As of July 1, 2020

CORPORATE HEALTH SERVICES (CHS)

CHS is a Blue Cross Blue Shield of Arizona (BCBSAZ) product that provides large, self- insured
groups access to the BCBSAZ provider networks. Claims processing, investigation of other party
liability, verification of eligibility, benefits, claim payments, claim status, HIPAA compliance and
the Explanation of Benefits (EOB) are handled by the Third Party Administrator (TPA) or
employer group.

This listing contains all approved CHS group numbers. All claims submissions are required to be
billed with the CHS group number.

All Professional, Institutional & Dental Claims - electronic and paper – submit to BCBSAZ

 Submit all electronic claims directly to BCBSAZ using EDI# 53589.

 Submit all paper claims directly to:

Blue Cross Blue Shield of Arizona

PO Box 2924
Phoenix, AZ 85062-2924

Workers’ Compensation Claims for CopperPoint Mutual Insurance Company and CorVel

 Contact Workers’ Compensation carrier for claim submission instructions; do not

submit to BCBSAZ

Claims Status and Inquiries

 For CHS pricing status and inquiries, call the BCBSAZ CHS Claims Unit at (602) 864- 4885 or
(800) 232-2345, ext. 4885.

 For electronic billing inquiries, contact Integrated Customer Solutions (ICS) at (602) 864-
4844 or (800) 650-5656 or [email protected].

 Online access for membership status, schedule of benefits and claim status may be
available through the TPA. Websites are included in this listing. BCBSAZ network providers
may need to register at the TPAs’ web sites in order to obtain online access. Any questions
regarding the TPAs’ online capabilities should be directed to the TPAs.

