ECOM PPO ADVISORS INC

Fund No:PlanType: Group Health

ECOM PPO ADVISORS, INC(828) 281-9000

ECOM PPO ADVISORS, INC

8350 N. CENTRAL EXPWY, STE 600DALLAS TX 75206

Attn: ACCOUNTING

SOUTHERN BENEFIT ADMINISTRATORS INC(800) 831-4914

UM NOT APPLICABLESOUTHEASTERN CARPENTERS AND MILLWRIGHTS HEALTH TRUST

Affiliated With: SOUTHERN BENEFIT ADMINISTRATORS, INC

Fund No:PlanType: Group Health

SOUTHERN BENEFIT ADMINISTRATORS INC(800) 831-4914

SOUTHERN BENEFIT ADMINISTRATORS INC907 TWO MILE PKWY STE C-5GOODLETTSVILLE TN 37072

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-497• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 498: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERSoutheastern Claims Services IncAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

PRIMARY PHYSICIAN CARE(800) 446-5439

PRIMARY PHYSICIAN CARE(800) 582-7774

SOUTHEASTERN CONTAINERAffiliated With: PRIMARY PHYSICIANCARE INC

Fund No:PlanType: Group Health

PRIMARY PHYSICIAN CARE(800) 446-5439

PRIMARY PHYSICIAN CARE1515 SENECA MOCKINGBIRD LNCHARLOTTE NC 28220

CHECK BENEFIT CARD CHECK BENEFIT CARDSOUTHEASTERN LOUISIANA UNIVERSITY

Affiliated With: STUDENT ASSURANCE SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CI(817) 479-2115

CI(817) 479-2115

SOUTHER NAZARENE UNIVERSITY (STUDENTS)

Affiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 785-2446

TRUE CHOICEPO Box 700307DALLAS TX 75370

CHECK BENEFIT CARD CHECK BENEFIT CARDSOUTHERN CALIFORNIA INSTITUTE OF ARCHITECTURE

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-498• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 499: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SOUTHERN CALIFORNIA PIPE TRADES ADMIN(800) 595-7473

SOUTHERN CALIFORNIA PIPE TRADES ADMIN(213) 385-6161 Ext 268

SOUTHERN CALIFORNIA PIPE TRADES ADMIN CORP

Affiliated With: SOUTHERN CALIFORNIA PIPE TRADES ADMIN CORP

Fund No:PlanType: Group Health

SOUTHERN CALIFORNIA PIPE TRADES ADMIN(800) 595-7473

SOUTHERN CALIFORNIA PIPE TRADES ADMIN501 SHATTO PLACE 5TH FLOORLOS ANGELES CA 90020

ACORDIA NATIONAL(888) 685-7774

CHECK BENEFIT CARDSOUTHERN COUNCIL OF INDUSTRIAL WORKERS

Affiliated With: WELLS FARGO THIRD PARTY ADMINISTRATOR

Fund No:PlanType: Group Health

ACORDIA NATIONAL(888) 685-7774

ACORDIA NATIONAL602 VIRGINIA ST EASTCHARLESTON WV 25301

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDSOUTHERN NAZARENE UNIVERSITY - FACILITY AND EMPLOYEES

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

SOUTHERN NEVADA HCS CHECK BENEFIT CARDSOUTHERN NEVADA HCS 3193Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

SOUTHERN NEVADA HCS SOUTHERN NEVADA HCS

2455 W CHEYENNENORTH LAS VEGAS NV 89032

Attn: FEE 136C

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-499• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 500: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDSOUTHERN NEW ENGLAND SCHOOL OF LAW

Affiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

QVI RISK SOLUTIONS INC(541) 312-8512

INNOVATIVE CARE MANAGEMENT(800) 862-3338

SOUTHERN OREGON HEAD START

Affiliated With: QVI RISK SOLUTIONS INC

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

SOUTHERN OREGON REHAB CTR & CLINICS

CHECK BENEFIT CARDSOUTHERN OREGON REHAB CENTER & CLINICS 3117

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

SOUTHERN OREGON REHAB CTR & CLINICS

SOUTHERN OREGON REHAB CTR & CLINICS

8495 CRATER LAKE HWYWHITE CITY OR 97503

Attn: FEE 136C-7

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

SOUTHERN OREGON UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

CHECK BENEFIT CARD CHECK BENEFIT CARDSOUTHERN PAINTERS WELFARE FUND

Affiliated With: SOUTHERN PAINTERS WELFARE FUND

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-500• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 501: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDSOUTHERN POLYTECHNIC STATE UNIV AIH0058457

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLESOUTHERN POLYTECHNIC STATE UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDSOUTHWEST BAPTIST UNIVERSITY

Affiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

ASSURECARE(800) 968-6616

CHECK BENEFIT CARDSOUTHWEST BRAKEAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4050 HUNSACKER DR STE 110EAST LANSING MI 48823

CHECK BENEFIT CARD CHECK BENEFIT CARDSOUTHWEST CARPENTERS TRUST FUNDS

Affiliated With: SOUTHWEST CARPENTERS TRUST FUNDS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-501• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 502: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDSOUTHWEST ELECTRIC COMPANY

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

RESOURCEONE ADMINSTRATORS(800) 967-2077

MEDCAREONE CORP(800) 816-1206

SOUTHWEST ORTHOPAEDIC SPECIALIST PLLC

Affiliated With: RESOURCEONE ADMINISTRATORS

Fund No:PlanType: Group Health

RESOURCEONE ADMINSTRATORS(800) 967-2077

RESOURCEONE ADMINSTRATORS

PO Box 489BUCKEYSTOWN MD 21717

Attn: Mary Shepherd

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

SOUTHWEST SERVICES (TRAVEL)Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INC

SOUTHWEST SIGNAL ENGINEERING COMPANY

Affiliated With: PREFERRED BENEFIT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INCPO Box 916188LONGWOOD FL 32791-6188

CHECK BENEFIT CARD CHECK BENEFIT CARDSouthwestern BenefitsAffiliated With: Amalgamated Life Insurance Co.

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-502• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 503: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TRUE CHOICE(800) 251-9665

UM NOT APPLICABLESouthwestern Oklahoma StateAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 251-9665

TRUE CHOICEPO Box 700307DALLAS TX 75370

FCE BENEFIT ADMINISTRATORS(800) 899-9355

CHECK BENEFIT CARDSOUTHWESTERN SECURITY SERVICES, INC

Affiliated With: FCE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS(800) 899-9355

FCE BENEFIT ADMINISTRATORS4615 WALZEN RD STE 300SAN ANTONIO TX 78218

MERITAIN HEALTH(800) 844-7979

UM NOT APPLICABLESOUTHWESTERN VERMONT HEALTH CARE CORP.

Affiliated With: MERITAIN HEALTH

Fund No:PlanType: Group Health

MERITAIN HEALTH(800) 844-7979

MERITAIN HEALTH

PO Box 853921Richardson TX 75085-3921

Attn: Claims Dept

MIDWEST SECURITY ADMINISTRATORS INC(888) 672-4342

CHECK BENEFIT CARDSPACESAVER CORPORATIONAffiliated With: MIDWEST SECURITY ADMINISTRATORS INC

Fund No:PlanType: Group Health

MIDWEST SECURITY ADMINISTRATORS INC(888) 672-4342

MIDWEST SECURITY ADMINISTRATORS INC2700 Midwest Dr.ONALASKA WI 54650

First Health(800) 638-6589

CHECK BENEFIT CARDSpecial Agents Mutual Benefits Association (SAMBA)

Affiliated With: Special Agents Mutual Benefit Association (SAMBA)

Fund No:PlanType: Group Health

First Health(800) 638-6589

First HealthPO Box 8600London KY 40742

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-503• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 504: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

SPECIAL MARKETSAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARD(800) 525-8788

SPECIALIZED TECHNOLOGY RESOURCES JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

EBPA(802) 846-8060

CHECK BENEFIT CARDSPECIALIZED TECHNOLOGY RESOURCES WRAP JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

CHECK BENEFIT CARDSpecialty Accident SicknessAffiliated With: International Medical Group, Inc.

Fund No:PlanType: Group Health

International Medical Group, Inc.(317) 655-4500 Outside US (800) 628-4664 Inside US

International Medical Group, Inc.407 N Fulton StIndianapolis IN 46202-3684

The Hartford(800) 762-0666

CONTACT EMPLOYERSpecialty Risk Services (SRS)Affiliated With: Specialty Risk Services (SRS) #962500000

Fund No:PlanType: Workers' Compensation

The Hartford(800) 762-0666

The HartfordPO Box 4020Wheaton IL 60189

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-504• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 505: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Mountain States Administrative Services(520) 722-7133

Hines and Associates(847) 214-2780

SPELLMAN HARDWOODSAffiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

Mountain States Administrative Services(520) 722-7133

Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDSPELMAN COLLEGE AMH9023747Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2439Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDSPELMAN COLLEGE ICS AII9091697

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2439Florence SC 29503

CHECK BENEFIT CARD CHECK BENEFIT CARDSPINNAKER COATING LLCAffiliated With: MARSH ADVANTAGE AMERICA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

HEALTH NET FEDERAL SERVICES(916) 985-1259

CHECK BENEFIT CARDSPOKANE VAMC 3181Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(916) 985-1259

HEALTH NET FEDERAL SERVICES2025 AEROJET RDRANCHO CORDOVA CA 95742

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-505• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 506: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AMERIBEN SOLUTIONS(800) 786-7930

CHECK BENEFIT CARDSPORTSMANS WAREHOUSEAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

RESOURCEONE ADMINSTRATORS(800) 967-2077

MEDCAREONE CORP(800) 816-1206

Springdale Liquor AssociationAffiliated With: RESOURCEONE ADMINISTRATORS

*

Fund No:PlanType: Group Health

RESOURCEONE ADMINSTRATORS(918) 967-2077

RESOURCEONE ADMINSTRATORS

PO Box 489BUCKEYSTOWN MD 21717

Attn: Mary Shepherd

CHECK BENEFIT CARD CHECK BENEFIT CARDSRS Standard with QmedtrixAffiliated With: The Hartford SRS #962500000

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDSRS Standard without QmedtrixAffiliated With: The Hartford SRS #962500000

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

CHECK BENEFIT CARD CHECK BENEFIT CARD

FMH BENEFIT SERVICES INC(800) 990-9058

CHECK BENEFIT CARDSSM HEALTH CAREAffiliated With: FMH BENEFIT SERVICES INC

Fund No:PlanType: Group Health

FMH BENEFIT SERVICES INC(800) 990-9058

FMH BENEFIT SERVICES INCPO Box 25946OVERLAND PARK KS 66225-5946

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-506• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 507: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ST CLOUD VA MEDICAL CENTER

CHECK BENEFIT CARDST CLOUD VA MEDICAL CENTER 3705

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

ST CLOUD VA MEDICAL CENTER

ST CLOUD VA MEDICAL CENTER

4801 VETERANS DRIVEST CLOUD MN 56303

Attn: FEE BASIS 136F

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDST EDWARDS UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

ADVENTIST HEALTH SYSTEM/WEST(800) 441-2524

CHECK BENEFIT CARDST HELENAL HOSPITAL EXCLUSIVE

Affiliated With: ADVENTIST HEALTH SYSTEM/WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM/WEST(800) 441-2524

ADVENTIST HEALTH SYSTEM/WEST2100 DOUGLASROSEVILLE CA 95661

GISC, INC(800) 242-4472

TOTALCARE W / APS HEALTHCARE(866) 598-3973

ST JOHNSBURY ACADEMYAffiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

GISC, INC(800) 242-4472

GISC, INCPO Box 9120MARSHFIELD MA 02050

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

ST JOSEPH CATHOLIC ORPHANAGE

Affiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-507• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ST LOUIS VA MEDICAL CENTER

CHECK BENEFIT CARDST LOUIS VAMEDICAL CENTER 3528

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

ST LOUIS VA MEDICAL CENTER

ST LOUIS VA MEDICAL CENTER

ONE JEFFERSON BARRACKS DRST LOUIS MO 63125

Attn: FEE BASIS 04FJB

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDST MARY'S UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

ADVENTIST HEALTH SYSTEM WEST

CHECK BENEFIT CARDST. HELENA HOSPITAL PPOAffiliated With: ADVENTIST HEALTH SYSTEM/WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM WEST

ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002

PRIMARY PHYSICIANCARE, INC.(800) 446-5439

CHECK BENEFIT CARDSTABILUS, INCAffiliated With: PRIMARY PHYSICIANSCARE INC

Fund No:PlanType: Group Health

PRIMARY PHYSICIANCARE, INC.(800) 446-5439

PRIMARY PHYSICIANCARE, INC.PO Box 11088CHARLOTTE NC 28220

SOVEREIGN SOLUTIONS, LLC(229) 382-1360

MedWatch(800) 432-8421

STAFFORD DEVELOPMENTAffiliated With: SOVEREIGN SOLUTIONS LLC

Term Effective: 3/31/2008Fund No:PlanType: Group Health

SOVEREIGN SOLUTIONS, LLC(229) 382-1360

SOVEREIGN SOLUTIONS, LLC1805 U.S. HIGHWAY 82 WESTTIFTON GA 31794

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-508• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

STANDARD PLUMBINGAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

Benefits/Eligibility(800) 843-3106

CHECK BENEFIT CARD(800) 522-2161

Standard Security Life Insurance Company of New York

Affiliated With: Insurers Administrative Corporation #962500302

Fund No:PlanType: Group Health

Benefits/Eligibility(800) 843-3106

Benefits/EligibilityPO Box 828Park Ridge IL 60068-0828

Insurers Administrative Corporation (IAC)(800) 843-3106

Med-Valu(800) 522-2161

STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK

Affiliated With: INSURERS ADMINISTRATIVE CORPORATION #11337

Fund No:PlanType: Group Health

Insurers Administrative Corporation (IAC)(800) 843-3106

Insurers Administrative Corporation (IAC)PO Box 828Park Ridge IL 60068-0828

CHECK BENEFIT CARD CHECK BENEFIT CARDSTAR AFFORDABLE HEALTH BENEFITS

Affiliated With: STAR HEALTHCARE NETWORK INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-509• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 510: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

STAR HEALTHCARE NETWORK(212) 581-8228

UM NOT APPLICABLESTAR HEALTHCARE NETWORK INC

Affiliated With: STAR HEALTHCARE NETWORK INC

*

Fund No:PlanType: Group Health

STAR HEALTHCARE NETWORK(212) 581-8228

STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019

CHECK BENEFIT CARD CHECK BENEFIT CARDSTAR RELIABLE LIFEAffiliated With: STAR HEALTHCARE NETWORK INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(800) 877-3727

CRITIQUE(800) 666-5551

STAR VALLEY MEDICAL CENTERAffiliated With: MANAGED BENEFITS ADMIN. & INSURANCE CONSULTANTS

Fund No:PlanType: Group Health

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(800) 877-3727

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS3625 S WEST TEMPLE STE 200SALT LAKE CITY UT 84115

CHECK BENEFIT CARD CHECK BENEFIT CARDSTARMARKAffiliated With: STARMARK

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CompIQ Corporation(800) 293-3131

UM NOT APPLICABLESTARR COMPREHENSIVE SOLUTIONS, INC

Affiliated With: COMP IQ

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(800) 293-3131

CompIQ Corporation35 Tesla Way #100Irvine CA 92618

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-510• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDState Auto Insurance CompanyAffiliated With: State Auto Insurance Company

Fund No:PlanType: Auto

CHECK BENEFIT CARD CHECK BENEFIT CARD

State Farm California(818) 707-5317

State Farm California(818) 707-5317

State Farm CaliforniaAffiliated With: State Farm Fire and Casualty Company

Fund No:PlanType: Workers' Compensation

State Farm California(818) 707-5317

State Farm Fire and Casualty Company31303 Agoura RdWestlake Village CA 91363-4635

State Farm Workers' Compensation Claim Department(309) 763-0126

State Farm Workers' Compensation Claim Department(309) 763-0126

State Farm Fire and Casualty Company

Affiliated With: State Farm Fire and Casualty Company

Fund No:PlanType: Workers' Compensation

State Farm Workers' Compensation Claim Department(309) 763-0126

CONTACT EMPLOYER

Attn:

State Farm Fire and Casualty Company(863) 318-3563

State Farm Fire and Casualty Company(863) 318-3563

State Farm FloridaAffiliated With: State Farm Fire and Casualty Company

Fund No:PlanType: Workers' Compensation

State Farm Fire and Casualty Company(863) 318-3563

State Farm Fire and Casualty Company7401 Cypress Gardens BlvdWinter Haven FL 33888

State Farm Hawaii(512) 918-5608

State Farm Hawaii(512) 918-5608

State Farm HawaiiAffiliated With: State Farm Fire and Casualty Company

Fund No:PlanType: Workers' Compensation

State Farm Fire and Casualty Company(512) 918-5608

State Farm Fire and Casualty Company8900 Amberglen BlvdAustin TX 78729-1110

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-511• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 512: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

State Farm Health Insurance - Policy #05(707) 584-6688

CHECK BENEFIT CARDState Farm Individual Policy HoldersAffiliated With: State Farm Individual Policy Holders

Fund No:PlanType: Group Health

State Farm Health Insurance - Policy #05(707) 584-6672 (800) 845-6592 ECS Help Desk

State Farm Health Insurance - Policy #05PO Box 8629Scottsdale AZ 85252-8629

State Farm Fire and Casualty Company(800) 427-1160

CONTACT EMPLOYERState Farm LouisianaAffiliated With: State Farm Fire and Casualty Company

Fund No:PlanType: Workers' Compensation

State Farm Fire and Casualty Company(800) 427-1160

State Farm Fire and Casualty CompanyPO Box 11980Monroe LA 71211-1980

CONTACT EMPLOYER CONTACT EMPLOYERState Farm New JerseyAffiliated With: State Farm Fire and Casualty Company

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

State Farm Fire and Casualty Company(512) 918-5608

State Farm Fire and Casualty Company(512) 918-5608

State Farm TexasAffiliated With: State Farm Fire and Casualty Company

Fund No:PlanType: Workers' Compensation

State Farm Fire and Casualty Company(512) 918-5608

State Farm Fire and Casualty Company8900 Amberglen BlvdAustin TX 78729-1110

GLOBALHEALTH(405) 280-5600

GLOBALHEALTH(405) 230-8781

State of OklahomaAffiliated With: GLOBALHEALTH AND GENERATION HEALTHCARE

Fund No:PlanType: Group Health

GLOBALHEALTH(405) 280-5600

GLOBALHEALTH7001 NE 10th StOklahoma City OK 73104

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-512• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 513: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FairPay Solutions(972) 715-8000

FairPay Solutions(972) 715-8000

State of VermontAffiliated With: FairPay Solutions, Inc.

