Listing of Administrators - azfmc.com

1 Listing of Administrators FOR ACCURATE IDENTIFICATION, BOX 11C SHOULD ALWAYS READ AFMC / FOLLOWED BY THE NAME OF THE. APPROPRIATE PAYOR / administrator . FOR EXAMPLE: ABS / ABS OR AFMC / ADVANCED BENEFIT. SOLUTIONS. This administrator Listing is for benefits and eligibility information as well as claim status information. ALL CLAIMS SUBMISSIONS FROM PROVIDERS, PHYSICIAN, HOSPITAL AND ANCILLARY, SHOULD BE MAILED DIRECTLY TO THE AFMC ADDRESS LISTED BELOW. Arizona Foundation for Medical Care Box 2909. Phoenix, AZ 85062-2909. Emdeon Payor ID: 86062. IMPORTANT: Claims for Administrators listed WITH this symbol ( ) should be mailed to the administrator and not Arizona Foundation for Medical Care. ACRONYM: MAIL TO: Administrators : 3PA AFMC 3 PAdministrators, Inc. Box 247. Onalaska, WI 54650. (608) 779-3000, FAX (608) 779-3009. (888) 540-0094. ABS AFMC ADVANCED BENEFIT SOLUTIONS. Box 71490. Phoenix, AZ 85050. (623) 889-7200, FAX (623) 889-7299. (888) 419-1094.

2 ALBS AFMC ALLIED BENEFIT SYSTEMS. Box 909786-60690. Chicago, IL 60690. (800) 288-2078, FAX (312) 906-8359. ABIG AFMC AMERIBEN SOLUTIONS / IEC GROUP. Box 7186. Boise, ID 83707. (800) 786-7930, FAX (208) 424-0595. ANIC AFMC AMERICAN NATIONAL INSURANCE (Group Insurance). Box 696520. San Antonio, TX 78269. (409) 766-6601, (800) 899-6803. Arizona Foundation for Medical Care 1. Listing of Administrators ACRONYM: MAIL TO: Administrators : ANLI AFMC AMERICAN NATIONAL INSURANCE (Individual Insurance). Box 696520. San Antonio, TX 78269. (409) 763-4661, FAX (409) 766-6663. (800) 899-6520. ARIC AFMC AMERICAN REPUBLIC INSURANCE. Box 21670. Eagan, MN 55121-0670. (800) 247-2190, FAX (515) 245-4282. (800) 641-0366. ATA AFMC American Trust Administrators , Inc. 255 NW Blue Pkwy., #100. Lee's Summit, MO 64063. (800) 843-4121, FAX (816) 347-3620. ATPA AFMC HEALTH EZ (formerly America's TPA). EMPLOYER: Arizona Center for Cancer Care TH. 7201 W. 78 St., Ste 100.

3 Bloomington, MN 55439. (952) 896-9102, FAX (952) 896-4888. ATPA AFMC HEALTH EZ (formerly America's TPA). EMPLOYER: Arrowhead Health TH. 7201 W. 78 St., Ste 100. Bloomington, MN 55439. (888) 204-7871, FAX (952) 896-4888. ATPA AFMC HEALTH EZ (formerly America's TPA). EMPLOYER: Beus Gilbert TH. 7201 W. 78 St., Ste 100. Bloomington, MN 55439. (952) 896-1200, FAX (952) 896-4888. (866) 768-9683. ATPA AFMC HEALTH EZ (formerly America's TPA). EMPLOYER: Cardiovascular Management of Phoenix TH. 7201 W. 78 St., Ste 100. Bloomington, MN 55439. (877) 516-6687, FAX (952) 896-4888. ATPA AFMC HEALTH EZ (formerly America's TPA). EMPLOYER: Coe & Van Loo Consultants TH. 7201 W. 78 St., Ste 100. Bloomington, MN 55439. (877) 516-6687, FAX (952) 896-4888. Arizona Foundation for Medical Care Listing of Administrators ACRONYM: MAIL TO: Administrators : ATPA AFMC HEALTH EZ (formerly America's TPA). EMPLOYER: Great Hearts Academies th 7201 W. 78 St., Ste 100. Bloomington, MN 55439.