Page 1 of 6
Please submit CHS claims electronically to BCBSAZ using EDI #53589. (NOTE: do not submit 53589 as the member ID.)
Adelante Healthcare, Inc. AK-Chin Indian Community Amkor Technology, Inc.
Group #ADL001 -- TERMED 12/31/18 Medical Group #AKC001 - Effective 1/1/13 Medical Group #AMK001 -- TERMED 5/31/20
Group #ADL002 -- TERMED 12/31/17 Dental Only Group #AKD002 - Effective 1/1/13 Dental Website: www.myameriben.com
Website: www.healthsmart.com Website: www.myameriben.com AmeriBen Solutions, Inc.
HealthSmart Benefit Solutions AmeriBen Solutions, Inc. PO Box 7186 Boise, ID 83707
PO Box 93670 Lubbock, TX 79493-3670 PO Box 7186 Boise, ID 83707 (866) 879-6128
(855) 415-8697
Precert: AmeriBen Medical Management
Precert: (855) 240-3693
Arizona Care Network Arizona Federal Credit Union Arizona Local Government EBT
Group #ACN001 - Effective 12/1/18 Medical Only Group #AFC001 - Effective 1/1/16 Medical Only Group #ALG001 -- TERMED 6/30/19
Website: www.ebsobenefits.com Website: www.mygilsbar.com Website: www.mygilsbar.com
EBSO, Inc. Gilsbar, L.L.C. Gilsbar, L.L.C.
PO Box 928 Findlay, OH 45839-0928 PO Box 2947 Covington, LA 70434-2947 PO Box 2947 Covington, LA 70434-2947
(866) 296-4002 (888) 215-9841 (888) 215-9841
Precert: EBSO Review Precert: MedCom Care Management, LLC
Precert: (800) 426-9317 Precert: (800) 643-4416
Arizona Materials, L.L.C. an Arizona Limited Liability
Arizona Local Government EBT Company Arizona Metropolitan Trust
Group #AGT001 - Effective 7/1/19 Medical Only Group #AZM001 -- TERMED 1/31/20 Group #AMT001 - Effective 7/1/12 Medical Only
Website: www.myameriben.com Website: www.mygilsbar.com Website: www.myameriben.com
AmeriBen Solutions, Inc. Gilsbar, L.L.C. AmeriBen Solutions, Inc.
PO Box 7186 Boise, ID 83707 PO Box 2947 Covington, LA 70434-2947 PO Box 7186 Boise, ID 83707
(877) 635-2912 (888) 215-9841 (855) 350-8699 (800) 786-7930
Precert: American Health Group Precert: American Health Group
Precert: (800) 847-7605 Precert: (602) 265-3800 (800) 847-7605
BSA Precert: EAP Holman Group of Arizona
(800) 321-2843
Arizona Sheet Metal Trade Trust Fund Atembis, LLC Auer Precision Stamping, Inc.
Group #ASM001 - Effective 4/1/03 Medical Only Group #ACN002 -- TERMED 12/31/19 Group #AUR001 - Effective 8/1/09 Medical Only
Website: www.ssatpa.com Website: www.ebsobenefits.com Website: www.mygilsbar.com
Southwest Service Administrators, Inc. EBSO, Inc. Gilsbar, L.L.C.
2550 W Union Hills, Ste 290 Phoenix, AZ 85027-5163 PO Box 928 Findlay, OH 45839-0928 PO Box 2947 Covington, LA 70434-2947
(602) 249-3582 (800) 474-3485 (866) 296-4002 (888) 215-9841
Precert: SSA Precert: MedCom Care Management, LLC
Precert: (602) 249-3582 (800) 474-3485 #6 Precert: (800) 643-4416
BSA Precert: Mines & Associates
(800) 873-7138
Bashas' Inc. Blackwater Communiity School Borderland Construction Company, Inc.
Group #BAS001 - Effective 11/1/90 Medical Only Group #BCS001 - Effective 10/1/15 Medical Only Group #BCC001 - Effective 1/1/95 Medical
Website: www.myameriben.com Website: www.summit-inc.net Group #BCD002 - Effective 1/1/95 Dental
AmeriBen Solutions, Inc. Summit Administration Services, Inc. Website: www.myameriben.com
PO Box 7186 Boise, ID 83707 PO Box 25160 Scottsdale, AZ 85255-0102 AmeriBen Solutions, Inc.
(602) 275-8744 (800) 879-6400 (480) 505-0400 (888) 690-2020 PO Box 7186 Boise, ID 83707
Precert: American Health Group Precert: Hines & Associates (800) 393-7519
Precert: (602) 265-3800 (800) 847-7605 Precert: (800) 944-9401 Precert: AmeriBen Medical Management
BSA Precert: The Holman Group Precert: (800) 388-3193
(800) 321-2843
Bullhead City Fire Department CanAssistance, Inc. Casa Grande Elementary School District #4 EBT
Group #BCF001 - Effective 7/1/15 Medical Only Group #CAN001 - Effective 4/1/20 Medical Only Group #CGE001 - Effective 7/1/05 Medical Only
Website: www.meritain.com Website: www.canassistance.com Website: www.summit-inc.net
Meritain Health, Inc. CanAssistance, Inc. Summit Administration Services, Inc.
PO Box 853921 Richardson, TX 75085-3921 1981, McGill College Avenue, Ste 400 Montreal, Quebec, PO Box 25160 Scottsdale, AZ 85255-0102
(866) 300-8449 H3A 0H6 (480) 505-0400 (888) 690-2020
Precert: American Health Holding (800) 361-6068 (514) 286-8411 Precert: HealthSmart
Precert: (800) 242-1199 Precert: CanAssistance, Inc. Precert: (877) 202-6379, ext. 2530
Precert: (800) 361-6068
Cellular One of NE Arizona Central Arizona Water Conservation District (CAWCD) Christian Care Management, Inc.
Group #CEL001 - Effective 10/1/12 Medical Only Group #CAP001 - Effective 1/1/04 Medical Only Group #CMT001 - Effective 3/1/09 Medical Only
Website: www.summit-inc.net Website: www.myameriben.com Website: www.ebsobenefits.com
Summit Administration Services, Inc. AmeriBen Solutions, Inc. EBSO, Inc.
PO Box 25160 Scottsdale, AZ 85255-0102 PO Box 7186 Boise, ID 83707 PO Box 928 Findlay, OH 45839-0928
(480) 505-0400 (888) 690-2020 (866) 947-9205 (866) 296-4002
Precert: Action Healthcare Precert: AmeriBen Medical Management Precert: EBSO Review
Precert: (800) 433-6915 Precert: (800) 388-3193 Precert: (800) 426-9317
City of Nogales City of San Luis City of Show Low
Group #CNG001 - Effective 11/1/00 Medical Only Group #SLS001 - Effective 7/1/07 Medical Only Group #CSL001 - Effective 7/1/05 Medical Only
Website: www.summit-inc.net Website: www.ebsobenefits.com Website: www.mygilsbar.com
Summit Administration Services, Inc. EBSO, Inc. Gilsbar, L.L.C.
PO Box 25160 Scottsdale, AZ 85255-0102 PO Box 928 Findlay, OH 45839-0928 PO Box 2947 Covington, LA 70434-2947
(480) 505-0400 (888) 690-2020 (866) 296-4002 (888) 215-9841
Precert: Hines & Associates Precert: EBSO Review Precert: MedCom Care Management, LLC
Precert: (800) 944-9401 Precert: (800) 426-9317 Precert: (800) 643-4416
City of Sierra Vista Employee Benefit Trust Cochise Combined Trust Cocopah Indian Tribe
Group #CSV001 - Effective 7/1/07 Medical Only Group #CCT001 - Effective 7/1/13 Medical Only Group #CCP001 - Effective 1/1/04 Medical Only
Website: www.myameriben.com Website: www.myameriben.com Website: www.mygilsbar.com
AmeriBen Solutions, Inc. AmeriBen Solutions, Inc. Gilsbar, L.L.C.
PO Box 7186 Boise, ID 83707 PO Box 7186 Boise, ID 83707 PO Box 2947 Covington, LA 70434-2947
(800) 488-1129 (855) 258-6455 (888) 215-9841
Precert: AmeriBen Medical Management Precert: AmeriBen Medical Management Precert: MedCom Care Management, LLC
Precert: (800) 388-3193 Precert: (855) 240-3698 Precert: (800) 643-4416