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

FairPay Solutions(972) 715-8000

FairPay Solutions

14295 Midway Rd Ste 300Addison TX 75001

Attn: Jon Peebles

STAR HEALTHCARE NETWORK(212) 581-8228

CHECK BENEFIT CARDSTAYWELL HEALTH PLANAffiliated With: STAR HEALTHCARE NETWORK INC

*

Fund No:PlanType: Group Health

STAR HEALTHCARE NETWORK(212) 581-8228

STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019

SRT ADMINISTRATORS, INC.

CHECK BENEFIT CARDSTEPHENS MEDIA GROUPAffiliated With: SRT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

SRT ADMINISTRATORS, INC.

SRT ADMINISTRATORS, INC.PO Box 25160SCOTTSDALE AZ 85255-0102

CONTACT EMPLOYER CONTACT EMPLOYERSterling Administrators / Goff MGAAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

THE LOOMIS COMPANY(877) 634-9814

CHECK BENEFIT CARDSTERLING MEDICAL CORPORATION

Affiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(877) 634-9814

THE LOOMIS COMPANYPO Box 7045WYOMISSING PA 19610

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-513• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 514: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HCH ADMINISTRATORS(309) 282-1288

CHECK BENEFIT CARDSTEWART BROTHERS DRILLINGAffiliated With: HEALTH DATA SERVICES

Fund No:PlanType: Group Health

HCH ADMINISTRATORS(309) 282-1288

HCH ADMINISTRATORSPO Box 285PEORIA IL 61650

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 460-0238

STILLWATER DESIGNSAffiliated With: WATERSTONE BENEFITS ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

CHECK BENEFIT CARDSTILLWATER MEDICAL CENTERAffiliated With: WATERSTONE BENEFITS ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

BENEFIT ADMINISTRATIVE SYSTEMS(708) 647-3434

CHECK BENEFIT CARDSTOCKMAN'S BANKAffiliated With: AMERICAN TRUST ADMINISTRATORS

Fund No:PlanType: Group Health

BENEFIT ADMINISTRATIVE SYSTEMS(708) 647-3434

BENEFIT ADMINISTRATIVE SYSTEMS17475 JOVANNA DRHOMEWOOD IL 60430

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

STOCKYARD BANKAffiliated With: PREFERRED HEALTH PLAN INC 962550088

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(502) 992-4535

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-514• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDSTONEHILL COLLEGE SPORTSAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

KLAIS & COMPANY INC(800) 331-1096

CHECK BENEFIT CARDSTONEHILL UNIVERSITYAffiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(800) 331-1096

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

StrataCare Inc StrataCare IncSTRATACAREAffiliated With: STRATACARE

Fund No:PlanType: Workers' Compensation

Some service groups include, Interplan and/or MPN Select or MPN Primary in CA,

StrataCare Inc StrataCare Inc16800 Aston 2nd FloorIrvine CA 92606

THE LOOMIS COMPANY(866) 340-7182

UM NOT APPLICABLESTRINE PRINTINGAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(866) 340-7182

THE LOOMIS COMPANY850 N PARK RDWYOMISSING PA 19610

AMERICA'S CHOICE HEALTHPLANS, LLC(713) 895-3900

CHECK BENEFIT CARDSTURNER AND KLEINAffiliated With: AMERICA'S CHOICE HEALTHPLANS, LLC

Fund No:PlanType: Group Health

AMERICA'S CHOICE HEALTHPLANS, LLC(713) 895-3900

AMERICA'S CHOICE HEALTHPLANS, LLC13111 Northwest Fwy, Ste 510Houston TX 77040

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-515• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERSuffolkAffiliated With: New York State Insurance Fund

*

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CHECK BENEFIT CARD CHECK BENEFIT CARDSUFFOLK UNIVERSITY SPORTSAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

WAUSAU BENEFITS, INC.(715) 841-7802

CHECK BENEFIT CARDSUMMIT ELECTRIC SUPPLY COMPANY INC

Affiliated With: WAUSAU BENEFITS INC

Fund No:PlanType: Group Health

WAUSAU BENEFITS, INC.(715) 841-7802

WAUSAU BENEFITS, INC.

PO Box 8046WAUSAU WI 54401-8046

Attn: LeAnn Fichtner

PREFERRED BENEFIT ADMINISTRATORS(407) 786-2777

CHECK BENEFIT CARDSun Coast Media GroupAffiliated With: PREFERRED BENEFIT ADMINISTRATORS INC

*

Fund No:PlanType: Group Health

PREFERRED BENEFIT ADMINISTRATORS(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORSPO Box 916188LONGWOOD FL 32791-6188

America's TPA(952) 896-4888

CHECK BENEFIT CARDSUN COUNTY AIRLINESAffiliated With: AMERICA'S TPA

Fund No:PlanType: Group Health

America's TPA(952) 896-4888

America's TPAPO Box 398220Bloomington MN 55439

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-516• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SCHALLER ANDERSON HEALTHCARE LLC(866) 479-1130

SCHALLER ANDERSON HEALTHCARE LLC(866) 479-1130

SUN HEALTHAffiliated With: SCHALLER ANDERSON HEALTHCARE

Fund No:PlanType: Group Health

SCHALLER ANDERSON HEALTHCARE LLC(866) 479-1130

SCHALLER ANDERSON HEALTHCARE LLCPO Box 60850Phoenix AZ 85082

DELTA HEALTH SYSTEMS(800) 422-6099

UM NOT APPLICABLESUN PACIFICAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(800) 422-6099

DELTA HEALTH SYSTEMS555 W Benjamin Holt DrStockton CA 95207

PINNACLE CLAIMS MANAGEMENT

CHECK BENEFIT CARDSUN PACIFIC FARMINGAffiliated With: PINNACLE CLAIMS MANAGEMENT

Fund No:PlanType: Group Health

PINNACLE CLAIMS MANAGEMENT

PINNACLE CLAIMS MANAGEMENT17620 FITCH STIRVINE CA 92614

TRIDENT PLAN ADMINISTRATORS(602) 240-2404

CHECK BENEFIT CARDSUN VALLEY MASONRY, INC.Affiliated With: UNITED CLAIMS SOLUTIONS

Fund No:PlanType: Group Health

TRIDENT PLAN ADMINISTRATORS(602) 240-2404

TRIDENT PLAN ADMINISTRATORS5045 N 12TH St Ste APhoenix AZ 85014

PPC(800) 446-5439

PRIMARY PHYSICIANCARE, INC.7045232758

SUNBELT RENTALSAffiliated With: PRIMARY PHYSICIANSCARE INC

Fund No:PlanType: Group Health

PPC(800) 446-5439

PPCPO Box 11088CHARLOTTE NC 28220

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-517• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDSUNMEDAffiliated With: STAR HEALTHCARE NETWORK INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDSUNRISE CREATIVE GROUP INCAffiliated With: BENESIGHT

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SUNVIEW VINEYARDS OF CALIFORNIA(661) 725-6662

SUNVIEW VINEYARDS OF CALIFORNIA

SUNVIEW VINEYARDS OF CALIFORNIA

Affiliated With: SUNVIEW VINEYARDS OF CALIFORNIA

Fund No:PlanType: Group Health

SUNVIEW VINEYARDS OF CALIFORNIA(661) 725-6662

SUNVIEW VINEYARDS OF CALIFORNIA1998 Road 152DELANO CA 93215

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

SUPERIOR FEDERAL CREDIT UNION (SFCU)

Affiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

CHECK BENEFIT CARDSUPERIOR JANITORIALAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-518• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ADMINONE CORPORATION(800) 967-2077

MEDCARE ONE INC(800) 816-1206

SURGERY CENTER OF OKLAHOMA

Affiliated With: ADMINONE CORPORATION

Fund No:PlanType: Group Health

ADMINONE CORPORATION(800) 967-2077

RESOURCEONE ADMINSTRATORS

PO Box 489BUCKEYSTOWN MD 21717

Attn: Mary Shepherd

BENEFIT CONCEPTS, INC.(610) 337-2600

CHECK BENEFIT CARDSURGICAL MONITORING SERVICES INC

Affiliated With: BENEFIT CONCEPTS INC

Fund No:PlanType: Group Health

BENEFIT CONCEPTS, INC.(610) 337-2600

BENEFIT CONCEPTS, INC.PO Box 61553KING OF PRUSSIA PA 19406

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

SW RESOURCES INCAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 869-7093 Ext 117

HEALTHCARE MANAGEMENT ADMINISTRATORS(425) 289-5142

SWANSON GROUP INCAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC

Fund No:PlanType: Group Health

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 869-7093 Ext 117

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.PO Box 85008BELLEVUE WA 98015

CHECK BENEFIT CARD CHECK BENEFIT CARDSWEETWATER COUNTY SCHOOL DISTRICT

Affiliated With: BENESIGHT INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-519• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Broadspire(860) 282-4960

CONTACT EMPLOYERSwiss ReAffiliated With: Swiss Re

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

Broadspire(860) 282-4960

First HealthPO Box 5318Tampa FL 33675-5318

CONTACT EMPLOYER CONTACT EMPLOYERSyracuseAffiliated With: New York State Insurance Fund

*

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

SYRACUSE CHINA - ACTIVEAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

SYRACUSE CHINA - RETIREDAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

HEALTH NET FEDERAL SERVICES(972) 550-2836

UM NOT APPLICABLESYRACUSE FEE BASISAffiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

HEALTH NET FEDERAL SERVICES(972) 550-2836

SYRACUSE FEE BASIS

113 HOLLAND AVEALBANY NY 12208

Attn: FEE BASIS 136E

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-520• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SYRACUSE VAMC CHECK BENEFIT CARDSYRACUSE VAMC 3199Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

SYRACUSE VAMC SYRACUSE VAMC

800 IRVING AVESYRACUSE NY 13210

Attn: FEE BASIS 04

FLORIDA HEALTH ADMINISTRATORS(954) 366-0111

DELPHI(727) 573-5737

SYSTEMAX, INCAffiliated With: FLORIDA HEALTH ADMINISTRATORS (FHA)

Fund No:PlanType: Group Health

FLORIDA HEALTH ADMINISTRATORS(954) 366-0111

FLORIDA HEALTH ADMINISTRATORSPO Box 327810Fort Lauderdale FL 33332

WEB TPA(888) 898-2432

AVIDYN HEALTH(800) 580-0293

TACO BUENO RESTAURANTSAffiliated With: WEB TPA

Fund No:PlanType: Group Health

WEB TPA(888) 898-2432

WEB TPAPO Box 539508GRAND PRAIRIE TX 75053

America's TPA(866) 478-6268

CHECK BENEFIT CARDTAHERAffiliated With: AMERICAS TPA

Fund No:PlanType: Group Health

America's TPA(866) 478-6268

America's TPAPO Box 398220Bloomington MN 55439

C.L. FRATES AND COMPANY(405) 290-5696

CHECK BENEFIT CARDTAHLEQUAH CITY HOSPITALAffiliated With: C L FRATES & COMPANY

Fund No:PlanType: Group Health

C.L. FRATES AND COMPANY(405) 290-5696

C.L. FRATES AND COMPANYPO Box 26967OKLAHOMA CITY OK 73126-0967

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-521• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

TAHOE BILTMORE LODGE & CASINO % OF SAVINGS - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

TAHOE BILTMORE LODGE & CASINO PEPM

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

DELTA HEALTH SYSTEMS CHECK BENEFIT CARDTAHOE FOREST HOSPITALAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS DELTA HEALTH SYSTEMSPO Box 1147STOCKTON CA 95201

CHECK BENEFIT CARD CHECK BENEFIT CARDTAHOE TRUCKEE SIERRA DISPOSAL COMPANY

Affiliated With: CAPITOL ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

STAR HEALTHCARE NETWORK(212) 581-8228

UM NOT APPLICABLETAKECARE INSURANCE COMPANY

Affiliated With: STAR HEALTHCARE NETWORK INC

Fund No:PlanType: Group Health

STAR HEALTHCARE NETWORK(212) 581-8228

STAR HEALTHCARE NETWORK850 Seventh Ave STE 803New York NY 10019

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-522• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD4194233823

CHECK BENEFIT CARDTALBOT AGENCY INCAffiliated With: ADVANCED BENEFIT RESOURCES CORP

Fund No:PlanType: Group Health

CHECK BENEFIT CARD4194233823

CHECK BENEFIT CARD

TAMPA VAMC CHECK BENEFIT CARDTAMPA VAMC 3141Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

TAMPA VAMC TAMPA VAMC10770 NORTH 46TH STTAMPA FL 33617

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

TANNER MEMORIAL CLINIC

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

GROUP & PENSION ADMINISTRATORS(972) 238-7900

CHECK BENEFIT CARDTANOX INCAffiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(972) 744-2311

GROUP & PENSION ADMINISTRATORSPO Box 749075DALLAS TX 75374-9075

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

TATE & SNYDER ARCHITECTSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-523• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SMITH ADMINISTRATORS, INC.(801) 261-5511

SERVICE ADVOCATES(801) 261-5511

TAYLORS UNITED AUTO GROUPAffiliated With: SMITH ADMINISTRATORS INC

Fund No:PlanType: Group Health

SMITH ADMINISTRATORS, INC.(801) 261-5511

SMITH ADMINISTRATORS, INC.3761 S 700 E SUITE 202SALT LAKE CITY UT 84106

EBA&M(800) 776-1545

HINES & ASSOCIATES(800) 528-2498

TBP ARCHITECTUREAffiliated With: EBA&M #10160

Fund No:PlanType: Group Health

EBA&M(800) 776-1545

EBA&MPO Box 5079WESTLAKE VILLAGE CA 91359

CENBEN USA(614) 797-5204

CHECK BENEFIT CARDTC CONSTRUCTIONAffiliated With: CENBEN USA INC

Fund No:PlanType: Group Health

CENBEN USA(614) 797-5204

CENBEN USA

4079 Executive PkwyWesterville OH 43081

Attn: Melissa Joseph

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

TED WIENS TIRE & AUTO CENTERS TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

TEMPLE VAMC CHECK BENEFIT CARDTEMPLE VAMC 3167Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

TEMPLE VAMC TEMPLE VAMC

1901 VETERANS MEMORIAL DRTEMPLE TX 76504

Attn: MED ACCT MGT SECT

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-524• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CBCA Administrators Inc CBCA Administrators IncTENDER LOVING CARE HEALTH CARE SERVICES

Affiliated With: CBCA Administrators, Inc.

Fund No:PlanType: Group Health

CBCA Administrators Inc CBCA Administrators IncPO Box 9000LONDON KY 40742

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

CHECK BENEFIT CARDTERO TEK INTERNATIONAL INCAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

TERRA CONTRACTINGAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

WAUSAU BENEFITS, INC.(715) 841-7802

CHECK BENEFIT CARDTERRACON INCAffiliated With: WAUSAU BENEFITS INC

Fund No:PlanType: Group Health

WAUSAU BENEFITS, INC.(715) 841-7802

WAUSAU BENEFITS, INC.

PO Box 8046WAUSAU WI 54401-8046

Attn: LeAnn Fichtner

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

TERRIBLE HERBSTAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-525• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

THE LOOMIS COMPANY(800) 346-1223

SIERRA HEALTH OPTIONS(800) 873-5791

TERRIBLE HERBSTAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(800) 346-1223

THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011

BOON CHAPMAN(800) 252-9653

CHECK BENEFIT CARDTETRA Technologies Inc.Affiliated With: BOON CHAMPMAN

*

Term Effective: 12/31/2007Fund No:PlanType: Group Health

BOON CHAPMAN(800) 252-9653

BOON CHAPMANPO Box 9201AUSTIN TX 78766

American Administrative Group(800) 658-9777

American Administrative Group(877) 202-6379 Ext 2530

TEXAS AGRICULTURAL COOPERATIVE TRUST

Affiliated With: AMERICAN ADMINISTRATIVE GROUP

Fund No:PlanType: Group Health

American Administrative Group(800) 658-9777

American Administrative GroupPO Box 53070LUBBOCK TX 79453

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDTEXAS WESLEYAN UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDTEXAS WOMAN'S UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-526• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 527: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDTextile Staff FundAffiliated With: Amalgamated Life Insurance Co.