4 (952) 896-9102, FAX (952)896-4888. (877) 496-0754. ATPA AFMC HEALTH EZ (formerly America's TPA). EMPLOYER: Lifetime Fitness 8500 Normandale Lake Blvd., Ste. 1150. Bloomington, MN 55437. (800) 948-3253. ATPA AFMC HEALTH EZ (formerly America's TPA). EMPLOYER: Maricopa County Medical Society th 7201 W. 78 St., Ste 100. Bloomington, MN 55439. (952) 896-9102, FAX (952) 896-4888. (877) 321-3167. ATPA AFMC HEALTH EZ (formerly America's TPA). EMPLOYER: Pebble Technology TH. 7201 W. 78 St., Ste 100. Bloomington, MN 55439. (877) 516-6687, FAX (952) 896-4888. ATPA AFMC HEALTH EZ (formerly America's TPA). EMPLOYER: Pink Jeep th 7201 W. 78 St., Ste 100. Bloomington, MN 55439. (952) 896-9102, FAX (952) 896-4888. (877) 321-3167. ATPA AFMC HEALTH EZ (formerly America's TPA). EMPLOYER: Science Care th 7201 W. 78 St. Ste 100. Bloomington, MN 55439. (877) 516-6681, FAX (952) 896-4888. ATPA AFMC HEALTH EZ (formerly America's TPA). EMPLOYER: TriState CareFlight th 7201 W.

5 78 St., Ste 100. Bloomington, MN 55439. (866) 746-4056, FAX (952) 896-4888. ATPA AFMC HEALTH EZ (formerly America's TPA). th 7201 W. 78 St., Suite 100. Bloomington, MN 55439. (952) 896-1200, FAX (952) 896-4888. Arizona Foundation for Medical Care Listing of Administrators ACRONYM: MAIL TO: Administrators : ASH AFMC ASSURANT HEALTH. Box 3131. Milwaukee, WI 53201-3131. (800) 800-8463, FAX (414) 224-0472. BAS AFMC BENEFIT ADMINISTRATIVE SYSTEMS. 17475 Jovanna Dr. Homewood, IL 60430. (708) 799-7400, FAX (708) 799-2848. (800) 523-0582. BEST AFMC BEST LIFE ASSURANCE COMPANY. Box 19721. Irvine, CA 92713-9721. (949) 253-4080, FAX (949) 222-1004. (800) 433-0088. CMN CMN CANADIAN MEDICAL NETWORK / CARE MGMT NETWORK. (Covers International Travelers). th 150 Commerce Valley Drive West, 9 Floor Thornhill, Ontario, Canada L3T 7Z3. (905) 669-4333, FAX (905) 669-2221. CDS AFMC CDS Administrators . Five Gateway Center, Ste. 600. Pittsburgh, PA 15202. (412) 201-2242, FAX (412) 201-2250.

6 CRLI CRLI CENTRAL RESERVE LIFE / CERES. Box 21680. Eagan, MN 55121-0680. (800) 253-4641, FAX (440) 496-8030. CBE CBE CHOICE BENEFITS/ECOM. 8350 N. Central Expressway, Ste. 600. Dallas, TX 75206. Pre-certification: (800) 451-6907. Eligibility: (479) 785-6178. FAX (214) 561-6301. CNIC AFMC CNIC HEALTH SOLUTIONS. Box 3559. Englewood, CO 80155-3559. (800) 426-7453, FAX (303) 749-1176. CONS AFMC CONSOCIATE, INC. 2828 N. Monroe Decatur, IL 62526. (800) 798-2422, FAX (217) 233-7252. Arizona Foundation for Medical Care Listing of Administrators ACRONYM: MAIL TO: Administrators : CYPB AFMC CYPRESS BENEFIT Administrators . Box 880. Farmington, MI 48331. (800) 223-5508. EMI AFMC EMI HEALTH. 852 E. Arrowhead Lane Murray, UT 84107. (801) 262-7476, FAX (801) 269-9734. (800) 662-5851. EBMS AFMC EMPLOYEE BENEFIT MANAGEMENT SERVICES. Box 21367. Billings, MT 59104-1367. (866) 304-1345, FAX (406) 652-5380. FMHB AFMC FMH BENEFIT SERVICES, INC. Box 25946. Overland Park, KS 66225.

7 (800) 990-9058, FAX (913) 387-5974. FLIC AFMC FREEDOM LIFE INSURANCE COMPANY OF AMERICA. th 110 W. 7 St., Ste. 300. Fort Worth, TX 76102. (817) 878-3876, FAX (817) 878-3480. (800) 387-9027. GEHA AFMC GEHA. GROUP: Federal Box 4665. Independence, MO 64051-4665. (800) 821-6136, FAX (816) 257-3247. GEHA AFMC GEHA. Group: PCIP. Box 300. Independence, MO 64051-4665. (800) 220-7898. GILS AFMC GILSBAR, INC. 2100 Covington Centre Covington, LA 70433. (800) 445-7227, FAX (985) 898-1666. (888) 215-9841. Arizona Foundation for Medical Care Listing of Administrators ACRONYM: MAIL TO: Administrators : GCI GCI GlobalCare, Inc. 6875 Shiloh Road East Alpharetta, GA 3005. (678) 341-1999, FAX (678) 341-1900. (800) 860-1111. GLOB GEM GLOBAL EXCEL MANAGEMENT, INC. (Covers International Travelers). 73 Queen St. Sherbrooke, Quebec, Canada J1M1J3. (819) 566-2901, (877) 881-7411, FAX (775) 640-4493. GRI AFMC GROUP RESOURCES INCORPORATED. (Refer to ID card for mailing instructions; varies by provider).