* new group ** change to existing group Page 2 of 6 EBT = Employee Benefit Trust
Please submit CHS claims electronically to BCBSAZ using EDI #53589. (NOTE: do not submit 53589 as the member ID.)
CopperPoint Mutual Insurance Company (formerly State
Compensation Fund, dba SCF Arizona ) Diné Schools Employee Benefit Plans EMI Health
Group #SCA012 -- TERMED 12/31/18 Group #DSP212 - Effective 6/1/99 Medical Only Group #EMH222 - Effective 5/1/19 Medical Only
Website: www.hnas.com Website: www.summit-inc.net Website: www.emihealth.com
HealthNow Administrative Services Summit Administration Services, Inc. EMI Health
PO Box 211034 Eagan, MN 55121 PO Box 25160 Scottsdale, AZ 85255-0102 5101 South Commerce Drive Murray, UT 84107
(855) 581-1809 (480) 505-0400 (888) 690-2020 (801) 262-7476 (800) 662-5851
Medical claims only; do not submit workers' comp claims with Precert: Hines & Associates Precert: EMI Health
group #SCA012 Precert: (800) 944-9401 Precert: (800) 662-5851
Farnsworth Companies, Inc. FMKC Employee Benefit Trust Fort McDowell Yavapai Nation
Group #FWG001 -- TERMED 8/31/18 Group #FCS001 - Effective 9/1/15 Medical Only Group #FMC001 - Effective 1/1/02 Medical Only
Website: www.meritain.com Website: www.summit-inc.net NOTE: Dental Termed 12/31/16
Meritain Health, Inc. Summit Administration Services, Inc. Website: www.mygilsbar.com
PO Box 853921 Richardson, TX 75085-3921 PO Box 25160 Scottsdale, AZ 85255-0102 Gilsbar, L.L.C.
(800) 925-2272 (480) 505-0400 (888) 690-2020 PO Box 2947 Covington, LA 70434-2947
Precert: Hines & Associates (888) 215-9841
Precert: (800) 944-9401 Precert: MedCom Care Management, LLC
Precert: (800) 643-4416
Gadsden Elementary School District #32 Gila River Healthcare Corporation Gila River Indian Community
Group #GES001 - Effective 7/1/03 Medical Only Group #GHC001 - Effective 5/1/11 Medical Only Group #GIC001 - Effective 10/1/19 Medical Only
Website: www.summit-inc.net Website: www.summit-inc.net Website: www.healthsmart.com
Summit Administration Services, Inc. Summit Administration Services, Inc. HealthSmart Benefit Solutions
PO Box 25160 Scottsdale, AZ 85255-0102 PO Box 25160 Scottsdale, AZ 85255-0102 PO Box 93670 Lubbock, TX 79493-3670
(480) 505-0400 (888) 690-2020 (480) 505-0400 (888) 690-2020 (833) 771-2973
Precert: Action Healthcare Precert: Hines & Associates Precert: HealthSmart Care Management Solutions
Precert: (800) 433-6915 Precert: (800) 944-9401 Precert: (877) 202-6379 option 3
For claims with DOS on or before 9/30/19, submit with group
#GRI001 to TPA Summit.
Gilbert Public Schools EBT Gowan Company, LLC Gowan Milling Company, LLC
Group #GIL033 - Effective 3/1/97 Medical & Dental Group #GWN001 - Effective 1/1/12 Medical Only Group #GOM001 - Effective 6/1/13 Medical Only
Website: www.meritain.com Website: www.meritain.com Website: www.meritain.com
Meritain Health, Inc. Meritain Health, Inc. Meritain Health, Inc.
PO Box 853921 Richardson, TX 75085-3921 PO Box 853921 Richardson, TX 75085-3921 PO Box 853921 Richardson, TX 75085-3921
(866) 300-8449 (866) 300-8449 (866) 300-8449
Precert: American Health Group Precert: American Health Holding Precert: American Health Holding
Precert: (602) 265-3800 (800) 847-7605 Precert: (800) 242-1199 Precert: (800) 242-1199
Halvorson-Seibold, Inc. dba Grand Canyon Squire Inn HonorHealth (formerly Scottsdale Healthcare Corp.) Hopi Grant Schools EBT
Group #HNS001 - Effective 1/1/18 Medical Only Group #HHH001 - Effective 1/1/18 Medical Only Group #HGS001 - Effective 7/1/12 Medical Only
Website: www.summit-inc.net Website: www.myameriben.com Website: www.summit-inc.net