Fund No:PlanType: Group Health

CHECK BENEFIT CARD ALICOPO Box 1449New York NY 10116-1449ECS Payor ID 13550

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLETHE ARC OF SAN DIEGOAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 742-7345

THE ASTORIA CORPORATION - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

FISERV HEALTH INC(866) 868-8230

FISERV HEALTH INC(866) 868-8230

THE BAMA COMPANIESAffiliated With: FISERV HEALTH

Fund No:PlanType: Group Health

FISERV HEALTH INC(866) 868-8230

FISERV HEALTH INCPO Box 690450SAN ANTONIO TX 78269

HEALTHCARE SOLUTIONS GROUP, INC.(800) 749-1422

CHECK BENEFIT CARDTHE BEACH GROUP INCAffiliated With: HEALTHCARE SOLUTIONS GROUP INC

Fund No:PlanType: Group Health

HEALTHCARE SOLUTIONS GROUP, INC.(800) 749-1422

HEALTHCARE SOLUTIONS GROUP, INC.PO Box 1309MUSKOGEE OK 74402

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-527• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 528: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBC(800) 342-1407

CHECK BENEFIT CARDTHE BOLDT COMPANYAffiliated With: EMPLOYEE BENEFIT CONSULTANTS

Fund No:PlanType: Group Health

EBC(800) 342-1407

EBCPO Box 884APPLETON WI 54912

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

MED-CERT(800) 356-7126

THE BRINK GROUPAffiliated With: NORTH AMERICA ADMINISTRATORS LP TENNESSEE

Fund No:PlanType: Group Health

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

GROUP INSURANCE SERVICE CENTER, INC(800) 242-4472

GISC TOTALCARE(866) 598-3973

THE CADMUS GROUPAffiliated With: GROUP INSURANCE SERVICE CENTER INC

Fund No:PlanType: Group Health

GROUP INSURANCE SERVICE CENTER, INC(800) 242-4472

GROUP INSURANCE SERVICE CENTER, INCPO Box 9120MARSHFIELD MA 02050

PRIMARY PHYSICIANCARE, INC.(800) 446-5439

PRIMARY PHYSICIANCARE, INC.(800) 446-5439

THE CATO CORPORATIONAffiliated With: RRIMARY PHYSICIANCARE INC

Fund No:PlanType: Group Health

PRIMARY PHYSICIANCARE, INC.(800) 446-5439

PRIMARY PHYSICIANCARE, INC.PO Box 11088CHARLOTTE NC 28220

EPOCH GROUP LC(800) 255-6065

UM NOT APPLICABLETHE CBE GROUPAffiliated With: THE EPOCH GROUP

Fund No:PlanType: Group Health

EPOCH GROUP LC(800) 255-6065

EPOCH GROUP LCPO Box 12170OVERLAND PARK KS 66282

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-528• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

CHECK BENEFIT CARDTHE CHILDREN CENTERAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORSPO Box 42096Oklahoma City OK 73123-3096

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDTHE CHILDRENS PLACE RETAIL STORES INC

Affiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDTHE CITADELAffiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 722-1668

PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437

PROFESSIONAL CLAIMS MGMT(800) 590-6500

CHECK BENEFIT CARDTHE CITY OF EAST CHICAGOAffiliated With: PROFESSIONAL CLAIMS MANAGEMENT

Fund No:PlanType: Group Health

PROFESSIONAL CLAIMS MGMT(800) 590-6500

PROFESSIONAL CLAIMS MGMT16 W 455 S FRONTGATE RD STE 216BURR RIDGE IL 60527

PROFESSIONAL CLAIMS MGMT(800) 590-6500

CHECK BENEFIT CARDTHE CITY OF HAMMONDAffiliated With: PROFESSIONAL CLAIMS MANAGEMENT

Fund No:PlanType: Group Health

PROFESSIONAL CLAIMS MGMT(800) 590-6500

PROFESSIONAL CLAIMS MGMT16 W 455 S FRONTGATE RD STE 216BURR RIDGE IL 60527

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-529• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 530: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ACS BENEFIT SERVICES, INC.(800) 255-6065

CHECK BENEFIT CARDTHE ENCORE GROUPAffiliated With: ACS BENEFIT SERVICES, INC

Fund No:PlanType: Group Health

ACS BENEFIT SERVICES, INC.(800) 849-5370

ACS BENEFIT SERVICES, INC.PO Box 2000Winston-Salem SC 27102

FISERV HEALTH KANSAS(800) 235-7160

AVIDYN HEALTH(866) 802-1328

THE FIRST NATIONAL OF FLETCHER

Affiliated With: FISERV HEALTH KANSAS - 11297

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS(800) 235-7160

FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

THE GREENSPUN CORPORATIONAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

THE LOOMIS COMPANY(800) 346-1223

UM NOT APPLICABLETHE HERBST GAMING MIDWEST CASINOS

Affiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(800) 346-1223

THE LOOMIS COMPANYPO Box 7011WYOMISSING PA 19610-6011

EMPLOYEE BENEFITS ADMINISTRATION & MGMT. (EBA&M)(800) 249-8440

HINES & ASSOCIATES(800) 787-5361

THE J DAVID GLADSTONE INSTITUTES

Affiliated With: EMPLOYEE BENEFITS ADMIN. & MANAGEMENT (EBA&M)

Fund No:PlanType: Group Health

EMPLOYEE BENEFITS ADMINISTRATION & MGMT. (EBA&M)(800) 249-8440

EMPLOYEE BENEFITS ADMINISTRATION & MGMT. (EBA&M)PO Box 5079WESTLAKE VILLAGE CA 91359

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-530• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 531: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

THE KEENEY MANUFACTURING COMPANY

Affiliated With: DIVERSIFIED ADMINISTRATION CORPORATION

Fund No:PlanType: Group Health

DIVERSIFIED ADMINISTRATION CORPORATION(888) 322-2524

DIVERSIFIED ADMINISTRATION CORPORATIONPO Box 299MARLBOROUGH CT 06447

CHECK BENEFIT CARD CHECK BENEFIT CARDTHE KEMPTON CO ADVANTAGE HEALTH PLANS

Affiliated With: NATIONAL HEALTH BENEFIT CORPORATION (NHBC)

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

WAUSAU BENEFITS, INC.(715) 841-7802

CHECK BENEFIT CARDTHE KEMTAH GROUP INCAffiliated With: WAUSAU BENEFITS INC

Fund No:PlanType: Group Health

WAUSAU BENEFITS, INC.(715) 841-7802

WAUSAU BENEFITS, INC.

PO Box 8046WAUSAU WI 54401-8046

Attn: LeAnn Fichtner

CHECK BENEFIT CARD CHECK BENEFIT CARDTHE LAYTON COMPANIESAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

THE LIFELINE HEALTH GROUPAffiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(502) 992-4535

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-531• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 532: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Health Design Plus(877) 286-3559

Health Design Plus(800) 385-7085

THE LONGABERGER COMPANY - PRIMARY

Affiliated With: HEALTH DESIGN PLUS

Fund No:PlanType: Group Health

Health Design Plus(330) 463-1181

Health Design Plus1755 GEORGETOWN ROADHUDSON OH 44236

Health Design Plus(877) 286-3559

Health Design Plus(800) 385-7085

THE LONGABERGER COMPANY - WRAP

Affiliated With: HEALTH DESIGN PLUS

Fund No:PlanType: Group Health

Health Design Plus(330) 463-1181

Health Design Plus1755 GEORGETOWN ROADHUDSON OH 44236

Health Design Plus(800) 893-0777

Health Design Plus(888) 463-3737

THE LUBRIZOL CORPORATIONAffiliated With: HEALTH DESIGN PLUS

Fund No:PlanType: Group Health

Health Design Plus(800) 893-0777

Health Design PlusPO Box 2581HUDSON OH 44236

THE LOOMIS COMPANY(866) 473-6615

CHECK BENEFIT CARDThe Medical TeamAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(866) 473-6615

THE LOOMIS COMPANY850 N PARK RDWYOMISSING PA 19610

Health Design Plus(877) 286-3559

Health Design Plus(800) 385-7085

THE MIDLAND GUARDIAN COMPAN - PRIMARY

Affiliated With: HEALTH DESIGN PLUS

Fund No:PlanType: Group Health

Health Design Plus(877) 286-3559

Health Design Plus1755 GEORGETOWN ROADHUDSON OH 44236

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-532• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 533: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Health Design Plus(877) 286-3559

Health Design Plus(800) 385-7085

THE MIDLAND GUARDIAN COMPANY TRAVEL

Affiliated With: HEALTH DESIGN PLUS

Fund No:PlanType: Group Health

Health Design Plus(877) 286-3559

Health Design Plus1755 GEORGETOWN ROADHUDSON OH 44236

SUPERIOR ADMINISTRATORS, INC.(714) 429-1700

CHECK BENEFIT CARDTHE MOBILE SOLUTION CORPORATION

Affiliated With: SUPERIOR ADMINISTRATORS INC

Fund No:PlanType: Group Health

SUPERIOR ADMINISTRATORS, INC.(714) 429-1700

SUPERIOR ADMINISTRATORS, INC.3720 SOUTH SUSAN ST STE 200SANTA ANA CA 92704

COASTAL TPA, INC.(800) 564-7475

CYPRESS MEDICAL NETWORK(831) 657-2600

THE MONTEREY PLAZA HOTEL & SPA-CCN PRIME

Affiliated With: COASTAL TPA, INC.

Fund No:PlanType: Group Health

COASTAL TPA, INC.(800) 564-7475

COASTAL TPA, INC.PO Box 80308SALINAS CA 93912

EQUITABLE PLAN SERVICES(405) 755-2929

CHECK BENEFIT CARDTHE MUNDY COMPANIESAffiliated With: EQUITABLE PLAN SERVICES #962501270

Fund No:PlanType: Group Health

EQUITABLE PLAN SERVICES(405) 755-2929

EQUITABLE PLAN SERVICES12312 ST ANDREWS DROKLAHOMA CITY OK 73172

TRUSTMARK INSURANCE CO(800) 544-7312

PHS(800) 253-4417

THE PAPER TIGERSAffiliated With: TRUSTMARK INS CO #962500650

Fund No:PlanType: Group Health

TRUSTMARK INSURANCE CO

TRUSTMARK INSURANCE COPO Box 2942CLINTON IA 52733

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-533• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

JSL ADMINISTRATORS, INC.(770) 683-1050

DOCTORS DIRECT HEALTHCARE(877) 503-0388

THE PARK AVENUE BANKAffiliated With: JSL ADMINISTRATORS

Fund No:PlanType: Group Health

JSL ADMINISTRATORS, INC.(770) 683-1050

JSL ADMINISTRATORS, INC.PO BOX 71489Newnan GA 30271

American Administrative Group(877) 782-6828

American Administrative Group(877) 202-6379 Ext 2530

The Parker GroupAffiliated With: American Administrative Group

Fund No:PlanType: Group Health

Includes Exclusive Preferred Providers (OCN ONLY)

American Administrative Group(877) 782-6828

American Administrative GroupPO Box 33159San Antonio TX 78265-3159

ULTRABENEFITS INC(866) 858-7223

CHECK BENEFIT CARDTHE PATRON SPIRITS COMPANYAffiliated With: ULTRABENEFITS

Fund No:PlanType: Group Health

ULTRABENEFITS INC(866) 858-7223

ULTRABENEFITS INCPO Box 763WESTBOROUGH MA 01581

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

THE PENN TRAFFIC COMPANYAffiliated With: NORTH AMERICAN ADMINISTRATORS - NY

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226

CHECK BENEFIT CARD5094734074

CHECK BENEFIT CARDTHE PHYSICIAN HOSP COMMUNITY ORGANIZATION PHCO

Affiliated With: THE PHYSICIAN HOSP COMMUNITY ORGANIZATION PHCO

Fund No:PlanType: Group Health

CHECK BENEFIT CARD5094734074

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-534• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 535: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

CHECK BENEFIT CARDTHE PHYSICIANS GROUPAffiliated With: WATERSTONE BENEFITS ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

CNIC HEALTH SOLUTIONS(800) 426-7453

CNIC HEALTH SOLUTIONS

THE POINT ORLANDO RESORTAffiliated With: CNIC HEALTH SOLUTIONS

Fund No:PlanType: Group Health

CNIC HEALTH SOLUTIONS(800) 426-7453

CNIC HEALTH SOLUTIONSPO Box 3559ENGLEWOOD CO 80155-3559

FISERV HEALTH KANSAS CHECK BENEFIT CARDTHE PREFERRED PLANAffiliated With: FISERV HEALTH - KANSAS

Fund No:PlanType: Group Health

FISERV HEALTH KANSAS FISERV HEALTH KANSASPO Box 520Pueblo CO 81002-0520

ADMINONE CORPORATION(800) 967-2077

MEDCAREONE CORP(800) 816-1206

THE PRICE COMPANYAffiliated With: ADMINONE CORPORATION

Fund No:PlanType: Group Health

ADMINONE CORPORATION(800) 967-2077

RESOURCEONE ADMINSTRATORS

PO Box 489BUCKEYSTOWN MD 21717

Attn: Mary Shepherd

MERITAIN HEALTH(440) 356-8426

CHECK BENEFIT CARDTHE RIGHT THING, INCAffiliated With: MERITAIN HEALTH

Fund No:PlanType: Group Health

MERITAIN HEALTH(440) 356-8426

MERITAIN HEALTH19800 Detroit Rd.ROCKY RIVER OH 44116

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-535• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 536: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDTHE SCRIPPS RESEARCH INSTITUTE

Affiliated With: PRINCIPAL FINANCIAL GROUP

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

Employee Benefit Management Corp (EBMC)(888) 865-7774

CHECK BENEFIT CARDTHE SMOOT CORPORATIONAffiliated With: EMPLOYEE BENEFIT MANAGEMENT CORP

Fund No:PlanType: Group Health

Employee Benefit Management Corp (EBMC)(888) 865-7774

Employee Benefit Management Corp (EBMC)PO Box 9057Dublin OH 43017

Employee Benefit Management Corp (EBMC)(888) 865-7774

CHECK BENEFIT CARDTHE SMOOT CORPORATIONAffiliated With: EMPLOYEE BENEFIT MANAGEMENT CORP

Fund No:PlanType: Group Health

Employee Benefit Management Corp (EBMC)(888) 865-7774

Employee Benefit Management Corp (EBMC)PO Box 9057Dublin OH 43017

Mountain States Administrative Services(520) 722-7133

CHECK BENEFIT CARDTHE SUNDT COMPANIESAffiliated With: MT STATES ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

Mountain States Administrative Services(520) 722-7133

Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710

SCHALLER ANDERSON HEALTHCARE LLC(602) 659-1418

SCHALLER ANDERSON HEALTHCARE LLC(602) 659-1488

THE SUNDT COMPANIES INCAffiliated With: SCHALLER ANDERSON HEALTHCARE

Fund No:PlanType: Group Health

SCHALLER ANDERSON HEALTHCARE LLC(602) 659-1418

SCHALLER ANDERSON HEALTHCARE LLC4645 E. COTTON CENTER BLVD BLDG 1 #200PHOENIX AZ 85040

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-536• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 537: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

THE TERTELIN COMPANY, INC.

CHECK BENEFIT CARDTHE TERTELING COMPANY INCAffiliated With: THE TERTELING COMPANY INC

Fund No:PlanType: Group Health

THE TERTELIN COMPANY, INC.

THE TERTELIN COMPANY, INC.1665 Hill RdBoise ID 83702

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

THE TILE SHOPAffiliated With: PREFERREDONE ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICESPO Box 59212MINNEAPOLIS MN 55459

TR Paul Inc(203) 426-8161

HINES & ASSOCIATESTHE VANTAGE GROUP, INCAffiliated With: TR PAUL INC

Fund No:PlanType: Group Health

TR Paul Inc(203) 426-8161

TR Paul IncPO Box 5508NEWTOWN CT 06470-5508

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

THE VERMONT TEDDY BEAR COAffiliated With: NORTH AMERICAN ADMINISTRATORS - NY

Fund No:PlanType: Group Health

NORTH AMERICAN ADMINISTRATORS-NY(800) 828-6922

NORTH AMERICAN ADMINISTRATORS-NYPO Box 9501AMHERST NY 14226

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

THE WALTERS GROUPAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-537• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 538: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARDTHE WINE GROUPAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARD

BUSINESS ADMINISTRATORS & CONSULTANTS INC(800) 521-2654

BAC(614) 863-8780

THEORIS INCAffiliated With: BUSINESS ADMINISTRATORS & CONSULTANTS

Fund No:PlanType: Group Health

BUSINESS ADMINISTRATORS & CONSULTANTS INC(800) 521-2654

BUSINESS ADMINISTRATORS & CONSULTANTS INC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

CHECK BENEFIT CARDTHOMAS & SKINNER INCAffiliated With: ALLIED BENEFIT SYSTEMS INC

Fund No:PlanType: Group Health

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

ALLIED BENEFIT SYSTEMS, INC208 S LASALLE ST STE 1300CHICAGO IL 60604

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

CHECK BENEFIT CARDTHOMAS AND SKINNER INCAffiliated With: ALLIED BENEFIT SYSTEMS

Fund No:PlanType: Group Health

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

ALLIED BENEFIT SYSTEMS, INC208 S LASALLE ST STE 1300CHICAGO IL 60604

CHECK BENEFIT CARD CHECK BENEFIT CARDTHOMPSON MICHIE ASSOCIATESAffiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-538• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 539: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HUDSON VALLEY VA HEALTHCARE SYSTEM(702) 242-7345

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

THORNDAL ARMSTRONG AND DELK - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

THORNWOOD FUNITUREAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

CHECK BENEFIT CARD CHECK BENEFIT CARDTIC AGENCIESAffiliated With: STAR HEALTHCARE NETWORK INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

EBMS(800) 777-3575

EBMS(800) 777-3575

TIDEWATER BARGED LINES, INCAffiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES INC (EBMS)

Fund No:PlanType: Group Health

EBMS(800) 777-3575

EBMSPO Box 21367BILLINGS MT 59104-1367

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-539• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 540: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

International Claims Services(877) 916-7920

International Claims Services(877) 916-7920

TieCare International IncAffiliated With: TieCare International Inc

Fund No:PlanType: Group Health

-Network participation is contingent upon proper member identification. The First Health® Network Logo must be on the benefit card.

International Claims Services(877) 916-7920

International Claims Services27092 BurbankFoothill Ranch CA 92610

BENEFIRST LLC7818374402

CHECK BENEFIT CARDTIGHEWAREHOUSING AND DISTRIBUTION INC

Affiliated With: BENEFIRST LLC

Term Effective: 8/31/2007Fund No:PlanType: Group Health

BENEFIRST LLC7818374402

BENEFIRST LLC1020 PLAINMARSHFIELD CENTER MA 02050

CHECK BENEFIT CARD CHECK BENEFIT CARDTILLAMOOK COUNTY GENERAL HOSPITAL

Affiliated With: ADVENTIST HEALTH SYSTEM / WEST

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

KEY BENEFIT ADMINISTRATORS(866) 387-0489

FORTIS BENEFITS INSURANCE COMPANY(866) 387-3407

TIME HEALTHY VENTURESAffiliated With: ASSURANT HEALTH

Fund No:PlanType: Group Health

KEY BENEFIT ADMINISTRATORS(317) 284-7649

KEY BENEFIT ADMINISTRATORS8330 ALLISON POINT TRAILINDIANAPOLIS IL 46250

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-540• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 541: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURANT HEALTH(800) 800-8463

UM NOT APPLICABLETIME INSURANCE COMPANYAffiliated With: ASSURANT HEALTH

Fund No:PlanType: Group Health

ASSURANT HEALTH(800) 800-8463

ASSURANT HEALTHPO Box 981602EL PASO TX 79998

THE BENEFIT GROUP(402) 964-9900

CHECK BENEFIT CARDTIMMERMAN FEEDING CORPORATION

Affiliated With: AMERICAN HEALTHCARE ALLIANCE #13780

Fund No:PlanType: Group Health

THE BENEFIT GROUP(402) 964-9900

THE BENEFIT GROUP10675 BEDFORDOMAHA NE 68134

MERITAIN HEALTH(800) 842-3216

CHECK BENEFIT CARDTIPPMAN GROUPAffiliated With: MERITAIN HEALTH

Fund No:PlanType: Group Health

MERITAIN HEALTH(800) 842-3216

MERITAIN HEALTH

PO Box 853921Richardson TX 75085-3921

Attn: Claims Dept

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 742-7345

TITAN STAIRS & TRIM TRAVELAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CHECK BENEFIT CARD CHECK BENEFIT CARDTMCAAffiliated With: STAR HEALTHCARE NETWORK INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-541• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 542: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Harrington Benefit Services Harrington Benefit Services

TMP WORLDWIDE, INC.Affiliated With: BENESIGHT, INC.

