Word Bound Listing of Administrators

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, I.E. PHYSICIAN, HOSPITAL AND ANCILLARY,
SHOULD BE MAILED DIRECTLY TO THE AFMC ADDRESS LISTED BELOW.
Arizona Foundation for Medical Care
P.O. 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
3PAdministrators, Inc.
P.O. Box 247
Onalaska, WI 54650
(608) 779-3000, FAX (608) 779-3009
(888) 540-0094
ABS
AFMC
ADVANCED BENEFIT SOLUTIONS
P.O. Box 71490
Phoenix, AZ 85050
(623) 889-7200, FAX (623) 889-7299
(888) 419-1094
ALBS
AFMC
ALLIED BENEFIT SYSTEMS
P.O. Box 909786-60690
Chicago, IL 60690
(800) 288-2078, FAX (312) 906-8359
ABIG
AFMC
AMERIBEN SOLUTIONS / IEC GROUP
P.O. Box 7186
Boise, ID 83707
(800) 786-7930, FAX (208) 424-0595
ANIC
AFMC
AMERICAN NATIONAL INSURANCE (Group Insurance)
P.O. 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)
P.O. Box 696520
San Antonio, TX 78269
(409) 763-4661, FAX (409) 766-6663
(800) 899-6520
ARIC
AFMC
AMERICAN REPUBLIC INSURANCE
P.O. 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
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
(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. 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
P.O. 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
P.O. 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
CRLI
CRLI
CENTRAL RESERVE LIFE / CERES
P.O. 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
P.O. 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
P.O. 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
P.O. Box 21367
Billings, MT 59104-1367
(866) 304-1345, FAX (406) 652-5380
FMHB
AFMC
FMH BENEFIT SERVICES, INC.
P.O. Box 25946
Overland Park, KS 66225
(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
P.O. Box 4665
Independence, MO 64051-4665
(800) 821-6136, FAX (816) 257-3247
GEHA
AFMC
GEHA
Group: PCIP
P.O. 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)
Employer: Arrowhead Health
P.O. 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)
P.O. Box 30541
Salt Lake City, UT 84130-0541
(866) 213-3063, Provider
(877) 233-1800, Member
FAX (330) 286-4091
HCA
AFMC
HEALTHCOMP ADMINISTRATORS
P.O. Box 45018
Fresno, CA 93718-5018
(559) 499-2450, (559) 499-2464
(800) 442-7247
HFEC
AFMC
HEALTHFIRST TPA / ECOM PPO
P.O. 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
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.
P.O. 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)
P.O. Box 27267
Minneapolis, MN 55427-0267
(763) 852-5077, FAX 952-541-9943
(800) 925-2272
MERI
AFMC
MERITAIN HEALTH
EMPLOYER: Simpson Norton Corp
P.O. 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
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
P.O. Box 7676
St. Clair Shores, MI 48080
(877) 647-0083, FAX (586) 416-2378
NAA
AFMC
NORTH AMERICA ADMINISTRATORS
P.O. 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
P.O. 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
P.O. Box 9720
Salt Lake City, UT 84109-9720
(877) 655-8467, FAX (612) 338-2673
PBA
AFMC
PROFESSIONAL BENEFIT ADMINISTRATORS,INC.
P.O. Box 4687
Oak Brook, IL 60522-4687
(800) 435-5694, (630) 286-4638
QVI
AFMC
QVI RISK SOLUTIONS, INC.
P.O. Box 7199
Bend, OR 97708
(800) 408-9717, FAX (541) 312-8524
RCN
AFMC
REGIONAL CARE, INC.
th
905 W. 27 St.
Scottsbluff, NE 69361
(800) 795-7772, FAX (308) 635-2018
Arizona Foundation for Medical Care
Listing of Administrators
ACRONYM:
MAIL TO:
ADMINISTRATORS:
SSBA
AFMC
SELECT BENEFIT ADMINISTRATORS OF AMERICA
P.O. Box 440
Ashland, WI 54806
(800) 497-3699, FAX (715) 682-5919
SHAS
SHAS
SHASTA ADMINISTRATIVE SERVICES
EMPLOYER: The Confederated Tribes of Grande Ronde
P.O. Box 1747
Redmond, OR 97756
(800) 880-5877, FAX (541) 880-5950
SIGN
AFMC
SIGNIFICA INSURANCE GROUP
P.O. Box 7777
Lancaster, PA 17604-7777
(800) 796-7460, FAX (717) 581-8379
SSA
AFMC
SOUTHWEST SERVICE ADMINISTRATORS
2400 W. Dunlap Ave., Ste. 250
Phoenix, AZ 85021
(602) 249-3582, FAX (602) 249-3795
(800) 474-3485
STAR
AFMC
STARMARK
P.O. Box 2942
Clinton, IA 52733-2942
(847) 615-1500, FAX (847) 615-3910
(800) 522-1246
SASI
AFMC
SUMMIT ADMINISTRATION SERVICES
P.O. Box 25160
Scottsdale, AZ 85255-0120
(480) 505-0400, FAX (480) 505-0406
(888) 690-2020
TALL
AFMC
TALL TREE ADMINISTRATORS
P.O. Box 71747
Salt Lake City, UT 84171-0747
(877) 453-4201, FAX (801) 274- 8900
TOUR
TOUR
TOURMED ASSISTANCE INC.
(Covers International Travelers)
5944 Coral Ridge Drive #207
Coral Springs, FL 33076
(954) 340-1912, FAX (954) 340-5677
(888) 620-6588
Arizona Foundation for Medical Care
Listing of Administrators
ACRONYM:
MAIL TO:
ADMINISTRATORS:
MAX
AFMC
MAXOR (formerly Trident Plan Administrators)
th
5045 N. 12 St., Ste. 102
Phoenix, AZ 85014
(602) 240-2404, FAX (602) 240-6000
(800) 362-5894
TRMK
AFMC
TRUSTMARK INSURANCE COMPANY
P.O. Box 2942
Clinton, IA 52733
(800) 396-2960, FAX (330) 758-3242
HTH
HTH
UNITEDHEALTH INTERNATIONAL
(Refer to Hygeia)
UCS
AFMC
UNITED CLAIM SOLUTIONS
th
10835 N. 25 Ave., Suite 105
Phoenix, AZ 85029
(602) 393-4553, FAX (602) 863-1681
(866) 762-4455
♦ USLI
USLI
UNITED SECURITY LIFE
P.O. Box 24655
Seattle, WA 98124
(800) 875-4422
WAUS
AFMC
UMR (formerly Wausau Benefits/Fiserv)
P.O. Box 30541
Salt Lake City, UT 84130-0541
(800) 826-9781, FAX (715) 841-7667
(800) 472-0041
WTPA
AFMC
WEBTPA
P.O. Box 99906
Grapevine, TX 76099-9706
(469) 417-1700, FAX (469) 417-1951
(888) 440-3644
WMIT
AFMC
WMI TPA, INC.
P.O. Box 572488
Murray, UT 84157-2488
(800) 748-5340, FAX (801) 263-1189
ZAI
AFMC
ZENITH AMERICAN SOLUTIONS
2001 W. Camelback Rd., Ste B350
Phoenix, AZ 85015
(602) 248-8434, FAX (602) 248-8301
(800) 553-2801
REVISED 02/24/2014
Arizona Foundation for Medical Care

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