Summit Administration Services, Inc. AmeriBen Solutions, Inc. Summit Administration Services, Inc.
PO Box 25160 Scottsdale, AZ 85255-0102 PO Box 7186 Boise, ID 83707 PO Box 25160 Scottsdale, AZ 85255-0102
(480) 505-0400 (888) 690-2020 (602) 231-8855 (480) 505-0400 (888) 690-2020
Precert: Hines & Associates Precert: ICP Health Precert: Hines & Associates
Precert: (800) 944-9401 Precert: (800) 250-6647 Precert: (800) 944-9401
BSA Precert: Magellan Behavioral Health
(800) 424-4138
Hopi Junior/Senior High School, Inc. Hualapai Nation Interstate Mechanical Corporation dba IMCOR
Group #HHS001 - Effective 7/1/12 Medical Only Group #HUA001 - Effective 5/1/00 Medical Only Group #INT001 - Effective 1/1/17 Medical Only
Website: www.summit-inc.net Website: www.summit-inc.net Website: www.healthsmart.com
Summit Administration Services, Inc. Summit Administration Services, Inc. HealthSmart Benefit Solutions
PO Box 25160 Scottsdale, AZ 85255-0102 PO Box 25160 Scottsdale, AZ 85255-0102 PO Box 93670 Lubbock, TX 79493-3670
(480) 505-0400 (888) 690-2020 (480) 505-0400 (888) 690-2020 (844) 803-1756
Precert: Hines & Associates Precert: Hines & Associates Precert: HealthSmart Care Management Solutions
Precert: (800) 944-9401 Precert: (800) 944-9401 Precert: (877) 202-6379 option 3
iT1 Source, LLC La Paz Regional Hospital La Posada at Park Centre
Group #ITE001 - Effective 4/1/15 Medical Only Group #LHG001 - Effective 7/1/18 Medical Only Group #LAP001 - Effective 1/1/13 Medical Only
Website: www.talltreehealth.com Website: www.ebsobenefits.com Website: www.myameriben.com
Tall Tree Administrators EBSO, Inc. AmeriBen Solutions, Inc.
PO Box 1807 Draper, UT 84020 PO Box 928 Findlay, OH 45839-0928 PO Box 7186 Boise, ID 83707
(877) 453-4201 (866) 296-4002 (855) 258-6457
Precert: AZ Foundation for Medical Care Precert: EBSO Review Precert: AmeriBen Medical Management
Precert: (800) 624-4277 Precert: (800) 426-9317 Precert: (800) 388-3193
Lake Havasu Unified School District #1 M.R. Tanner Development and Construction, Inc. Maricopa County Community College District
Group #LHU001 -- TERMED 6/30/20 Group #TMC001 -- TERMED 1/31/20 Group #MCC001 - Effective 7/1/14 Medical Only
Website: www.mygilsbar.com Website: www.mygilsbar.com Website: www.meritain.com
Gilsbar, L.L.C. Gilsbar, L.L.C. Meritain Health, Inc.
PO Box 2947 Covington, LA 70434-2947 PO Box 2947 Covington, LA 70434-2947 PO Box 853921 Richardson, TX 75085-3921
(888) 215-9841 (888) 215-9841 (866) 300-8449
Precert: American Health Holding
Precert: (800) 242-1199
For claims with DOS on or after 2/1/20, submit with group BSA Precert: MHN/Health-net
#EMH222 to TPA EMI Health. (800) 603-2970
Mayo Clinic Arizona Microchip Technology Incorporated Moencopi Day School
Group #MAY001 - Effective 1/1/19 Medical Only Group #MPT001 - Effective 1/1/19 Medical Only Group #MDS001 - Effective 7/1/15 Medical Only
Website: www.medica.com Website: www.mygilsbar.com Website: www.summit-inc.net
Medica Gilsbar, L.L.C. Summit Administration Services, Inc.
PO Box 211435 Eagan, MN 55121 PO Box 2947 Covington, LA 70434-2947 PO Box 25160 Scottsdale, AZ 85255-0102
(952) 992-2900 (866) 839-4015 (888) 215-9841 (480) 505-0400 (888) 690-2020
Precert: Medica Health Plan Solutions Precert: MedCom Care Management, LLC Precert: Hines & Associates
Precert: (866) 839-4015 Precert: (800) 643-4416 Precert: (800) 944-9401
For claims with DOS on or before 12/31/18, submit with For claims with DOS on or before 12/31/18, submit with
group #MCA001 to TPA Medica. group #MRP001 to TPA HealthSmart.