Fund No:PlanType: Group Health

Harrington Benefit Services Harrington Benefit ServicesPO Box 197347LOUISVILLE KY 40259

TOGUS VA MEDICAL CENTER

CHECK BENEFIT CARDTOGUS VA MEDICAL CENTER 3115

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

TOGUS VA MEDICAL CENTER

TOGUS VA MEDICAL CENTER

ONE VA CENTER - RT 17AUGUSTA ME 04330

Attn: FEE BASIS (BSL4)

CHECK BENEFIT CARD CHECK BENEFIT CARDTOKIO MARINE - CHANNELINGAffiliated With: Tokio Marine Management, Inc.

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER CONTACT EMPLOYERTokio Marine ManagementAffiliated With: Tokio Marine Management, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

CHECK BENEFIT CARD CHECK BENEFIT CARDTokio Marine Management AutoAffiliated With: Tokio Marine Management Auto

Fund No:PlanType: Auto

CHECK BENEFIT CARD CHECK BENEFIT CARD

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-542• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 543: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EMPLOYER GROUP EMPLOYER GROUPTokio Marine Management BR4 WCAffiliated With: Tokio Marine Management

Fund No:PlanType: Workers' Compensation

EMPLOYER GROUP EMPLOYER GROUP

CONTACT EMPLOYER CONTACT EMPLOYERTokio Marine Management, Inc.Affiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

-Formerly accessed through GENEX Services, Inc.

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

THE EPOCH GROUP(800) 255-6065

CHECK BENEFIT CARDTOM LANGE COMPANYAffiliated With: THE EPOCH GROUP #10469

Fund No:PlanType: Group Health

THE EPOCH GROUP(800) 255-6065

THE EPOCH GROUP6717 SHAWNEE MISSION PARKWAYOVERLAND PARK KS 66202

TOMAH VAMC CHECK BENEFIT CARDTOMAH VAMC 3166Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

TOMAH VAMC TOMAH VAMC

500 E VETERANS STTOMAH WI 54660

Attn: FEE 136B2

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLETOP FLIGHT BUILDING SERVICES, INC

Affiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-543• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 544: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MEDICAL CLAIMS SERVICES, INC.(888) 225-0522

AMERICAN HEALTH HOLDINGS INC(800) 592-9858

TOP LINE EXPRESS INCAffiliated With: MEDICAL CLAIMS SERVICE INC

Fund No:PlanType: Group Health

MEDICAL CLAIMS SERVICES, INC.(888) 225-0522

MEDICAL CLAIMS SERVICES, INC.1 WALL ST STE 2ARAVENSWOOD WV 26164

TOPEKA VA MEDICAL CENTER

CHECK BENEFIT CARDTOPEKA VA MEDICAL CENTER 3529

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

TOPEKA VA MEDICAL CENTER

TOPEKA VA MEDICAL CENTER

2200 S W GAGE BLVDTOPEKA KS 66622

Attn: FEE BASIS

PINNACLE CLAIMS MANAGEMENT

CHECK BENEFIT CARDTORRANCE UNIFIED SCHOOL DISTRICT (RETIREES)

Affiliated With: PINNACLE CLAIMS MANAGEMENT

Fund No:PlanType: Group Health

PINNACLE CLAIMS MANAGEMENT

PINNACLE CLAIMS MANAGEMENT17620 FITCH STIRVINE CA 92614

PINNACLE CLAIMS MANAGEMENT

CHECK BENEFIT CARDTORRANCE UNIFIED SCHOOL DISTRICT (WRAP)

Affiliated With: PINNACLE CLAIMS MANAGEMENT

Fund No:PlanType: Group Health

PINNACLE CLAIMS MANAGEMENT

PINNACLE CLAIMS MANAGEMENT17620 FITCH STIRVINE CA 92614

HERITAGE CONSULTANTS INC8639674139

HEALTHCHOICE8639674139

TORWESTAffiliated With: HERITAGE CONSULTANTS INC

Fund No:PlanType: Group Health

HERITAGE CONSULTANTS INC8639674139

HERITAGE CONSULTANTS INC

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-544• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 545: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CompIQ Corporation(800) 293-3131

CompIQ Corporation(800) 293-3131

Total Managed Care (TMC)Affiliated With: CompIQ

Fund No:PlanType: Workers' Compensation

CompIQ Corporation(800) 293-3131

CompIQ Corporation2 South PointeLake Forest CA 92630

CHECK BENEFIT CARD CHECK BENEFIT CARDTOUR MEDAffiliated With: STAR HEALTHCARE NETWORK INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

MMSI(866) 222-3914

MMSI(866) 222-3914

TOWN OF GILBERTAffiliated With: MMSI

Fund No:PlanType: Group Health

MMSI(866) 222-3914

MMSI4001 41ST STREET NWROCHESTER MN 55901

EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002

UM NOT APPLICABLE(800) 367-9939

TOWN OF SCHERERVILLEAffiliated With: EMPLOYEE BENEFIT CONSULTANTS INC

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002

EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839

CHECK BENEFIT CARD CHECK BENEFIT CARDTOWNE AIR FREIGHTAffiliated With: HEALTHSCOPE BENEFITS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-545• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 546: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SUPERIEN HEALTH NETWORK(800) 266-5896

CHECK BENEFIT CARDTOWNE PROPERTIESAffiliated With: SUPERIEN HEALTH NETWORK

Fund No:PlanType: Group Health

SUPERIEN HEALTH NETWORK(800) 266-5896

SUPERIEN HEALTH NETWORK

PO Box 2388 CSTOW OH 44224

Attn: Supervisor of the Claims Dept

COMMUNITY ADMINISTRATORS(800) 838-2869

CHECK BENEFIT CARDTOYOTA OF ESCONDIDOAffiliated With: COMMUNITY ADMINISTRATORS INC

Fund No:PlanType: Group Health

COMMUNITY ADMINISTRATORS(800) 838-2869

COMMUNITY ADMINISTRATORS740 Bay BlvdChula Vista CA 91910

TRUSTEED PLANS SERVICE GROUP(800) 426-9786

TRUSTEED PLANS SERVICE GROUP(800) 426-9786

TPSC WRAPAffiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

TRUSTEED PLANS SERVICE GROUP(800) 426-9786

TRUSTEED PLANS SERVICE GROUPPO Box 1894TACOMA WA 98401-1894

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

TRADITIONS HEALTH CAREAffiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

CHECK BENEFIT CARD8008832000

CHECK BENEFIT CARDTRANSAXLE CORPORATIONAffiliated With: BROKERAGE CONCEPTS INC BENEFIT CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8008832000

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-546• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 547: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

CHECK BENEFIT CARDTRANSITIONS MHRAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

MED-CERT(800) 356-7126

TRANSITIONS OF WESTERN ILAffiliated With: NORTH AMERICA ADMINISTRATORS LP TENNESSEE

Fund No:PlanType: Group Health

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

BENEFIT PROGRAM ADMINISTRATOR(562) 463-5070

CHECK BENEFIT CARDTRANSPORTATION COMMUNICATIONS UNION

Affiliated With: TRANSPORTATION COMMUNICATIONS UNION

Fund No:PlanType: Group Health

BENEFIT PROGRAM ADMINISTRATOR(562) 463-5070

BENEFIT PROGRAM ADMINISTRATOR13191 CROSSROADS PARK NORTH STE 205CITY OF INDUSTRY CA 91746-3434

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLETRANSPORTATION EMPLOYEEAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

AFFORDABLE BENEFIT ADMINISTRATORS INC(818) 842-0147

AFFORDABLE BENEFIT ADMINISTRATORS INC(818) 842-0147

TRAPAC, INCAffiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC. (ABA)

Fund No:PlanType: Group Health

AFFORDABLE BENEFIT ADMINISTRATORS INC(818) 842-0147

AFFORDABLE BENEFIT ADMINISTRATORS INCPO Box 10787BURBANK CA 91510

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-547• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 548: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDTRAVEL GUARD CANADAAffiliated With: STAR HEALTHCARE NETWORK INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CONTACT EMPLOYER Travelers Property Casualty(800) 842-6569

TravelersAffiliated With: Travelers

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CHECK BENEFIT CARD CHECK BENEFIT CARDTRAX INTERNATIONALAffiliated With: GILSBAR INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

P5 HEALTH PLAN SOLUTIONS(888) 212-0261

CHECK BENEFIT CARDTRAX INTERNATIONAL CORPORATION

Affiliated With: P5 HEALTH PLAN SOLUTIONS

Fund No:PlanType: Group Health

P5 HEALTH PLAN SOLUTIONS(888) 212-0261

P5 HEALTH PLAN SOLUTIONS2455 E. Parleys Way #300Salt Lake City UT 84109

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

TRENDCOAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-548• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 549: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

DELTA HEALTH SYSTEMS DELTA HEALTH SYSTEMS

TRI COUNTY SCHOOLS INSURANCE GROUP

Affiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS DELTA TEAM CAREPO Box 1147STOCKTON CA 95201

KLAIS & COMPANY INC(330) 867-8443

CHECK BENEFIT CARDTRINITY COLLEGEAffiliated With: KLAIS AND COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(330) 867-8443

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

KLAIS & COMPANY INC(330) 867-8443

CHECK BENEFIT CARDTRINITY COLLEGE SPORTS PLANAffiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(330) 867-8443

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

ADMINONE CORPORATION(800) 967-2077

MEDCAREONE CORP(800) 816-1206

TRINITY HOSPICE INCAffiliated With: ADMINONE CORPORATION

Fund No:PlanType: Group Health

ADMINONE CORPORATION(800) 967-2077

RESOURCEONE ADMINSTRATORS

PO Box 489BUCKEYSTOWN MD 21717

Attn: Mary Shepherd

ADMINONE CORPORATION(800) 967-2077

MEDCAREONE CORP(800) 816-1206

Trinity Hospice Inc. (KS)Affiliated With: ADMINONE CORPORATION

Fund No:PlanType: Group Health

ADMINONE CORPORATION(800) 967-2077

RESOURCEONE ADMINSTRATORS

PO Box 489BUCKEYSTOWN MD 21717

Attn: Mary Shepherd

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-549• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 550: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

TRINITY SALES & LEASING, INC.Affiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDTRINITY UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

TRISTAR Managed Care(714) 245-4813

UM NOT APPLICABLETRISTAR Managed CareAffiliated With: CompIQ #13910

Fund No:PlanType: Workers' Compensation

TRISTAR Managed Care(714) 245-4813

TRISTAR Managed Care203 N Golden Circle Dr Ste 310Santa Ana CA 92705

HEALTHSCOPE BENEFITS INC(866) 885-4944

HEALTHSCOPE BENEFITS INC(501) 218-7691

TRMI/TRAMAffiliated With: HEALTHSCOPE BENEFITS, INC

Fund No:PlanType: Group Health

HEALTHSCOPE BENEFITS INC(800) 560-4664

HEALTHSCOPE BENEFITS INC27 CORPORATE HILL DRLITTLE ROCK AR 72205

REGIONAL CARE INC(800) 795-7772

REGIONAL CARE INC(800) 795-7772

TRONA VALLEY COMMUNITY FEDERAL CREDIT UNION

Affiliated With: REGIONAL CARE INC

Fund No:PlanType: Group Health

REGIONAL CARE INC(800) 795-7772

REGIONAL CARE INC905 W 27th StScottsbluff NE 69361

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-550• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 551: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Professional Benefit Administrators, Inc.(630) 655-3755

CHECK BENEFIT CARD(714) 668-8920

Troy Community School Dist, 30-CAffiliated With: Troy Community School Dist, 30-C

Fund No:PlanType: Group Health

Professional Benefit Administrators, Inc.(630) 655-3755

Professional Benefit Administrators, Inc.900 Jorie Blvd Ste 250Oakbrook IL 60523

UNDERWRITERS SAFETY & CLAIMS(502) 244-1343

UNDERWRITERS SAFETY & CLAIMS

TRUCHECK, INC.Affiliated With: UNDERWRITERS SAFETY & CLAIMS, INC.

Fund No:PlanType: Group Health

UNDERWRITERS SAFETY & CLAIMS(502) 244-1343

UNDERWRITERS SAFETY & CLAIMSPO Box 23790LOUISVILLE KY 40223

BENEFIT PLAN MANAGEMENT(781) 753-7544

CHECK BENEFIT CARDTRUMBULL NELSON CONSTRUCTION COMPANY INC

Affiliated With: BENEFIT PLAN MANAGEMENT

Fund No:PlanType: Group Health

BENEFIT PLAN MANAGEMENT(781) 753-7544

BENEFIT PLAN MANAGEMENTPO Box 536ROCKLAND MA 02370

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 240-8931

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

TRUMP RUFFIN TOWER I - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 240-8931

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA2720 N. Tenaya Way, Room 507Las Vegas NV 89128

CHECK BENEFIT CARD CHECK BENEFIT CARDTRUSTMARK INSURANCE COMPANY

Affiliated With: TRUSTMARK INSURANCE COMPANY

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-551• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 552: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Total Claims Solution(800) 376-0110

Total Claims Solution(800) 376-0110

TTX CompanyAffiliated With: TTX Company

*

Term Effective: 12/31/2007Fund No:PlanType: Group Health

The First Health® Network is not used for Behavioral Health services.

Total Claims Solution(800) 376-0110

Total Claims SolutionPO Box 10888Green Bay WI 54307-0888

TUCSON VAMC CHECK BENEFIT CARDTUCSON VAMC 3176Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

TUCSON VAMC TUCSON VAMC

3601S 6TH AVETUCSON AZ 85723

Attn: 9-13E

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

CHECK BENEFIT CARDTUFTS UNIVERSITY - ACIAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706

CHECK BENEFIT CARD8884191094

ADVANCED BENEFITS SOLUTIONS

TUNICA BILOXI INDIAN TRIBE OF LOUISANA

Affiliated With: ADVANCED BENEFIT SOLUTIONS LLC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8884191094

CHECK BENEFIT CARD

DELTA HEALTH SYSTEMS(800) 201-3150

DELTA TEAMCARE(209) 939-3407

TURLOCK IRRIGATION DISTRICTAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(800) 201-3150

DELTA HEALTH SYSTEMSPO Box 2049STOCKTON CA 95201-2049

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-552• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 553: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TUSCALOOSA VAMC CHECK BENEFIT CARDTUSCALOOSA VAMC 3541Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

TUSCALOOSA VAMC TUSCALOOSA VAMC

3701 LOOP RD EASTTUSCALOOSA AL 35404

Attn: FEE BASIS BMS/FB

TUSKEGEE VAMC (CENTRAL ALABAMA HCS)

CHECK BENEFIT CARDTUSKEGEE VAMC (CENTRAL ALABAMA HCS) 3544

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

TUSKEGEE VAMC (CENTRAL ALABAMA HCS)

TUSKEGEE VAMC (CENTRAL ALABAMA HCS)

2400 HOSPITAL RDTUSKEGEE AL 36083

Attn: FEE BASIS 136F

NATIVE PLUS(800) 811-0119

CHECK BENEFIT CARDTWENTY-NINE PALMS BAND OF MISSION INDIANS

Affiliated With: NATIVE PLUS

Fund No:PlanType: Group Health

NATIVE PLUS(800) 811-0119

NATIVE PLUS100 SUNRISE WAY PMB 355PALM SPRINGS CA 92262

DIRECT CARE AMERICA(800) 266-5896

CHECK BENEFIT CARDTWIN OAKS JUVENILE DEVELOPMENTS INC

Affiliated With: THE CHANDLER GROUP #13352

Fund No:PlanType: Group Health

DIRECT CARE AMERICA(800) 266-5896

DIRECT CARE AMERICAPO Box 2090 CSTOW OH 44224

COVENANT ADMINISTRATORS(800) 680-8728

MEDICOR(678) 258-8412

TY COBB HEALTHCARE SYSTEM, INC

Affiliated With: COVENANT ADMINISTRATORS INC

Fund No:PlanType: Group Health

COVENANT ADMINISTRATORS(800) 680-8728

COVENANT ADMINISTRATORS1745 N Brown Rd Ste 400Lawrenceville GA 30043

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-553• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 554: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDTYBRIN CORPORATIONAffiliated With: BENEFIT PLANNERS LTD

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

QVI RISK SOLUTIONS INC(541) 312-8512

CASCADE COMPREHENSIVE CARE(541) 883-2947

TYRHOLM BIG R STORES, INC.Affiliated With: QVI RISK SOLUTIONS, INC.