8 Employer: Arrowhead Health Box 100043. Duluth, GA 30096-9343. (888) 620-1297, Provider (800) 749-9963, Member FAX (770) 623-0288. HBFS AFMC UMR (formerly Harrington Benefits/Fiserv). Box 30541. Salt Lake City, UT 84130-0541. (866) 213-3063, Provider (877) 233-1800, Member FAX (330) 286-4091. HCA AFMC HEALTHCOMP Administrators . Box 45018. Fresno, CA 93718-5018. (559) 499-2450, (559) 499-2464. (800) 442-7247. HFEC AFMC HEALTHFIRST TPA / ECOM PPO. Box 130217. Tyler, TX 75713. (800) 477-2287, FAX (903) 509-5798. HTH HTH HYGEIA TRAVEL HEALTH. (Covers International Travelers). 121 Richmond St. W., Penthouse Toronto, Ontario, Canada, M5H2K1. (416) 595-1094, FAX (416) 595-1043. (888) 249-4342. Arizona Foundation for Medical Care Listing of Administrators ACRONYM: MAIL TO: Administrators : IMER AFMC IMERICA / HEALTHTRANS. (American Life & Disability Insurance Guaranty Fund). 1110 W. Washington St., Suite 270. Phoenix, AZ 85007. (847) 803-9629, FAX (847) 803-9643.

9 IHC AFMC IHC ADMINISTRATIVE SERVICES. 2101 W. Peoria Ave., Ste. 100. Phoenix, AZ 85029. (602) 870-1400, FAX (602) 395-0496. (800) 843-3106. INTF INTF INTERNATIONAL FUNDING, LTD. Box 2478. Madison, WI 53701-2478. (800) 610-1920, FAX (608) 255-2360. JAFO AFMC JOHN ALDEN (FORTIS). (Refer to Assurant Health). KPI AFMC KEY PARTNERS, INC. 8330 Allison Pointe Trail Inidanapolis, IN 46250. (317) 284-7100, (800) 331-4757. MMSI AFMC MAYO CLINIC HEALTH SOLUTIONS, dba MMSI. st 4001 41 St. NW. Rochester, MN 55901-8901. (866) 498-7685, FAX (507) 284-1963. MERI AFMC MERITAIN HEALTH. EMPLOYER: (all groups except Simpson Norton Corp). Box 27267. Minneapolis, MN 55427-0267. (763) 852-5077, FAX 952-541-9943. (800) 925-2272. MERI AFMC MERITAIN HEALTH. EMPLOYER: Simpson Norton Corp Box 853921. Richardson, TX 75085-3921. (800) 283-9538. NFLI AFMC NATIONAL FOUNDATION LIFE INSURANCE COMPANY. th 110 W. 7 St., Ste. 300. Fort Worth, TX 76102. (817) 878-3627, FAX (817) 878-3480.

10 Arizona Foundation for Medical Care Listing of Administrators ACRONYM: MAIL TO: Administrators : NHBC AFMC NATIONAL HEALTH BENEFIT CORPORATION. th 17851 N. 85 St., Ste 105. Scottsdale, AZ 85255. (888) 621-7900, FAX (888) 451-9087. NGSA AFMC NGS American Box 7676. St. Clair Shores, MI 48080. (877) 647-0083, FAX (586) 416-2378. NAA AFMC NORTH AMERICA Administrators . Box 1984. Nashville, TN 37202. (800) 411-3650, FAX (615) 255-6654. NOVA NOVA NOVANET / COOPERATIVE BENEFIT Administrators . EMPLOYERS: Navopache Electric Co-op;. Electric District No 2. Box 6249. Lincoln, NE 68506. (402) 483-9200. ONE ONE ONEWORLD ASSIST. (Covers International Travelers). th 6081 No. 3 Road, 10 Floor Richmond, British Columbia V6Y 2B2. (800) 663-0399, FAX (604) 244-7065. OSOB AFMC OUTSOURCE ONE BENEFITS. Box 9720. Salt Lake City, UT 84109-9720. (877) 655-8467, FAX (612) 338-2673. PBA AFMC PROFESSIONAL BENEFIT Administrators ,INC. Box 4687. Oak Brook, IL 60522-4687.