* new group ** change to existing group Page 3 of 6 EBT = Employee Benefit Trust
Please submit CHS claims electronically to BCBSAZ using EDI #53589. (NOTE: do not submit 53589 as the member ID.)
Mohave County EBT Mountainside Fitness Acquisitions Mountain Public Employee Benefit Trust
Group #MCT106 - Effective 1/1/01 Medical Only Group #MSF001 -- TERMED 12/31/19 Group #NVS001 - Effective 1/1/11 Medical Only
Website: www.meritain.com Website: www.ebsobenefits.com Group #NVD002 -- TERMED 6/30/16 Dental Only
Meritain Health, Inc. EBSO, Inc. Website: www.summit-inc.net
PO Box 853921 Richardson, TX 75085-3921 PO Box 928 Findlay, OH 45839-0928 Summit Administration Services, Inc.
(866) 300-8449 (866) 296-4002 PO Box 25160 Scottsdale, AZ 85255-0102
Precert: American Health Group (480) 505-0400 (888) 690-2020
Precert: (602) 265-3800 (800) 847-7605 Precert: American Health Group
Precert: (602) 265-3800 (800) 847-7605
North Country Healthcare, Inc. Northern Arizona Council of Governments (NACOG) Northwest Arizona EBT
Group #NTH001 - Effective 1/1/13 Medical Only Group #NAC001 - Effective 1/1/15 Medical Only Group #NWA001 -- TERMED 6/30/19
Website: www.hnas.com Website: www.mygilsbar.com Website: www.mygilsbar.com
HealthNow Administrative Services Gilsbar, L.L.C. Gilsbar, L.L.C.
P O Box 211034 Eagan, MN 55121 PO Box 2947 Covington, LA 70434-2947 PO Box 2947 Covington, LA 70434-2947
(855) 581-1810 (888) 215-9841 (888) 215-9841
Precert: HNAS Comprehensive Care Solutions Precert: American Health Group
Precert: (800) 631-0734 Precert: (800) 847-7605
Operating Engineers' Local 428 Health and Welfare Trust
OB Sports Golf Management, Inc. Fund Orion Health Insurance Pool
Group #SGF001 -- TERMED 8/31/19 Group #OET001 - Effective 4/1/03 Medical Only Group #RHP001 - Effective 1/1/16 Medical Only
Website: www.myameriben.com Website: www.zenith-american.com Website: www.myameriben.com
AmeriBen Solutions, Inc. Zenith American Solutions AmeriBen Solutions, Inc.
PO Box 7186 Boise, ID 83707 PO Box 16200 Phoenix, AZ 85011-6200 PO Box 7186 Boise, ID 83707
(866) 658-1533 (602) 650-8161 (855) 258-6458
For claims with DOS on or before 12/31/17, submit with Precert: American Health Group Precert: AmeriBen Medical Management
group #SGM001 to TPA AmeriBen. Precert: (602) 265-3800 (800) 847-7605 Precert: (800) 388-3193
Parks & Sons of Sun City, Inc. Pink Jeep Tours, Inc. Rockford Corporation
Group #PKS001 - Effective 12/1/18 Medical Only Group #PJT001 - Effective 1/1/20 Medical Only Group #RKF001 - Effective 3/1/17 Medical Only
Website: www.summit-inc.net Website: www.hnas.com Website: www.healthsmart.com
Summit Administration Services, Inc. HealthNow Administrative Services HealthSmart Benefit Solutions
PO Box 25160 Scottsdale, AZ 85255-0102 P O Box 211034 Eagan, MN 55121 PO Box 93670 Lubbock, TX 79493-3670
(480) 505-0400 (888) 690-2020 (855) 581-1810 (844) 522-7034
Precert: Hines & Associates Precert: HNAS Comprehensive Care Solutions Precert: American Health Holding
Precert: (800) 944-9401 Precert: (800) 631-0734 Precert: (800) 874-2378
RSNA EBT Rural Arizona Group Health Trust Russell Sigler, Inc.
Group #RBT001 - Effective 7/1/04 Medical Only Group #AGH680 - Effective 7/1/02 Medical Only Group #RSC001 - Effective 6/1/09 Medical Only
Website: www.mygilsbar.com Website: www.meritain.com Website: www.myameriben.com
Gilsbar, L.L.C. Meritain Health, Inc. AmeriBen Solutions, Inc.