Fund No:PlanType: Group Health

QVI RISK SOLUTIONS INC(541) 312-8512

QVI RISK SOLUTIONS INC1011 SW EMKAY DR STE 209BEND OR 97702

CHECK BENEFIT CARD CHECK BENEFIT CARDU C RIVERSIDEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDU C SAN DIEGOAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDU C SAN FRANCISCOAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-554• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 555: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

CHECK BENEFIT CARDUC EXTENSINS - UC SANTA CRUZAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

CHECK BENEFIT CARDUC EXTENSION - UC BERKLEYAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

CHECK BENEFIT CARDUC EXTENSION - UC DAVISAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

CHECK BENEFIT CARDUC EXTENSION - UC IRVINEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

CHECK BENEFIT CARDUC EXTENSION - UC LOS ANGELES

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-555• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 556: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

CHECK BENEFIT CARDUC EXTENSION - UC RIVERSIDEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

CHECK BENEFIT CARDUC EXTENSION - UC SAN DIEGOAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

CHECK BENEFIT CARDUC EXTENSION - UC SANTA BARBARA

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376

CHECK BENEFIT CARD CHECK BENEFIT CARDUC IRVINEAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

UC MERCED INTERNATIONAL AND DOMESTIC GRADUATE STUDENTS

Affiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-556• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 557: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AMERIBEN SOLUTIONS(800) 953-1801

CHECK BENEFIT CARDUCDHSC-HEALTH SCIENCES CAMPUSES

Affiliated With: AMERIBEN SOLUTIONS

Term Effective: 8/31/2007Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 953-1801

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

CONSUMER HEALTH SOLUTIONS(877) 573-9541

CHECK BENEFIT CARDUHAULAffiliated With: CONSUMER HEALTH SOLUTION

Fund No:PlanType: Group Health

CONSUMER HEALTH SOLUTIONS(877) 573-9541

CONSUMER HEALTH SOLUTIONS333 SOUTH PINE STSPARTANBURG SC 29302

CHECK BENEFIT CARD CHECK BENEFIT CARDUICI THE INSURANCE CENTERAffiliated With: MEGA LIFE AND HEALTH INSURANCE COMPANY

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDUKIAH VALLEY MEDICAL CENTER EXCLUSIVE

Affiliated With: ADVENTIST HEALTH SYSTEM WEST

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

ADVENTIST HEALTH SYSTEM WEST

CHECK BENEFIT CARDUKIAH VALLEY MEDICAL CENTER PPO

Affiliated With: ADVENTIST HEALTH SYSTEM WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM WEST

ADVENTIST HEALTH SYSTEM WESTPO Box 619031ROSEVILLE CA 95661-9002

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-557• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

JSL ADMINISTRATORS, INC.(910) 480-3100

DOCTORS DIRECT HEALTHCARE(910) 485-0510

Ultimate Textile Inc.Affiliated With: JSL ADMINISTRATORS INC

*

Fund No:PlanType: Group Health

JSL ADMINISTRATORS, INC.(910) 480-3100

JSL ADMINISTRATORS, INC.PO Box 2857FAYETTEVILLE NC 28302

CHECK BENEFIT CARD6514397098

CHECK BENEFIT CARDUMPQUA COMMUNITY COLLEGEAffiliated With: STUDENT ASSURANCE SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD6514397098

CHECK BENEFIT CARD

UNARCO COMMERCIAL PRODUCTS INC(800) 749-2631

CHECK BENEFIT CARDUNARCO COMMERCIAL PRODUCTS INC

Affiliated With: EQUITABLE PLAN SERVICES

Fund No:PlanType: Group Health

UNARCO COMMERCIAL PRODUCTS INC(800) 749-2631

UNARCO COMMERCIAL PRODUCTS INCPO Box 720460OKLAHOMA CITY OK 73172

ADVANCED BENEFIT SOLUTIONS LLC(888) 419-1094

AZ Foundation(602) 417-2337

UNI- TEKAffiliated With: ADVANCED BENEFIT SOLUTIONS LLC

Fund No:PlanType: Group Health

ADVANCED BENEFIT SOLUTIONS LLC(888) 419-1094

ADVANCED BENEFIT SOLUTIONS LLC

2222 W Pinnacle Peak Rd Ste 190Phoenix AZ 85027

Attn: Michele Terzich

GLOBALCARE(678) 341-1811

UM NOT APPLICABLEUNIFIED GROUP SERVICES - INTEGRAL TECHNOLOGIES

Affiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-558• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 559: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GLOBALCARE(678) 341-1811

UM NOT APPLICABLEUNIFIED GROUP SERVICES - WORLD GOSPEL MISSION

Affiliated With: GLOBALCARE INC

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005

GLOBALCARE(678) 341-1811

UM NOT APPLICABLEUNILIANCEHEALTH - THE HUGHSTON CLINIC

Affiliated With: GLOBALCARE

Fund No:PlanType: Group Health

GLOBALCARE(678) 341-1811

GLOBALCARE6875 SHILOH RD EALPHARETTA GA 30005

THE LOOMIS COMPANY(866) 452-4054

AMERICAN HEALTH HOLDINGS(866) 245-8131

UNION DRILLING COMPANYAffiliated With: THE LOOMIS COMPANY

Fund No:PlanType: Group Health

THE LOOMIS COMPANY(866) 452-4054

THE LOOMIS COMPANY850 N PARK RDWYOMISSING PA 19610

ASSURANT HEALTH(800) 444-6254

UM NOT APPLICABLEUNION SECURITY INSURANCE COMPANY

Affiliated With: ASSURANT HEALTH

Fund No:PlanType: Group Health

ASSURANT HEALTH(800) 444-6254

ASSURANT HEALTHPO Box 981602EL PASO TX 79998

Benefit Planners(210) 558-2100

CHECK BENEFIT CARDUNIROYAL HOLDING INCAffiliated With: BENEFIT PLANNERS

Fund No:PlanType: Group Health

Benefit Planners(210) 558-2100

Benefit PlannersPO Box 690450SAN ANTONIO TX 78269

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-559• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 560: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERUnisourceAffiliated With: GENEX Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Mountain States Administrative Services(520) 722-7133

Hines and Associates(847) 214-2780

UNISOURCE ENERGY / TUCSON POWER

Affiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

Mountain States Administrative Services(520) 722-7133

Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710

ALICARE, Inc(800) 332-5426

ALICARE, Inc(800) 332-5426

Unite Staff Health Benefit PlanAffiliated With: Amalgamated Life Insurance Co.

Fund No:PlanType: Group Health

ALICARE, Inc(800) 888-5554

For electronic claims submission ID, refer to Benefit Card. Mail all other claims to: ALICARE, Inc.PO Box 1435New York NY 10116-1435ECS Payor ID 13550

PINNACLE CLAIMS MANAGEMENT INC(800) 649-9121

CHECK BENEFIT CARDUNITED CHURCH OF GODAffiliated With: PINNACLE CLAIMS MANAGEMENT

Fund No:PlanType: Group Health

PINNACLE CLAIMS MANAGEMENT INC(800) 649-9121

PINNACLE CLAIMS MANAGEMENT INCPO Box 2220NEWPORT BEACH CA 92658

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

UNITED COIN & MACHINE COMPANY

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-560• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 561: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GROUP & PENSION ADMINISTRATORS(800) 827-7223

HEALTH WATCH(972) 238-7900

UNITED FASHIONS OF TEXAS TRAVEL

Affiliated With: GROUP & PENSION ADMINISTRATORS

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

CHECK BENEFIT CARD CHECK BENEFIT CARDUNITED FINANCIAL MORTGAGE CORP

Affiliated With: ALLIED BENEFIT SYSTEMS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

NATIONAL EMPLOYEE BENEFIT ADMINISTRATORS(800) 842-5899

UM NOT APPLICABLEUnited Food and Commercial Workers Allied Trades Trust Fund

Affiliated With: UNITED FOOD AND COMMERCIAL WORKERS ALLIED TRADES

*

Fund No:PlanType: Group Health

NATIONAL EMPLOYEE BENEFIT ADMINISTRATORS(800) 842-5899

NATIONAL EMPLOYEE BENEFIT ADMINISTRATORS

2010 N W 150th Ave Ste 100Pembroke Pines FL 33028

Attn: Claims Dept

UnitedHealthCare(952) 992-6063

CHECK BENEFIT CARDUnited Health Care (Shared Savings Program)

Affiliated With: United Health Care

Fund No:PlanType: Group Health

UnitedHealthCare(952) 992-6063

UnitedHealthCare5901 Lincoln DrEdina MN 55436

CHECK BENEFIT CARD6783411722

CHECK BENEFIT CARDUNITED MEDICAL RESOURCESAffiliated With: GLOBALCARE

Fund No:PlanType: Group Health

CHECK BENEFIT CARD6783411722

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-561• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BENEFIT CONCEPTS, INC.(610) 337-2600

BENEFIT CONCEPTS, INC.(800) 883-2000

UNITED OIL RECOVERYAffiliated With: BROKERAGE CONCEPTS #15074

Fund No:PlanType: Group Health

BENEFIT CONCEPTS, INC.(610) 337-2600

BENEFIT CONCEPTS, INC.1021 W 8TH AVEKING OF PRUSSIA PA 19406

Benefit Planners(800) 292-5386

CHECK BENEFIT CARDUNITED STATES BEEF CORPORATION

Affiliated With: BENEFIT PLANNERS

Fund No:PlanType: Group Health

Benefit Planners(800) 292-5386

Benefit PlannersPO Box 690450SAN ANTONIO TX 78269

CONTACT EMPLOYER CONTACT EMPLOYERUnited States Postal ServiceAffiliated With: United States Postal Service

Fund No:PlanType: Workers' Compensation

Hospital Outpatient Bills are not part of the USPS WC Program as of 12/1/2001.

First Health(800) 571-4501

USPS Workers' CompensationPO Box 23808Tucson AZ 85734-3808

ADMINONE CORPORATION(479) 657-3900

CHECK BENEFIT CARDUNITED SUPERMARKETS OF OKLAHOMA

Affiliated With: ADMINONE CORPORATION

Fund No:PlanType: Group Health

ADMINONE CORPORATION(479) 657-3900

ADMINONE CORPORATION

PO Box 489BUCKEYSTOWN MD 21717

Attn: Mary Shepherd

ALTERNATIVE INSURANCE RESOURCES(202) 871-3229

CHECK BENEFIT CARDUNITED SURGICAL ASSISTANTS INC

Affiliated With: ALTERNATIVE INSURANCE RESOURCES

Fund No:PlanType: Group Health

ALTERNATIVE INSURANCE RESOURCES(202) 871-3229

ALTERNATIVE INSURANCE RESOURCESPO Box 660787BIRMINGHAM AL 35266

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-562• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

UNITED TRIBES TECHNICAL COLLEGE

Affiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

CHECK BENEFIT CARD CHECK BENEFIT CARDUNITED WORLD MISSIONAffiliated With: NATIONAL CLAIMS ADMINISTRATIVE SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

UnitedHealthcare (for the Shared Savings Program).(952) 992-6063

CHECK BENEFIT CARDUnitedHealthcare (for the Shared Savings Program).

Affiliated With: UnitedHealthcare

Fund No:PlanType: Group Health

For provider services inquires please contact 800-774-4339.

UnitedHealthcare (for the Shared Savings Program).(952) 992-6063

UnitedHealthcare (for the Shared Savings Program).5901 Lincoln DrEdina MN 55436

ALLIED ADMINISTRATORS(619) 297-8235

CHECK BENEFIT CARDUNITE-HERE ALLIEDAffiliated With: SAN DIEGO HOTEL & RESTAURANT EMPLOYEE

Fund No:PlanType: Group Health

ALLIED ADMINISTRATORS(619) 297-8235

ALLIED ADMINISTRATORS2831 Camino del Rio S STE 311SAN DIEGO CA 92108

BENEFIT ADMINISTRATIVE SYSTEMS(708) 647-3434

CHECK BENEFIT CARDUNITEXAffiliated With: AMERICAN TRUST ADMINISTRATORS

Fund No:PlanType: Group Health

BENEFIT ADMINISTRATIVE SYSTEMS(708) 647-3434

BENEFIT ADMINISTRATIVE SYSTEMS17475 JOVANNA DRHOMEWOOD IL 60430

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-563• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

BAC(614) 863-8780

BAC(614) 863-8780

UNITRANSAffiliated With: BUSINES ADMINISTRATORS & CONSULTANTS INC

*

Term Effective: 8/31/2007Fund No:PlanType: Group Health

BAC(614) 863-8780

BAC6331 E LIVINGSTON AVEREYNOLDSBURG OH 43068

CHECK BENEFIT CARD CHECK BENEFIT CARDUnitrin (Auto)Affiliated With: Mitchell Medical

Fund No:PlanType: Auto

Unitrin: Administered by Mitchell Medical

CHECK BENEFIT CARD CHECK BENEFIT CARD

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

CHECK BENEFIT CARDUNITY HEALTH CENTERAffiliated With: WATERSTONE BENEFITS ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

CHECK BENEFIT CARD CHECK BENEFIT CARDUNIV OF NEW HAMPSHIRE SPORTS

Affiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

MT STATES ADMINISTRATION CO(520) 722-7133

HINES & ASSOCIATES(847) 214-2780

UNIVERSAL AVIONICSAffiliated With: MT STATES ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

MT STATES ADMINISTRATION CO(520) 722-7133

MT STATES ADMINISTRATION CO7202 E ROSEWOOD STE 200TUCSON AZ 85710

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-564• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 565: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ADMINISTRATIVE SOLUTIONS INC(678) 339-0211

CHECK BENEFIT CARDUNIVERSAL ENVIRONMENTAL CORPORATION

Affiliated With: ADMINISTRATIVE SOLUTIONS, INC.

Fund No:PlanType: Group Health

ADMINISTRATIVE SOLUTIONS INC(678) 339-0211

ADMINISTRATIVE SOLUTIONS INCPO Box 2490ALPHARETTA GA 30023

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADVANTAGE(800) 825-3540

UNIVERSAL FIDELTY LIFE INSURANCE COMPANY

Affiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORS3121 QUAIL SPRINGS PKWYOKLAHOMA CITY OK 73134

TRUE CHOICE(800) 251-9665

UM NOT APPLICABLEUNIVERSITY CENTRAL OF OKLAHOMA

Affiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 251-9665

TRUE CHOICEPO Box 700307DALLAS TX 75370

UNIVERSITY HEALTH ALLIANCE

UNIVERSITY HEALTH ALLIANCE

UNIVERSITY HEALTH ALLIANCEAffiliated With: UNIVERSITY HEALTH ALLIANCE

Fund No:PlanType: Group Health

UNIVERSITY HEALTH ALLIANCE

UNIVERSITY HEALTH ALLIANCE700 BISHOP STREETHONOLULU HI 96813

PEARCE ADMINISTRATION

CHECK BENEFIT CARDUNIVERSITY NORTH CAROLINA - ASHEVILLE

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(888) 722-1668

PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-565• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDUNIVERSITY NORTH CAROLINA - GREENSBORO

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(888) 722-1668

PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDUNIVERSITY NORTH CAROLINA AT PEMBROKE

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(888) 722-1668

PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDUNIVERSITY NORTH CAROLINA WILMINGTON

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(888) 722-1668

PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408

TRUE CHOICE(800) 251-9665

UM NOT APPLICABLEUNIVERSITY OF ARKANSAS FOR MEDICAL SERVICES

Affiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 251-9665

TRUE CHOICEPO Box 700307DALLAS TX 75370

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-566• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AMERIBEN SOLUTIONS(800) 953-1801

CHECK BENEFIT CARDUNIVERSITY OF COLORADO AT DENVER - DOWNTOWN CAMPUS

Affiliated With: AMERIBEN SOLUTIONS #15255

Term Effective: 8/31/2007Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 953-1801

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDUNIVERSITY OF DALLASAffiliated With: ACADEMIC RISK MANAGEMENT

Term Effective: 8/31/2007Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDUNIVERSITY OF GEORGIA AIH0058507

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

MAKSIN MANAGEMENT CORP(800) 285-8133

CHECK BENEFIT CARDUNIVERSITY OF HOUSTON MAINAffiliated With: MAKSIN MANAGEMENT CORPORATION

Fund No:PlanType: Group Health

MACORI ADMINISTRATION(281) 651-8787

MACORI ADMINISTRATION19609 WIEDSPRING TX 77388

STUDENT INSURANCE A DIVISION OF UICI

CHECK BENEFIT CARDUNIVERSITY OF JUDAISMAffiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-567• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONSOLIDATED HEALTH PLANS(800) 633-7867

CHECK BENEFIT CARDUNIVERSITY OF MAINEAffiliated With: CONSOLIDATED HEALTH PLANS

Fund No:PlanType: Group Health

CONSOLIDATED HEALTH PLANS(800) 633-7867

CONSOLIDATED HEALTH PLANS195 STAFFORD STSPRINGFIELD MA 01104

CHECK BENEFIT CARD CHECK BENEFIT CARDUNIVERSITY OF MASS AT BOSTON SPORTS

Affiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDUNIVERSITY OF MASSACHUSETTS SCHOLARS

Affiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

STUDENT ASSURANCE SERVICES INC

STUDENT ASSURANCE SERVICES INC(800) 328-2739

UNIVERSITY OF MISSOURI SYSTEM

Affiliated With: STUDENT ASSURANCE SERVICES, INC

Fund No:PlanType: Group Health

STUDENT ASSURANCE SERVICES INC(800) 328-2739

STUDENT ASSURANCE SERVICES INC333 N. MAIN STREETSTILLWATER MN 55082

KLAIS & COMPANY INC(330) 867-8443

CHECK BENEFIT CARDUNIVERSITY OF NEW HAMPSHIREAffiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(330) 867-8443

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-568• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

STUDENT ASSURANCE SERVICES INC(800) 328-2739

CHECK BENEFIT CARDUNIVERSITY OF NEW ORLEANSAffiliated With: STUDENT ASSURANCE SERVICES INC

Fund No:PlanType: Group Health

STUDENT ASSURANCE SERVICES INC(800) 328-2739

STUDENT ASSURANCE SERVICES INC333 N. MAIN STREETSTILLWATER MN 55082

MAKSIN MANAGEMENT CORP(888) 722-1668

CHECK BENEFIT CARDUNIVERSITY OF NORTH CAROLINA - CHARLOTTE

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

MACORI ADMINISTRATION(888) 722-1668

MACORI ADMINISTRATIONPO Box 2408Florence SC 29503-2408

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDUNIVERSITY OF PHOENIXAffiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDUNIVERSITY OF PORTLANDAffiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDUNIVERSITY OF SOUTH CAROLINA - MMH0000136

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-569• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 570: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDUNIVERSITY OF SOUTH FLORIDA - AIH0000346

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 722-1668

PEARCE ADMINISTRATIONPO Box 2438Florence SC 29503

STUDENT ASSURANCE SERVICES(800) 328-2739

CHECK BENEFIT CARDUNIVERSITY OF SOUTHERN INDIANA

Affiliated With: STUDENT ASSURANCE SERVICES

Fund No:PlanType: Group Health

STUDENT ASSURANCE SERVICES(651) 439-7098

STUDENT ASSURANCE SERVICES333 N. MAIN STREETSTILLWATER MN 55082

MAKSIN MANAGEMENT CORP(877) 775-5430

UM NOT APPLICABLEUNIVERSITY OF THE CUMBERLANDS

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

MAKSIN MANAGEMENT CORP(877) 775-5430

MAKSIN MANAGEMENT CORP2500 McClellan AvePennsauken NJ 08109

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

CHECK BENEFIT CARDUNIVERSITY OF VERMONT - ACIAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706

CONSOLIDATED HEALTH PLANS INC(800) 633-7867

CHECK BENEFIT CARDUNIVERSITY OF VERMONT SCHOOL SYSTEM

Affiliated With: CONSOLIDATED HEALTH PLANS

Fund No:PlanType: Group Health

CONSOLIDATED HEALTH PLANS INC(800) 633-7867

CONSOLIDATED HEALTH PLANS INC195 STAFFORD STSPRINGFIELD MA 01104

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-570• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 571: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDUNIVERSITY OF WEST GEORGIA AIH0058477

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDUNIVERSITY OF WEST GEORGIA AIH0058487

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEUNIVERSITY OF WEST GEORGIA UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

CHECK BENEFIT CARD CHECK BENEFIT CARDUNX INCORPORATEDAffiliated With: JSL ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

GROUP & PENSION ADMINISTRATORS(800) 827-7223

CHECK BENEFIT CARDUpshur County TravelAffiliated With: GROUP & PENSION ADMINISTRATORS

*

Fund No:PlanType: Group Health

GROUP & PENSION ADMINISTRATORS(800) 827-7223

GROUP & PENSION ADMINISTRATORS12770 MERIT DR STE 200DALLAS TX 75251

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-571• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 572: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PARAGON BENEFITS, INC.(706) 327-9218

AMERICAN HEALTH HOLDING(706) 327-9218

UPSON COUNTYAffiliated With: PARAGON BENEFITS INC.

Fund No:PlanType: Group Health

PARAGON BENEFITS, INC.(706) 327-9218

PARAGON BENEFITS, INC.PO Box 12288COLUMBUS GA 31917

NGS AMERICAN8005211555

UM NOT APPLICABLEURBAN SCIENCEAffiliated With: NGS AMERICAN INC

*

Term Effective: 12/31/2007Fund No:PlanType: Group Health

NGS AMERICAN8005211555

NGS AMERICANPO Box 7676DETROIT MI 48080

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

MED-CERT(800) 356-7126

URSA FARMERS CO-OPAffiliated With: NORTH AMERICA ADMINISTRATORS LP TENNESSEE

Fund No:PlanType: Group Health

NORTH AMERICA ADMINISTRATORS, L.P.(800) 411-3650

NORTH AMERICA ADMINISTRATORS, L.P.PO Box 1984NASHVILLE TN 37202

CONTACT EMPLOYER CONTACT EMPLOYERUS ConcreteAffiliated With: US Concrete

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CHECK BENEFIT CARD9166692468

CHECK BENEFIT CARDUS MARSHALL SERVICES PREFERRED PRICING PLAN

Affiliated With: CAPITOL ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD9166692468

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-572• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 573: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AMERIHEALTH ADMINISTRATORS2158302596

AMERIHEALTH ADMINISTRATORS2158302596

US VISIONAffiliated With: AMERIHEALTH ADMINISTRATORS

Fund No:PlanType: Group Health

AMERIHEALTH ADMINISTRATORS2158302596

AMERIHEALTH ADMINISTRATORS720 BLAIR MILL RDHORSHAM PA 19044

Health Net USELECT(866) 813-5300

Health Net USELECT(800) 978-3424

USELECT ArizonaAffiliated With: Health Net, Inc.

Fund No:PlanType: Group Health

The First Health® Network is not used for Behavioral Health services.

Health Net USELECT(866) 813-5300

Health Net USELECTPO Box 4225Lexington KY 40512-4225

Health Net USELECT(866) 813-5300

Health Net USELECT(800) 978-3424

USELECT Arizona Travel Member Benefit

Affiliated With: Health Net, Inc.

Fund No:PlanType: Group Health

The First Health® Network is not used for Behavioral Health services.

Health Net USELECT(866) 813-5300

Health Net USELECTPO Box 4225Lexington KY 40512-4225

CHECK BENEFIT CARD CHECK BENEFIT CARDUTAH IDAHO TEAMSTERS SECURITY FUND

Affiliated With: UTAH IDAHO TEAMSTERS SECURITY FUND

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

COMPUSYS(800) 628-6562

UM NOT APPLICABLEUTAH LABORERS HEALTH & WELFARE FUND TRUST / ID

Affiliated With: UTAH PIPE TRADES WELFARE TRUST FUND

Fund No:PlanType: Group Health

COMPUSYS(800) 628-6562

COMPUSYS2156 W 2200 SSALT LAKE CITY UT 84119-1326

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-573• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 574: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

COMPUSYS(800) 628-6562

UM NOT APPLICABLEUTAH LABORERS HEALTH & WELFARE ID

Affiliated With: UTAH LABORERS HEALTH & WELFARE

Fund No:PlanType: Group Health

COMPUSYS(800) 628-6562

COMPUSYS2156 W 2200 SSALT LAKE CITY UT 84119-1326

COMPUSYS(800) 628-6562

UM NOT APPLICABLEUTAH PIPE TRADES WELFARE TRUST FUND / ID

Affiliated With: UTAH PIPE TRADES WELFARE TRUST FUND

Fund No:PlanType: Group Health

COMPUSYS(800) 628-6562

COMPUSYS2156 W 2200 SSALT LAKE CITY UT 84119-1326

COMPUSYS(800) 628-6562

UM NOT APPLICABLEUTAH PIPE TRADES WELFARE TRUST FUND/ID

Affiliated With: UTAH PIPE TRADES WELFARE TRUST FUND

Fund No:PlanType: Group Health

COMPUSYS(800) 628-6562

COMPUSYS2156 W 2200 SSALT LAKE CITY UT 84119-1326

CHECK BENEFIT CARD CHECK BENEFIT CARDUTAH SHEET METAL WELFARE FUND

Affiliated With: UTAH SHEET METAL WELFARE FUND

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDVACo Risk Management Programs.Affiliated With: VACo Risk Management Programs.

Fund No:PlanType: Workers' Compensation

CHECK BENEFIT CARD VACo Risk Management Programs104 Church Ave SERoanoke VA 24011

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-574• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 575: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDVALDOSTA STATE UNIV AIH0058517

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDVALDOSTA STATE UNIV AIH0058527

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEVALDOSTA STATE UNIVERSITY UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDVALENCIA COMMUNITY COLLEGE DISTRICT

Affiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

Valley Oak Systems(925) 242-4659

CHECK BENEFIT CARDValley Oak SystemsAffiliated With: Valley Oak Systems

Fund No:PlanType: Workers' Compensation

Valley Oak Systems(925) 242-4659

Valley Oak SystemsBishop Ranch 8 - 5000 Executive Pkwy Ste 340San Ramon CA 94583

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-575• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

Mountain States Administrative Services(520) 722-7133

Hines and Associates(847) 214-2780

VALLEY OF THE SUN UNITED WAY

Affiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

Mountain States Administrative Services(520) 722-7133

Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

VALLEY SERVICE CONNECTIONAffiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 460-0238

VALLEY VIEW REGIONAL HOSPITAL

Affiliated With: WATERSTONE BENEFIT ADMINISTRATORS #962501227

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(888) 440-0971

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002

UM NOT APPLICABLE(800) 367-9939

VALPARAISO COMMUNITY SCHOOL CORPORATION

Affiliated With: EMPLOYEE BENEFIT CONSULTANTS INC

Fund No:PlanType: Group Health

EMPLOYEE BENEFIT CONSULTANTS(866) 296-4002

EMPLOYEE BENEFIT CONSULTANTSPO Box 928FINDLAY OH 45839

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-576• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 577: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PRINCIPAL FINANCIAL GROUP(800) 533-5044

CHECK BENEFIT CARDVALPARAISO UNIVERSITYAffiliated With: PRINCIPAL FINANCIAL GROUP

*

Fund No:PlanType: Group Health

PRINCIPAL FINANCIAL GROUP(800) 533-5044

PRINCIPAL FINANCIAL GROUPPO Box 5319TAMPA FL 33675-5319

INTERNATIONAL BENNEFITS ADMINISTRATOR(800) 422-7617

CHECK BENEFIT CARDVAN WAGNER COMMUNICATIONSAffiliated With: HEALTHDATAINSIGHTS DBA MVPPO

Fund No:PlanType: Group Health

INTERNATIONAL BENNEFITS ADMINISTRATOR(800) 422-7617

INTERNATIONAL BENNEFITS ADMINISTRATOR100 GARDEN CITY PLAZA #102GARDEN CITY NY 11530

GREAT WEST LIFE(800) 795-6610

CHECK BENEFIT CARDVARCO INTERNATIONAL INCAffiliated With: GREAT WEST LIFE

Fund No:PlanType: Group Health

GREAT WEST LIFE(800) 795-6610

GREAT WEST LIFE1000 GREAT-WEST DR.KENNETT MO 63857

SELF INSURED PLANS LLC(239) 403-7884

CHECK BENEFIT CARDVCBO ARCHITECTURE LLCAffiliated With: SELF INSURED PLANS, LLC

Fund No:PlanType: Group Health

SELF INSURED PLANS LLC(239) 403-7884

SELF INSURED PLANS LLC1016 COLLIER CENTER WAY STE 200NAPLES FL 34110

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

VEGAS GENERALAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-577• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 578: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

VEGAS GENERAL - TRAVELAffiliated With: SIERRA HEALTH AND LIFE HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CONTACT EMPLOYER CONTACT EMPLOYERVenture ProgramsAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CHECK BENEFIT CARD CHECK BENEFIT CARDVERICLAIMAffiliated With: STAR HEALTHCARE NETWORK INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

HCH ADMINISTRATORS(309) 282-1272

CHECK BENEFIT CARDVERMILLION COUNTYAffiliated With: HEALTH DATA SERVICES

Fund No:PlanType: Group Health

HCH ADMINISTRATORS(309) 282-1272

HCH ADMINISTRATORSPO Box 1986PEORIA IL 61656

EBPA(800) 846-8060

CHECK BENEFIT CARDVERMONT CTR FOR THE DEAF & HARD OF HEARING - WRAP % JMS

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATOR INC

Fund No:PlanType: Group Health

EBPA(800) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05407

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-578• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 579: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(800) 525-8788

CHECK BENEFIT CARDVERMONT LEGAL AID WRAP JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATOR INC(802) 846-8060

COMPREHENSIVE BENEFITS ADMINISTRATOR INCPO Box 2365SOUTH BURLINGTON VT 05403

EBPA(802) 846-8060

CHECK BENEFIT CARDVERMONT MECHANICALAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATOR, INC.

Fund No:PlanType: Group Health

EBPA(802) 846-8060

EBPAPO Box 2365SOUTH BURLINGTON VT 05403

CHECK BENEFIT CARD CHECK BENEFIT CARDVERNON E FAULCONER INCAffiliated With: HEALTHFIRST TPA

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

VERNON SHELTERED WORKSHOP

Affiliated With: HEALTH & WELFARE BENEFIT SYSTEMS

Fund No:PlanType: Group Health

HEALTH AND WELFARE BENEFIT SYSTEMS INC(800) 283-4927

HEALTH AND WELFARE BENEFIT SYSTEMS INCPO Box 21109ROANOKE VA 24018

GISC, INC(800) 242-4472

GISC TOTALCARE(800) 999-1077

VERTEX DISTRIBUTIONAffiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

GISC, INC(800) 242-4472

GISC, INC20 WINTER STPEMBROKE MA 02359

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-579• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

HEALTH PLAN INC(800) 532-7575

CARE MANAGEMENT SERVICES(866) 325-1550

VESCOMAffiliated With: HEASLTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

DELTA HEALTH SYSTEMS(209) 939-3403

DELTA TEAM CARE(800) 336-0123

VESTAR DEVELOPMENTAffiliated With: DELTA HEALTH SYSTEMS

Fund No:PlanType: Group Health

DELTA HEALTH SYSTEMS(209) 939-3403

DELTA HEALTH SYSTEMS1234 W OAK STSTOCKTON CA 95201

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

UM NOT APPLICABLEVESTCOMAffiliated With: MUTUAL ASSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

MUTUAL ASSURANCE ADMINISTRATORS(800) 825-3540

MUTUAL ASSURANCE ADMINISTRATORS3121 QUAIL SPRINGS PKWYOKLAHOMA CITY OK 73134

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLEVGS INCAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

HEALTHCARE SOLUTIONS GROUP, INC.(800) 749-1422

CHECK BENEFIT CARDVICTORY CHRISTIAN CENTERAffiliated With: HEALTHCARE SOLUTIONS GROUP INC

Fund No:PlanType: Group Health

HEALTHCARE SOLUTIONS GROUP, INC.(800) 749-1422

HEALTHCARE SOLUTIONS GROUP, INC.PO Box 1309MUSKOGEE OK 74402

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-580• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 581: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AFFORDABLE BENEFIT ADMINISTRATORS, INC.(818) 842-0147

AFFORDABLE BENEFIT ADMINISTRATORS, INC.(818) 842-0147

VIDIOM SYSTEMS CORPORATIONAffiliated With: AFFORDABLE BENEFIT ADMINISTRATORS, INC. (ABA)

Fund No:PlanType: Group Health

AFFORDABLE BENEFIT ADMINISTRATORS, INC.(818) 842-0147

AFFORDABLE BENEFIT ADMINISTRATORS, INC.444 IRVING DRIVE STE 202BURBANK CA 91504

ZENITH ADMINISTRATORS INC(888) 876-6789

INTRACORP(770) 446-7412

VILLAGE MISSIONSAffiliated With: ZENITH ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

ZENITH ADMINISTRATORS INC(888) 876-6789

ZENITH ADMINISTRATORS INCPO Box 91013SEATTLE WA 98111-9103

ASSURECARE(800) 759-1311

Careline UR(763) 383-4800

VILLAGE OF ALSIPAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 759-1311

ASSURECARE340 Quadrangle DrBolingbrook IL 60440

ASSURECARE(800) 759-1311

Careline UR(763) 383-4800

VILLAGE OF BOLINGBROOKAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 759-1311

ASSURECARE340 Quadrangle DrBolingbrook IL 60440

Western Health(605) 719-4600 or (888) 341-1766

Western Health(605) 719-4640 or (800) 229-0892

Village/Clarkson MT ViewAffiliated With: Rapid City Regional Hospital DBA Western Health

Fund No:PlanType: Group Health

Western Health(605) 719-4600 or (888) 341-1766

Western Health529 Kansas City St Ste 200Rapid City SD 57701

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-581• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 582: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TRUE CHOICE(800) 251-9665

UM NOT APPLICABLEVIRGINIA WESLEYAN COLLEGEAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 251-9665

TRUE CHOICEPO Box 700307DALLAS TX 75370

CONTACT EMPLOYER CONTACT EMPLOYERVirtueMedAffiliated With: VirtueMed, Inc.

Fund No:PlanType: Workers' Compensation

Includes Exclusive Preferred Providers (OCN ONLY)

CONTACT EMPLOYER CONTACT EMPLOYER

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

UM NOT APPLICABLEVOCATIONAL TRAINING CENTERAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

Mountain States Administrative Services(520) 722-7133

Hines and Associates(847) 214-2780

VOCATIONAL TRAINING INSTITUTE INC

Affiliated With: MOUNTAIN STATES ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

Mountain States Administrative Services(520) 722-7133

Mountain States Administrative Services7202 E ROSEWOOD STE 200TUCSON AZ 85710

CHECK BENEFIT CARD CHECK BENEFIT CARDVOLCANO THERAPEUTICS INCAffiliated With: HEALTHCOMP ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-582• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 583: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

AMERICAN HEALTH HOLDING(312) 906-8080 Ext 259

VON TOBLEAffiliated With: ALLIED BENEFIT SYSTEMS INC

Fund No:PlanType: Group Health

ALLIED BENEFIT SYSTEMS, INC(312) 906-8080 Ext 259

ALLIED BENEFIT SYSTEMS, INC208 S LASALLE ST STE 1300CHICAGO IL 60604

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

VSR LOCKAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

PRIME DX(512) 233-7127

PRIME DX(512) 233-7114

VSS, LLCAffiliated With: BOON CHAPMAN BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

PRIME DX(512) 233-7127

PRIME DXPO Box 9201AUSTIN TX 78766

HEALTHSCOPE BENEFITS(877) 883-5352

AMERICAN HEALTH HOLDINGS8009723025

W C BRADLEY COAffiliated With: HEALTHSCOPE BENEFITS

Fund No:PlanType: Group Health

HEALTHSCOPE BENEFITS5012187702

HEALTHSCOPE BENEFITS27 CORPORATE HILL DRLITTLE ROCK AR 72205

EBPA(800) 578-3272

CHECK BENEFIT CARDW E AUBUCHON CO INC - JMSAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-583• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 584: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBPA(800) 578-3272

CHECK BENEFIT CARDW E AUBUCHON CO INC WRAP % JMS

Affiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

ULTRABENEFITS INC(866) 858-7223

CHECK BENEFIT CARDW E MANAGEMENT LLCAffiliated With: ULTRABENEFITS, INC.

Fund No:PlanType: Group Health

ULTRABENEFITS INC(508) 438-0007

ULTRABENEFITS INC29 EAST MOUNTAIN STWORCESTER MA 01606

MANAGED BENEFITS ADMINISTRATOR AND INSURANCE CONSULTANTS(800) 877-3727

CRITIQUE(800) 666-5551

WADA FARMS POTATOES INCAffiliated With: MANAGED BENEFITS ADMINISTRATORS AND INSURANCE CONS

Fund No:PlanType: Group Health

MANAGED BENEFITS ADMINISTRATOR AND INSURANCE CONSULTANTS(800) 877-3727

MANAGED BENEFITS ADMINISTRATOR AND INSURANCE CONSULTANTSPO Box 651109SALT LAKE CITY UT 84165-1109

TALL TREE ADMINISTRATORS(801) 274-8100

CORVEL(801) 269-8723

WADSWORTH CONSTRUCTION COMPANY

Affiliated With: TALL TREE ADMINISTRATORS

Fund No:PlanType: Group Health

TALL TREE ADMINISTRATORS(801) 274-8100

TALL TREE ADMINISTRATORS802 E WINCHESTER RD STE 205SALT LAKE CITY UT 84107

CORESOURCE INC(800) 274-6965

CORESOURCE INC(866) 794-0770

WAGNER AND BROWNAffiliated With: CORESOURCE, INC.