PO Box 2947 Covington, LA 70434-2947 PO Box 853921 Richardson, TX 75085-3921 PO Box 7186 Boise, ID 83707
(888) 215-9841 (866) 300-8449 (800) 723-2901
Precert: MedCom Care Management, LLC Precert: American Health Group Precert: Active Health
Precert: (800) 643-4416 Precert: (602) 265-3800 (800) 847-7605 Precert: (877) 518-0761
Safford Unified School District #1 Salt River Pima-Maricopa Indian Community Salt River Project
Group #SUS001 -- TERMED 6/30/19 Group #MIC001 - Effective 1/1/04 Medical Only Group #SAL001 - Effective 1/1/10 Medical Only
Website: www.mygilsbar.com Website: www.myameriben.com Website: www.mygilsbar.com
Gilsbar, L.L.C. AmeriBen Solutions, Inc. Gilsbar, L.L.C.
PO Box 2947 Covington, LA 70434-2947 PO Box 7186 Boise, ID 83707 PO Box 2947 Covington, LA 70434-2947
(888) 215-9841 (866) 215-0973 (888) 215-9841
Precert: AmeriBen Medical Management Precert: MedCom Care Management, LLC
Precert: (800) 388-3193 Precert: (800) 643-4416
BSA Precert: ComPsych Corporation
(888) 882-0771
San Carlos Apache Healthcare Corporation Shonto Preparatory School District Skyview Cooling Company
Group #SCH001 - Effective 9/1/17 Medical Only Group #SSD001 - Effective 8/1/10 Medical Only Group #SVC001 - Effective 1/1/19 Medical Only
Website: www.summit-inc.net Website: www.summit-inc.net Website: www.summit-inc.net
Summit Administration Services, Inc. Summit Administration Services, Inc. Summit Administration Services, Inc.
PO Box 25160 Scottsdale, AZ 85255-0102 PO Box 25160 Scottsdale, AZ 85255-0102 PO Box 25160 Scottsdale, AZ 85255-0102
(480) 505-0400 (888) 690-2020 (480) 505-0400 (888) 690-2020 (480) 505-0400 (888) 690-2020
Precert: Hines & Associates Precert: Hines & Associates Precert: Hines & Associates
Precert: (800) 944-9401 Precert: (800) 944-9401 Precert: (800) 944-9401
Teamsters Western Region and New Jersey Health Care
Southwest Multi-Craft Health and Welfare Trust Fund State Bank of Arizona Fund
Group #MCH001 - Effective 3/1/04 Medical Only Group #MSB001 -- TERMED 2/29/20 Group #CL400 - Effective 1/1/89 Medical Only
Website: www.ssatpa.com Website: www.meritain.com Website: www.ssatpa.com
Southwest Service Administrators, Inc. Meritain Health, Inc. Southwest Service Administrators, Inc.
2300 Buena Vista SE, Ste 127 Albuquerque, NM 87106 PO Box 853921 Richardson, TX 75085-3921 2550 W Union Hills, Ste 290 Phoenix, AZ 85027-5163
(800) 432-6636 (800) 925-2272 (602) 249-3582 (800) 474-3485
Precert: American Health Group Precert: SSA
Precert: (800) 847-7605 Precert: (602) 249-3582 (800) 474-3485 #6
BSA Precert: Mines & Associates BSA Precert: Mines & Associates
(800) 873-7138 (800) 873-7138
The Hopi Tribe Tonto Apache Tribe/Mazatzal Casino TRAX International Corporation
Group #HPT001 - Effective 1/1/08 Medical Only Group #TAT210 - Effective 1/1/01 Medical Only Group #TRA001 -- TERMED 12/31/19
Website: www.summit-inc.net Group #TAT211 - Effective 7/1/98 Medical Only Website: www.myameriben.com
Summit Administration Services, Inc. Website: www.summit-inc.net AmeriBen Solutions, Inc.
PO Box 25160 Scottsdale, AZ 85255-0102 Summit Administration Services, Inc. PO Box 7186 Boise, ID 83707
(480) 505-0400 (888) 690-2020 PO Box 25160 Scottsdale, AZ 85255-0102 (855) 258-2602
Precert: Hines & Associates (480) 505-0400 (888) 690-2020 Precert: AmeriBen Medical Management
Precert: (800) 944-9401 Precert: Hines & Associates Precert: (800) 388-3193
Precert: (800) 944-9401