Fund No:PlanType: Group Health

CORESOURCE INC(800) 274-6965

CORESOURCE INC7830 E. BroadwayTUCSON AZ 85710

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-584• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 585: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

WAKO ELECTRONICS (USA) INCAffiliated With: PREFERRED HEALTH PLAN INC 962550088

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(502) 992-4535

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

NGS AMERICAN8005211555

NGS AMERICAN8005211555

WALBRO ENGINE MANAGEMENTAffiliated With: NGS AMERICAN INC

Fund No:PlanType: Group Health

NGS AMERICAN8005211555

NGS AMERICANPO Box 7676DETROIT MI 48080

EBPA(800) 578-3272

CHECK BENEFIT CARDWALDRON GROUP - JMSAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

ASSURECARE(800) 328-0927

CHECK BENEFIT CARDWALL COLMONOYAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 328-0927

ASSURECARE13700 WATERTOWER CIRCLE STE DPLYMOUTH MN 55441-3705

WALLA WALLA VAMC CHECK BENEFIT CARDWALLA WALLA VAMC 3182Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

WALLA WALLA VAMC WALLA WALLA VAMC

77 WAINWRIGHT DRWALLA WALLA WA 99362-3994

Attn: FEE 208

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-585• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 586: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CONTACT EMPLOYER CONTACT EMPLOYERWalmart

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERWalt Disney CompanyAffiliated With: StratacareYTD NOAS102 Report

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

GREAT WEST LIFE(800) 795-6610

CHECK BENEFIT CARDWARD PETROLEUMAffiliated With: GREAT WEST LIFE

Fund No:PlanType: Group Health

GREAT WEST LIFE(800) 795-6610

GREAT WEST LIFE1000 GREAT-WEST DR.KENNETT MO 63857

CHECK BENEFIT CARD8882954864

CHECK BENEFIT CARDWAREHOUSE HOME FURNISHINGS DISTRIBUTORS

Affiliated With: JSL ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8882954864

CHECK BENEFIT CARD

STUDENT INSURANCE A DIVISION OF UICI(800) 767-0700

CHECK BENEFIT CARDWARNER PACIFIC COLLEGEAffiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT INSURANCE A DIVISION OF UICI(800) 237-0903 Ext 6352

STUDENT INSURANCE A DIVISION OF UICI2301 W. PLANO PKWY #300PLANO TX 75075

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-586• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 587: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ASSURECARE(800) 422-2026

Careline UR(763) 383-4800

WARREN FABRICATIONAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 422-2026

ASSURECARE1742 GEORGETOWN RD STE EHUDSON OH 44224

WASHINGTON DC VA MEDICAL CENTER

CHECK BENEFIT CARDWASHINGTON DC VA MEDICAL CENTER 3132

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

WASHINGTON DC VA MEDICAL CENTER

WASHINGTON DC VA MEDICAL CENTER

50 IRVING STATION WESTWASHINGTON DC 20422

Attn: FEE BASIS 122

CHECK BENEFIT CARD8004269786

CHECK BENEFIT CARDWASHINGTON FIRE COMMISSIONERS ASSOCIATION

Affiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8004269786

CHECK BENEFIT CARD

KEY BENEFIT ADMINISTRATORS(800) 331-4757

Health Care Management(317) 284-7650

WATERFURNACE INTERNATIONAL

Affiliated With: KEY BENEFIT ADMINISTRATORS #962501149

Fund No:PlanType: Group Health

KEY BENEFIT ADMINISTRATORS(317) 284-7769

KEY BENEFIT ADMINISTRATORS8330 ALLISON POINT TRAILINDIANAPOLIS IL 46250

WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 816-6049

UM NOT APPLICABLEWATERSTONE BENEFIT ADMINISTRATORS

Affiliated With: WATERSTONE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(800) 816-6049

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-587• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 588: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CENBEN USA(614) 797-5204

CHECK BENEFIT CARDWATKINS MANUFACTURINGAffiliated With: CENBEN USA INC

Fund No:PlanType: Group Health

CENBEN USA(614) 797-5204

CENBEN USA

4079 Executive PkwyWesterville OH 43081

Attn: Melissa Joseph

CENBEN USA(614) 797-5204

CHECK BENEFIT CARDWATKINS MANUFACTURING % TRAVEL

Affiliated With: CENBEN USA INC

Fund No:PlanType: Group Health

CENBEN USA(614) 797-5204

CENBEN USA

4079 Executive PkwyWesterville OH 43081

Attn: Melissa Joseph

SISCO(800) 547-4726

CHECK BENEFIT CARDWAUPACA NORTHWOODSAffiliated With: SISCO/Cottingham & Butler

Fund No:PlanType: Group Health

SISCO(800) 547-4726

SISCOPO Box 389DUBUQUE IA 52004-0389

CONTACT EMPLOYER CONTACT EMPLOYERWausau InsuranceAffiliated With: Liberty Mutual Insurance Group

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

WAUSAU BENEFITS, INC.(715) 841-7802

CHECK BENEFIT CARDWAUSAU MOSINEE PAPER CORPORATION

Affiliated With: WAUSAU BENEFITS INC

Fund No:PlanType: Group Health

WAUSAU BENEFITS, INC.(715) 841-7802

WAUSAU BENEFITS, INC.

PO Box 8046WAUSAU WI 54401-8046

Attn: LeAnn Fichtner

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-588• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 589: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDWAYCROSS COLLEGE AIH0058537

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDWAYCROSS COLLEGE AIH0058547

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2271Florence SC 29503

PEARCE ADMINISTRATION(800) 222-6491

UM NOT APPLICABLEWAYCROSS COLLEGE UNDERGRAD MANDATORY

Affiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(800) 222-6491

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

CHECK BENEFIT CARD CHECK BENEFIT CARDWAYNE AUTOMATIC FIRE SPRINKLER INC

Affiliated With: HERITAGE CONSULTANTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

TRUE CHOICE USA(800) 785-2446

CHECK BENEFIT CARDWEATHERFORD COLLEGEAffiliated With: ACADEMIC RISK MANAGEMENT

Term Effective: 8/31/2007Fund No:PlanType: Group Health

TRUE CHOICE USA(800) 785-2446

TRUE CHOICE USAPO Box 700307DALLAS TX 75370

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-589• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 590: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MCMC LLC(888) 350-1150 Ext 228

MCMC LLC(888) 350-1150 Ext 228

WEBSTER AUTOAffiliated With: MCMC LLC

Fund No:PlanType: Auto

MCMC LLC(888) 350-1150 Ext 228

MCMC LLC701 Technology Dr Ste 100Canonsburg PA 15317

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

CHECK BENEFIT CARDWEISER SECURITYAffiliated With: FCE BENEFIT ADMINISTRATORS INC #10388

*

Fund No:PlanType: Group Health

FCE BENEFIT ADMINISTRATORS INC(800) 899-9355

FCE BENEFIT ADMINISTRATORS INC4615 WALZEN RD STE 300SAN ANTONIO TX 78218

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 668-6004

AMERICAN BENEFIT COMPANY, INC.(425) 289-5142

WELCO LUMBER COMPANY USAAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS INC

Fund No:PlanType: Group Health

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(800) 668-6004

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.PO Box 85008BELLEVUE WA 98015

CHECK BENEFIT CARD CHECK BENEFIT CARDWELLESLEY COLLEGE SPORTSAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDWELLINGTON INVESTMENT CORPORATION

Affiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-590• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 591: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PITTMAN & ASSOCIATES, INC.(800) 238-1344

VALUECHECK(888) 545-6687

WENCOAST RESTAURANTSAffiliated With: PITTMAN AND ASSOCIATES

Fund No:PlanType: Group Health

PITTMAN & ASSOCIATES, INC.(800) 238-1344

PITTMAN & ASSOCIATES, INC.ONE PRESCOTT SOUTHMEMPHIS TN 38111

CONTACT EMPLOYER CONTACT EMPLOYERWerner EnterprisesAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

PEARCE ADMINISTRATION(843) 622-6001

UM NOT APPLICABLEWESLEYAN COLLEGEAffiliated With: MAKSIN MANAGEMENT CORP

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATION

419 S. COIT STFLORENCE SC 29501

Attn: WHIT WALTERS

KLAIS & COMPANY INC(330) 867-8443

CHECK BENEFIT CARDWESLEYAN UNIV BASIC PLAN & WESLEYAN UNIV ENHANCHED PLAN

Affiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(330) 867-8443

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

WESSIN TRANSPORT, INCAffiliated With: PREFERREDONE ADMINISTRATIVE SERVICES

Fund No:PlanType: Group Health

PREFERREDONE ADMINISTRATIVE SERVICES(800) 997-1750

PREFERREDONE ADMINISTRATIVE SERVICESPO Box 59212MINNEAPOLIS MN 55459

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-591• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 592: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

WEST BROTHERS CHRYSLER, INC

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SELF INSURED PLANS LLC

MedWatch(800) 432-8421

WEST MANATEE FIRE RESCUE DISTRICT

Affiliated With: SELF INSURED PLANS LLC

Fund No:PlanType: Group Health

SELF INSURED PLANS LLC SELF INSURED PLANS LLC1016 COLLIER CENTER STE 200NAPLES FL 34103

WEST PALM BEACH VAMC CHECK BENEFIT CARDWEST PALM BEACH VA MEDICAL CENTER 3142

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

WEST PALM BEACH VAMC WEST PALM BEACH VAMC

7305 N MILITARY TRAILWEST PALM BEACH FL 33410

Attn: 136-FEE BASIS

CHECK BENEFIT CARD CHECK BENEFIT CARDWEST VIRGINIA EMPLOYEE BENEFIT SERVICES

Affiliated With: GLOBALCARE

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

FMH / HCM FMH / HCM(800) 990-9058

WESTAR ENERGY - NATIONALAffiliated With: FMH BENEFIT SERVICES INC

Fund No:PlanType: Group Health

FMH / HCM FMH / HCM

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-592• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 593: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

WESTCOR CONSTRUCTIONAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

WESTCOR CONSTRUCTION TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDWESTERN CAROLINA UNIVERSITY

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(888) 722-1668

PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408

PINNACLE CLAIMS MANAGEMENT INC(800) 777-7898

Blue Cross of California(800) 274-7767

WESTERN GROWERS ASSURANCE TRUST

Affiliated With: WESTERN GROWERS ASSURANCE TRUST

Fund No:PlanType: Group Health

PINNACLE CLAIMS MANAGEMENT INC(800) 777-7898

PINNACLE CLAIMS MANAGEMENT INCPO Box 2130Newport Beach CA 92658

CONTACT EMPLOYER CONTACT EMPLOYERWestern Guaranty FundAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-593• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 594: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ADVENTIST HEALTH SYSTEM/WEST(800) 441-2524

UM NOT APPLICABLEWESTERN HEALTH RESOURCEAffiliated With: ADVENTIST HEALTH SYSTEMS/WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEM/WEST(800) 441-2524

ADVENTIST HEALTH SYSTEM/WEST2100 DOUGLASROSEVILLE CA 95661

TRUE CHOICE(800) 251-9665

UM NOT APPLICABLEWESTERN KENTUCKY UNIVERSITY

Affiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 251-9665

TRUE CHOICEPO Box 700307DALLAS TX 75370

PIONEER MANAGEMENT SYSTEMS(877) 868-9060

CHECK BENEFIT CARDWESTERN NEW ENGLAND COLLEGE

Affiliated With: PIONEER MANAGEMENT SYSTEMS

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(877) 868-9060

PIONEER MANAGEMENT SYSTEMS123 INTERSTATE DRW SPRINGFIELD MA 01090

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

WESTERN OREGON UNIVERSITYAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

CHECK BENEFIT CARD CHECK BENEFIT CARDWESTERN STATE UNIVERSITYAffiliated With: STUDENT ASSURANCE SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-594• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 595: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDWESTERN STATES CHIROPRACTIC COLLEGE

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

WESTERN STATES CONTRACTING - TRAVEL

Affiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

STUDENT RESOURCES(800) 237-0903 Ext 6352

CHECK BENEFIT CARDWESTERN THEOLOGICAL SEMINARY

Affiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT RESOURCES(800) 237-0903 Ext 6352

STUDENT RESOURCES2301 W. PLANO PKWY #300PLANO TX 75075

CHECK BENEFIT CARD CHECK BENEFIT CARDWESTERN TOOL SUPPLYAffiliated With: TRUSTEED PLANS SERVICE CORPORATION

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-595• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 596: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

WESTERN UNIVERSITY OF HEALTH SCIENCE

Affiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS, (PIA)(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS, (PIA)30401 Agoura Rd #250Agoura Hills CA 91376

CHECK BENEFIT CARD CHECK BENEFIT CARDWESTERN WASHINGTON ONCOLOGY

Affiliated With: TRUSTEED PLANS SERVICE CORPORATION

Term Effective: 9/30/2007Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

W HAVEN VA MEDICAL VENTER

CHECK BENEFIT CARDWESTHAVEN VA MEDICAL CENTER 3716

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

W HAVEN VA MEDICAL VENTER

W HAVEN VA MEDICAL VENTER

950 Campbell AveWest Haven CT 06516

Attn: Ian Kauffman - Dept 118

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

WESTSTAR CREDIT UNIONAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-596• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 597: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

EBMS(406) 245-3575

EBMS(406) 245-3575

WESTWARD SEAFOOD INCAffiliated With: EMPLOYEE BENEFIT MANAGEMENT SERVICES #15318

Fund No:PlanType: Group Health

EBMS(406) 245-3575

EBMSPO Box 21367BILLINGS MT 59104-1367

WEYCO INC(517) 349-7010 Ext 6059

CHECK BENEFIT CARDWEYCO, INCAffiliated With: WEYCO, INC

Fund No:PlanType: Group Health

WEYCO INC(517) 349-7010 Ext 6059

WEYCO INCPO Box 30132OKEMOS MI 48864

CORPORATE BENEFITS SERVICE, INC.(800) 277-9476

ALLIANCE REVIEW SERVICES(800) 373-4454

WHALEY FOOD SERVICE REPAIRS

Affiliated With: CORPORATE BENEFIT SERVICES, INC.

Fund No:PlanType: Group Health

CORPORATE BENEFITS SERVICE, INC.(800) 277-9476

CORPORATE BENEFITS SERVICE, INC.145 Scaleybark Rd. Ste BCHARLOTTE NC 28209

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(425) 482-1000

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(425) 482-1000

WHATCOM COUNTYAffiliated With: HEALTHCARE MANAGEMENT ADMINISTRATORS

Fund No:PlanType: Group Health

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.(425) 482-1000

HEALTHCARE MANAGEMENT ADMINISTRATORS, INC.220 120th Ave Ste D200Bellevue WA 98005

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

CHECK BENEFIT CARDWHEATON COLLEGE - ACIAffiliated With: ADMINISTRATIVE CONCEPTS INC

Fund No:PlanType: Group Health

ADMINISTRATIVE CONCEPTS, INC.(888) 293-9229

ADMINISTRATIVE CONCEPTS, INC.997 OLD EAGLE SCHOOLWAYNE PA 19087-1706

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-597• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 598: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

KLAIS & COMPANY INC(330) 867-8443

CHECK BENEFIT CARDWHEATON COLLEGE ACCIDENT AND SICKNESS PLAN AND WHEATON COLLEGE ACCIDENT ONLY

Affiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(330) 867-8443

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

CHECK BENEFIT CARDWHEATON COLLEGE ILLINOISAffiliated With: PIONEER MANAGEMENT SERVICES

Fund No:PlanType: Group Health

PIONEER MANAGEMENT SYSTEMS(413) 539-9900

PIONEER MANAGEMENT SYSTEMSPO Box 9040WEST SPRINGFIELD MA 01090

CLAIMS MANAGER(501) 219-5106

CHECK BENEFIT CARDWHITE COUNTY MEDICAL CENTER

Affiliated With: QUALCHOICE/QCA HEALTH PLAN INC #962500569

Fund No:PlanType: Group Health

CLAIMS MANAGER(501) 219-5106

CLAIMS MANAGER

10825 FINANCIAL CENTRE PKWY STE 400LITTLE ROCK AR 72211

Attn: DEBBIE PEARCE

PREFERRED HEALTH PLANS INC.(800) 832-8212

PHCS Utilization Management(888) 551-7427

WHITE COUNTY MEMORIAL HOSPITAL

Affiliated With: PREFERRED HEALTH PLANS, INC.

Fund No:PlanType: Group Health

PREFERRED HEALTH PLANS INC.(800) 832-8212

PREFERRED HEALTH PLANS INC.10160 LINN STATION RDLOUISVILLE KY 40223

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-598• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 599: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ADVENTIST HEALTH SYSTEMS/WEST

CHECK BENEFIT CARDWHITE MEMORIAL MEDICAL CENTER EPO PLAN

Affiliated With: ADVENTIST HEALTH SYSTEMS/WEST

Fund No:PlanType: Group Health

ADVENTIST HEALTH SYSTEMS/WEST

ADVENTIST HEALTH SYSTEMS/WESTPO Box 619031ROSEVILLE CA 95661-9002

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

White Pine County - TravelAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CONTACT EMPLOYER CONTACT EMPLOYERWhite PlainsAffiliated With: New York State Insurance Fund

*

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

WHITE RIVER JUNCTION VAMC & REG OFFICE

CHECK BENEFIT CARDWHITE RIVER JUNCTION VAMC & REG OFFICE 3116

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

WHITE RIVER JUNCTION VAMC & REG OFFICE

WHITE RIVER JUNCTION VAMC & REG OFFICE

215 N MAIN STWHITE RIVER JUNCTION VT 05009

Attn: FEE BASIS 136F

AMERIBEN SOLUTIONS(800) 786-7930

AMERIBEN SOLUTIONS(800) 786-7930

WHITMAN COLLEGE - INDUSTRIAL & DOMESTIC

Affiliated With: AMERIBEN SOLUTIONS

Term Effective: 8/31/2007Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-599• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

AMERIBEN SOLUTIONS(800) 953-1801

CHECK BENEFIT CARDWHITTIER COLLEGEAffiliated With: AMERIBEN SOLUTIONS

Fund No:PlanType: Group Health

AMERIBEN SOLUTIONS(800) 953-1801

AMERIBEN SOLUTIONSPO Box 7186BOISE ID 83707

DIRECTOR OF CLAIM OPERATION(800) 288-2078

MEDWATCH, INC.(800) 432-8421

WHITWORTH TOOL INCAffiliated With: ALLIED BENEFITS SYSTEMS, INC.