* new group ** change to existing group Page 4 of 6 EBT = Employee Benefit Trust
Please submit CHS claims electronically to BCBSAZ using EDI #53589. (NOTE: do not submit 53589 as the member ID.)
y gy ( y
Cardiovascular Management of Phoenix, L.L.C.) Tuba City Regional Health Care Corporation Tucson Orthopaedic Institute, P.C.
Group #CMP001 - Effective 1/1/14 Medical Only Group #TCR001 - Effective 1/1/13 Medical Only Group #TUN001 - Effective 1/1/20 Medical Only
Website: www.mygilsbar.com Website: www.myameriben.com Website: www.hnas.com
Gilsbar, L.L.C. AmeriBen Solutions, Inc. HealthNow Administrative Services
PO Box 2947 Covington, LA 70434-2947 PO Box 7186 Boise, ID 83707 P O Box 211034 Eagan, MN 55121
(888) 215-9841 (855) 258-2654 (855) 581-1810
Precert: MedCom Care Management, LLC Precert: AmeriBen Medical Management Precert: HNAS Comprehensive Care Solutions
Precert: (800) 643-4416 Precert: (800) 388-3193 Precert: (800) 631-0734
For claims with DOS on or before 12/31/19, submit with group
y #TOR001 to TPA Meritain.
Health & Welfare Trust Warner Angle Hallam Jackson & Formanek, PLC. Western Growers Assurance Trust
Group #UFC001 - Effective 5/1/17 Medical Only Group #WAH001 - Effective 6/1/18 Medical Only Group #WGA001 - Effective 10/1/94 Medical Only
Website: www.ssatpa.com Website: www.summit-inc.net Website: https://webopis.wga.com/
Southwest Service Administrators, Inc. Summit Administration Services, Inc. Pinnacle Claims Management, Inc.
PO Box 42048 Phoenix, AZ 85080-2048 PO Box 25160 Scottsdale, AZ 85255-0102 PO Box 7240 Newport Beach, CA 92658
(602) 249-3582 (800) 474-3485 (480) 505-0400 (888) 690-2020 (800) 777-7898 (949) 863-1000
Precert: American Health Group Precert: Hines & Associates Precert: Blue Cross of California
Precert: (800) 847-7605 Precert: (800) 944-9401 Precert: (800) 274-7767
BSA Precert: HMC Healthworks
(800) 464-7101
Winslow Indian Health Care Center Yavapai-Apache Nation Yavapai Combined Trust
Group #WHC001 - Effective 1/1/17 Medical Only Group #YAN001 - Effective 1/1/14 Medical Only Group #YCT001 - Effective 7/1/13 Medical Only
Website: www.talltreehealth.com Website: www.summit-inc.net Website: www.summit-inc.net
Tall Tree Administrators Summit Administration Services, Inc. Summit Administration Services, Inc.
PO Box 1807 Draper, UT 84020 PO Box 25160 Scottsdale, AZ 85255-0102 PO Box 25160 Scottsdale, AZ 85255-0102
(877) 453-4201 (480) 505-0400 (888) 690-2020 (480) 505-0400 (888) 690-2020
Precert: Integrated Healthcare Management Precert: Hines & Associates Precert: American Health Group
Precert: (877) 587-2700 Precert: (800) 944-9401 Precert: (602) 265-3800 (800) 847-7605
Yavapai Community Hospital Association, dba Yavapai
Regional Medical Center Yavapai Unified EBT Yavapai-Prescott Indian Tribe
Group #YRC001 - Effective 1/1/15 Medical Only Group #YUT410 -- TERMED 6/30/19 Group #YPI001 - Effective 1/1/06 Medical Only
Website: www.myameriben.com Website: www.meritain.com Website: www.mygilsbar.com
AmeriBen Solutions, Inc. Meritain Health, Inc. Gilsbar, L.L.C.
PO Box 7186 Boise, ID 83707 PO Box 853921 Richardson, TX 75085-3921 PO Box 2947 Covington, LA 70434-2947
(855) 275-6468 (866) 300-8449 (888) 215-9841
Precert: AmeriBen Medical Management Precert: MedCom Care Management, LLC
Precert: (855) 850-8104 Precert: (800) 643-4416
Yuma Area Benefit Consortium Yuma Union High School District #70
Group #YAB001 - Effective 7/1/07 Medical Only Group #YHS001 - Effective 10/1/10 Medical Only
Website: www.myameriben.com Website: www.summit-inc.net
AmeriBen Solutions, Inc. Summit Administration Services, Inc.
PO Box 7186 Boise, ID 83707 PO Box 25160 Scottsdale, AZ 85255-0102
(602) 231-8896 (866) 365-9198 (480) 505-0400 (888) 690-2020
Precert: American Health Group Precert: Action Healthcare
Precert: (602) 265-3800 (800) 847-7605 Precert: (602) 265-0681 (800) 433-6915