Fund No:PlanType: Group Health

DIRECTOR OF CLAIM OPERATION(800) 288-2078

DIRECTOR OF CLAIM OPERATION208 S LASALLE ST STE 1300CHICAGO IL 60604

CONTACT EMPLOYER CONTACT EMPLOYERWhole Foods Market IncAffiliated With: Genex Services, Inc.

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

WICHITA VA MEDICAL CENTER

CHECK BENEFIT CARDWICHITA VA MEDICAL CENTER 3530

Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

WICHITA VA MEDICAL CENTER

WICHITA VA MEDICAL CENTER

5500 E KELLOGGWICHITA KS 67218

Attn: FEE BASIS

EBPA(800) 578-3272

CHECK BENEFIT CARDWIGGIN AND NOURIE - JMSAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-600• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

WILKES-BARRE VAMC CHECK BENEFIT CARDWILKES-BARRE VAMC 3128Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

WILKES-BARRE VAMC WILKES-BARRE VAMC

1111 E END BLVDWILKES-BARRE PA 08711

Attn: FEE BASIS 16D

EQUITABLE PLAN SERVICES(405) 755-2929

CHECK BENEFIT CARDWILLBROS USA INCAffiliated With: EQUITABLE PLAN SERVICES

Fund No:PlanType: Group Health

EQUITABLE PLAN SERVICES(405) 755-2929

EQUITABLE PLAN SERVICESPO Box 720460OKLAHOMA CITY OK 73172

WILLIAM C. EARHART CO. INC.(800) 547-1314

UM NOT APPLICABLEWILLIAM C EARHART COMPANY, INC

Affiliated With: THE WILLIAM C EARHART COMPANY, INC

Fund No:PlanType: Group Health

WILLIAM C. EARHART CO. INC.(800) 547-1314

WILLIAM C. EARHART CO. INC.PO Box 4148PORTLAND OR 97208

CHECK BENEFIT CARD CHECK BENEFIT CARDWILLIAM F FENTON INC TOYOTA VOLVO OF KEENE

Affiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDWILLIAM RUSSELLAffiliated With: STAR HEALTHCARE NETWORK INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-601• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 602: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(307) 347-6151

MOUNTAIN STATES REVIEW(307) 347-7979

WILLIAM, PORTER, DAY & NEVILLE, PC

Affiliated With: MANAGED BENEFITS ADMINISTRATORS & INS CONSULTANTS

Fund No:PlanType: Group Health

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTS(307) 347-6151

MANAGED BENEFITS ADMINISTRATOR & INSURANCE CONSULTANTSPO Box 98WORLAND WY 82401

PARAGON BENEFITS, INC.(800) 277-9218

MEDWATCH, LLC(800) 432-8421

WILLIAMS BROTHERS TRUCKINGAffiliated With: PARAGON BENEFITS INC

*

Term Effective: 9/30/2007Fund No:PlanType: Group Health

PARAGON BENEFITS, INC.(800) 277-9218

PARAGON BENEFITS, INC.PO Box 1199STOCKTON CA 95201

KLAIS & COMPANY INC(330) 867-8443

CHECK BENEFIT CARDWILLIAMS COLLEGEAffiliated With: KLAIS & COMPANY

Fund No:PlanType: Group Health

KLAIS & COMPANY INC(330) 867-8443

KLAIS & COMPANY INC1867 W MARKET STAKRON OH 44313

GISC, INC(800) 242-4472

CHECK BENEFIT CARDWILLIAMS STONE CO, INCAffiliated With: GROUP INSURANCE SERVICE CENTER INC

Fund No:PlanType: Group Health

GISC, INC(800) 242-4472

GISC, INC20 WINTER STPEMBROKE MA 02359

CHECK BENEFIT CARD8004427247

CHECK BENEFIT CARDWILLIS CONSTRUCTIONAffiliated With: HEALTHCOMP ADMINISTRATORS INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8004427247

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-602• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 603: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD CHECK BENEFIT CARDWILLIS INCAffiliated With: FISERV HEALTH TENNESSEE

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDWILLIS OF KANSAS INCAffiliated With: WILLIS OF KANSAS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

WILMINGTON VAMC CHECK BENEFIT CARDWILMINGTON VAMC 3129Affiliated With: HEALTH NET FEDERAL SERVICES

Fund No:PlanType: Group Health

WILMINGTON VAMC WILMINGTON VAMC

1601 KIRKWOOD HWYWILMINGTON DE 19805

Attn: FEE BASIS 600

GROUP INSURANCE SERVICE CENTER(800) 242-4472

GISC TOTALCARE(800) 242-4472

WILSON FARMSAffiliated With: GROUP INSURANCE SERVICE CENTER

Fund No:PlanType: Group Health

GROUP INSURANCE SERVICE CENTER(800) 242-4472

GROUP INSURANCE SERVICE CENTER20 WINTER STPEMBROKE MA 02359

THIRD PARTY ADMINISTRATORS(800) 736-7872

CHECK BENEFIT CARDWILSON FOODS RETIREESAffiliated With: THIRD PARTY ADMINISTRATORS

Fund No:PlanType: Group Health

THIRD PARTY ADMINISTRATORS(800) 736-7872

THIRD PARTY ADMINISTRATORS1733 PARK STREET #300NAPERVILLE IL 60563

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-603• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 604: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INC

WINDERWEEDLE, HAINES, WARD & WOODMAN, P.A.

Affiliated With: PREFERRED BENEFIT ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INCPO Box 916188LONGWOOD FL 32791-6188

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.(800) 284-2273

WINNAffiliated With: OSF HEALTHPLANS, INC.

Fund No:PlanType: Group Health

OSF HealthPlans, Inc.(800) 673-5222

OSF HealthPlans, Inc.PO Box 1229Peoria IL 61601-5128

PEARCE ADMINISTRATION(888) 722-1668

CHECK BENEFIT CARDWINSTON-SALEM STATE UNIVERSITY

Affiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(888) 722-1668

PEARCE ADMINISTRATIONPO Box 2408Florence SC 29503-2408

PEARCE ADMINISTRATION(843) 622-6001

CHECK BENEFIT CARDWINTHROP UNIVERSITYAffiliated With: MAKSIN MANAGEMENT CORP #14005

Fund No:PlanType: Group Health

PEARCE ADMINISTRATION(843) 622-6001

PEARCE ADMINISTRATIONPO Box 2437Florence SC 29503-2437

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-604• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 605: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

CHECK BENEFIT CARDWITTWER CONSTRUCTION COMPANY INC

Affiliated With: WATERSTONE BENEFITS ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

WATERSTONE BENEFIT ADMINISTRATORS, INC.(405) 440-8888

WATERSTONE BENEFIT ADMINISTRATORS, INC.4013 NW EXPRESSWAY STE 575OKLAHOMA CITY OK 73116

HEALTH PLAN INC(508) 752-2480

CARE MANAGEMENT SERVICES(866) 325-1550

WOLLASTON ALLYOYS INCAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

ASSURECARE(800) 968-6616

CARELINE(763) 383-4800

WOLVERINEAffiliated With: ASSURECARE

Fund No:PlanType: Group Health

ASSURECARE(800) 968-6616

ASSURECARE4040 HUNSAKER STE 110LANSING MI 38823

EBPA(800) 578-3272

CHECK BENEFIT CARDWOOD STRUCTURES - JMSAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

CHECK BENEFIT CARDWOODBURY UNIVERSITYAffiliated With: PERSONAL INSURANCE ADMINISTRATORS PIA #10491

Fund No:PlanType: Group Health

PERSONAL INSURANCE ADMINISTRATORS(800) 468-4343

PERSONAL INSURANCE ADMINISTRATORS30401 Agoura Rd #250Agoura Hills CA 91376

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-605• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 606: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CHECK BENEFIT CARD8005514049

CHECK BENEFIT CARDWOODFIN SUITE HOTELSAffiliated With: P5 HEALTH PLAN SOLUTIONS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8005514049

CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDWOODGRAIN MILLWORK INCAffiliated With: SOVEREIGN SOLUTIONS

Term Effective: 3/31/2008Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD CHECK BENEFIT CARDWOODLAND FURNITURE HARKER DESIGN

Affiliated With: SMITH ADMINISTRATORS

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

STUDENT RESOURCES(800) 237-0903 Ext 6352

CHECK BENEFIT CARDWORCESTER POLYTECHNIC INSTITUTE

Affiliated With: UnitedHealthcare StudentResources #11689

Term Effective: 8/31/2007Fund No:PlanType: Group Health

STUDENT RESOURCES(800) 237-0903 Ext 6352

STUDENT RESOURCES2301 W. PLANO PKWY #300PLANO TX 75075

CHECK BENEFIT CARD6783411722

CHECK BENEFIT CARDWORKSITE RXAffiliated With: GLOBALCARE

Fund No:PlanType: Group Health

CHECK BENEFIT CARD6783411722

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-606• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 607: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

TAYLOR BENEFIT RESOURCE, INC.(229) 225-9795

TAYLOR BENEFIT RESOURCE, INC.(888) 352-5246

WORKSTAFFAffiliated With: TAYLORE BENEFIT RESOURCES

Fund No:PlanType: Group Health

TAYLOR BENEFIT RESOURCE, INC.(229) 225-9795

TAYLOR BENEFIT RESOURCE, INC.PO Box 6580THOMASVILLE GA 31758

BENESIGHT INC(877) 718-6920

CBCA Administrators Inc(214) 920-9076

WORLD COURIER GROUP INCAffiliated With: BENESIGHT INC

Fund No:PlanType: Group Health

BENESIGHT INC(877) 718-6920

BENESIGHT INCPO Box 360Pueblo CO 81002-0360

WORLD INSURANCE COMPANY(800) 786-7557

CHECK BENEFIT CARDWORLD INSURANCE COMPANYAffiliated With: AMERICAN REPUBLIC INSURANCE COMPANY

Fund No:PlanType: Group Health

WORLD INSURANCE COMPANY(402) 496-8044

WORLD INSURANCE COMPANYPO Box 2558OMAHA NE 68103-2558

CHECK BENEFIT CARD CHECK BENEFIT CARDWORLD LEARNINGAffiliated With: AIG CLAIMS SERVICES INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARDWORLD MINERALS INCAffiliated With: EBMS EMPLOYEE BENEFIT MANAGEMENT SERVICES

Fund No:PlanType: Group Health

CHECK BENEFIT CARD8007773575

CHECK BENEFIT CARD

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-607• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 608: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

WRIGHT ENGINEERSAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADAPO Box 15645LAS VEGAS NV 89114

CHECK BENEFIT CARD CHECK BENEFIT CARDWRIGHT TRAVEL AGENCYAffiliated With: BENESIGHT INC

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

SUPERIEN HEALTH NETWORK(800) 266-5896

CHECK BENEFIT CARDWW WILLIAMSAffiliated With: INTERPLAN HEALTH GROUP

Fund No:PlanType: Group Health

SUPERIEN HEALTH NETWORK(800) 266-5896

SUPERIEN HEALTH NETWORK

PO Box 2388 CSTOW OH 44224

Attn: Supervisor of the Claims Dept

COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272

COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272

WYMAN GORDAN COMPANYAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272

COMPREHENSIVE BENEFITS ADMINISTRATORS INCPO Box 2365SOUTH BURLINGTON VT 05407-2365

EBPA(800) 578-3272

CHECK BENEFIT CARDWYMAN GORDAN INVESTMENTS CASTINGS INC - JMS

Affiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-608• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 609: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272

COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272

WYMAN GORDON COMPANYAffiliated With: COMPREHENSIVE BENEFIT ADMINISTRATORS INC (EBPA)

Fund No:PlanType: Group Health

COMPREHENSIVE BENEFITS ADMINISTRATORS INC(800) 587-3272

COMPREHENSIVE BENEFITS ADMINISTRATORS INCPO Box 2365SOUTH BURLINGTON VT 05407-2365

CHECK BENEFIT CARD CHECK BENEFIT CARDXOMAX CRANE COAffiliated With: THE EPOCH GROUP L C

Fund No:PlanType: Group Health

CHECK BENEFIT CARD CHECK BENEFIT CARD

INSURANCE ADMINISTRATORS OF AMERICA INC8885991515

HEALTHCARE STRATEGIES8885991515

X-RAY ASSOCIATESAffiliated With: INSURANCE ADMINISTRATORS OF AMERICA INC

Fund No:PlanType: Group Health

INSURANCE ADMINISTRATORS OF AMERICA INC8885991515

INSURANCE ADMINISTRATORS OF AMERICA INC9841 BROKEN LANE PKWYCOLUMBIA MD 21046

Benefit Planners(800) 292-5386

CHECK BENEFIT CARDXTO ENERGYAffiliated With: BENEFIT PLANNERS

Fund No:PlanType: Group Health

Benefit Planners(800) 292-5386

Benefit PlannersPO Box 690450SAN ANTONIO TX 78269

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE/HEALTH PLAN OF NEVADA(702) 242-7345

XYIENCE INCAffiliated With: SIERRA HEALTH & LIFE / HEALTH PLAN OF NEVADA

Fund No:PlanType: Group Health

SIERRA HEALTH & LIFE / HEALTH PLAN(702) 242-7700

SIERRA HEALTH & LIFE / HEALTH PLANPO Box 15645LAS VEGAS NV 89114

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-609• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

Page 610: The First Health Network Outpatient Care Network COLORADO ... · Stockton CA 95201 Accident Fund Insurance Company of America (517) 367-1771 Accident Fund Insurance Company of America

PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

GILSBAR(985) 871-1863

CHECK BENEFIT CARDYAVAPAI-PRESCOTT INDIAN TRIBE

Affiliated With: GILSBAR, INC.

Fund No:PlanType: Group Health

GILSBAR(985) 871-1863

GILSBARPO Box 2947COVINGTON LA 70434

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

HINES & ASSOCIATES(888) 819-3775

YENMAN ENTERPRISES LTDAffiliated With: PREFERRED BENEFIT ADMINISTRATORS, INC

Fund No:PlanType: Group Health

PREFERRED BENEFIT ADMINISTRATORS INC(407) 786-2777

PREFERRED BENEFIT ADMINISTRATORS INCPO Box 916188LONGWOOD FL 32791-6188

TRUE CHOICE(800) 251-9665

UM NOT APPLICABLEYESHIVA UNIVERSITYAffiliated With: ACADEMIC RISK MANAGEMENT

Fund No:PlanType: Group Health

TRUE CHOICE(800) 251-9665

TRUE CHOICEPO Box 700307DALLAS TX 75370

HEALTH PLAN INC(508) 752-2480

CMS(866) 325-1550

YESTERDAY'S CHILDREN, INCAffiliated With: HEALTH PLANS INC

Fund No:PlanType: Group Health

HEALTH PLAN INC(508) 752-2480

HEALTH PLAN INC1500 WEST PARK DR STE 330WESTBOROUGH MA 01581

EBPA(800) 578-3272

CHECK BENEFIT CARDYORK HOSPITAL JMSAffiliated With: EMPLOYEE BENEFIT PLAN ADMINISTRATORS

Fund No:PlanType: Group Health

EBPA(800) 578-3272

EBPA

PO Box 2000Exeter NH 03833

Attn: Denise Oberg

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-610• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

ECOM PPO ADVISORS, INC(719) 381-1950

CHECK BENEFIT CARDYOUNG LIFEAffiliated With: ECOM PPO ADVISORS INC

Fund No:PlanType: Group Health

ECOM PPO ADVISORS, INC(719) 381-1950

ECOM PPO ADVISORS, INC

8350 N. CENTRAL EXPWY, STE 600DALLAS TX 75206

Attn: ACCOUNTING

MMSI(866) 222-3914

MMSI(800) 632-9885

YUMA COUNTYAffiliated With: MMSI

Fund No:PlanType: Group Health

MMSI(866) 222-3914

MMSI4001 41ST STREET NWROCHESTER MN 55901

HEALTHCOMP ADMINISTRATORS INC(559) 499-2450

HEALTHCOMP ADMINISTRATORS INC(559) 499-2450

ZACKY FARMSAffiliated With: HEALTHCOMP ADMINISTRATORS, INC.

Fund No:PlanType: Group Health

HEALTHCOMP ADMINISTRATORS INC(559) 499-2450

HEALTHCOMP ADMINISTRATORS INCPO Box 45018Fresno CA 93718

CONTACT EMPLOYER CONTACT EMPLOYERZenithAffiliated With: Zenith Insurance Company

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

NHBC(888) 621-7900

CHECK BENEFIT CARDZENITH ADMINISTRATORS WRAPAffiliated With: NATIONAL HEALTH BENEFIT CORPORATION NHBC #12717

Fund No:PlanType: Group Health

NHBC(888) 621-7900

NHBC8990 E. Raintree Dr.Scottsdale AZ 85260

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-611• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.

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PAYOR NAME

COLORADO Comprehensive Client List

Billing / Claims Submission

Eligibility/ Benefits/ Compensability

UM/Pre-Certification and/or Referral Management Billing/Claims

The First Health® Network Outpatient Care Network

CENBEN USA(614) 797-5204

CHECK BENEFIT CARDZODIAC DBA POLARIS POOL SYSTEMS

Affiliated With: CENBEN USA INC

Fund No:PlanType: Group Health

CENBEN USA(614) 797-5204

CENBEN USA

4079 Executive PkwyWesterville OH 43081

Attn: Melissa Joseph

CONTACT EMPLOYER CONTACT EMPLOYERZURICH AUTOAffiliated With: ZURICH NORTH AMERICAN

Fund No:PlanType: Auto

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERZurich Farmers Insurance GroupAffiliated With: Zurich Farmers Insurance Group

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Attn:

CONTACT EMPLOYER CONTACT EMPLOYERZurich North AmericaAffiliated With: Zurich Services Corporation

Fund No:PlanType: Workers' Compensation

CONTACT EMPLOYER CONTACT EMPLOYER

Info as of 12/27/2007

www.firsthealth.com

For further information, contact Provider Relations at (800) 937-6824

Page CCL CO-612• Patients using benefit cards with any AFFORDABLE logo should be recognized as having access to The First Health® Network. • * Indicates payor information has been revised since the last reporting period. • Providers may not be eligible for participation in certain Coventry or First Health network products due to client requirements or restrictions. Patient eligibility, benefits and compensability coverage MUST be confirmed by calling the telephone numbers and/or employer indicated under the "Eligibility/Benefits/Compensability" section.