3rd parties utilizing BCBSAZ Workers' Compensation

Network (contact WC carrier for claim submission):
City of Mesa
CorVel
CopperPoint Mutual Insurance Company (formerly SCF Arizona) - for institutional claims only
Anthem Workers' Compensation

Groups utilizing BCBSAZ Dental Network:

Adelante Healthcare, Inc. #ADL002 - termed 12/31/17
AK-Chin Indian Community #AKD002
Arizona School Board Assoc. Insurance Trust #ASB456 - termed 6/30/18
Borderland Construction Company, Inc. #BCD002
Fort McDowell Yavapai Nation #FMC001 - termed 12/31/16
Gilbert Public Schools Employee Benefit Trust #GIL033
Navajo County Schools EBT #NVD002 - termed 6/30/16
Title Security Agency of Arizona #TSA002 - termed 12/31/15
Tucson Orthopaedic Institute, P.C. #TOD002 - termed 12/31/16

Groups that have TERMINATED medical network access

on or after 7/31/18:
** ADL001 - Adelante Healthcare, Inc. - termed 12/31/18
** AMK001 - Amkor Technology, Inc. - termed 5/31/20
** ACN002 - Atembis, LLC - termed 12/31/19
** AZM001 - Arizona Materials, L.L.C. an Arizona Limited Liability Company - termed 1/31/20
** FWG001 - Farnsworth Companies, Inc - termed 8/31/2018
** LHU001 - Lake Havasu Unified School District #1 - termed 6/30/20
** MSB001 - State Bank of Arizona - termed 2/29/2020
** MSF001 - Mountainside Fitness Acquisitions - termed 12/31/19
** NWA001 - Northwest Arizona EBT - termed 6/30/19
** SCA012 - CopperPoint Mutual Insurance Company - termed 12/31/18
** SGF001 - OB Sports Golf Management, LLC - termed 8/31/19
** SUS001 - Safford Unified School District #1 - termed 6/30/19
** TRA001 - TRAX International Corporation - termed 12/31/19
** YUT410 - Yavapai Unified EBT - termed 6/30/19

* new group ** change to existing group Page 5 of 6 EBT = Employee Benefit Trust
Please submit CHS claims electronically to BCBSAZ using EDI #53589. (NOTE: do not submit 53589 as the member ID.)

Group that changed TPAs with claim runout

handled by prior TPA:

** MRP001 Microchip Technology Inc. - for claims with dates of service on or before 12/31/18 submit with group number MRP001 to TPA HealthSmart.
For claims with dates of service on or after 1/1/19, submit to new TPA Gilsbar with new group number MPT001.

** MCA001 Mayo Clinic Arizona - for claims with dates of service on or before 12/31/18 submit with group number MCA001 to TPA Medica.
For claims with dates of service on or after 1/1/19, submit to new TPA Medica with new group number MAY001.

** ALG001 Arizona Local EBT - for claims with dates of service on or before 6/30/19 submit with group number ALG001 to TPA Gilsbar.
For claims with dates of service on or after 7/1/19, submit to new TPA AmeriBen Solutions with new group number AGT001.

** GRI001 Gila River Indian Community - for claims with dates of service on or before 9/30/19 submit with group number GRI001 to TPA Summit.
For claims with dates of service on or after 10/1/19, submit to new TPA HealthSmart with new group number GIC001.

** TOR001 Tuscon Orthopaedic Institute, P.C. - for claims with dates of service on or before 12/31/19 submit with group number TOR001 to TPA Meritain.
For claims with dates of service on or after 1/1/20, submit to new TPA HealthNow with new group number TUN001.

** TMC001 M.R. Tanner Development and Construction, Inc. - for claims with dates of service on or before 1/31/20 submit with group number TMC001 to TPA Gilsbar.
For claims with dates of service on or after 2/1/20, submit to new TPA EMI Health with new group number EMH222.

* new group ** change to existing group Page 6 of 6 EBT = Employee Benefit Trust