If a patient presents with a First Health Network card, the first thing billing professionals must determine is who processes the claim and which payer ID should be used. Answering these questions is necessary because First Health Network functions as a Preferred Provider Organization (PPO) access network within a multi-entity payer structure. The First Health Network payer ID is a 5-digit identifier used during claim submission. Confused?
Fortunately, we will discuss what this network is, its owner, how First Health Network payer IDs work, and eligibility verification requirements. Additionally, we will discuss common challenges billing teams face. So, without further ado, let’s begin!
What is First Health Network Insurance?
First Health Network is a national PPO network. The network includes the following entities providing services throughout the U.S.
- Hospitals
- Physicians
- Healthcare facilities
According to Health Net’s official First Health Network FAQs, First Health members have access to a complete network of healthcare facilities and physicians, where patients may receive medical services at a contracted rate.
One advantage of the network is that patients can access these benefits whether they reside within their home state or not.
It is important to remember that First Health is not a standalone insurer. Similarly, it is not a government insurance program either. Instead, it is a product with network access.
With First Health Network insurance, self-funded employers and health plans provide members the option of accessing in-network providers at improved market rates. These services are in addition to the health plan’s regional coverage area.
Moreover, according to the same Health Net guidance, behavioral health services and medical services can be accessed through the First Health Network providers.
Ownership: The Full Acquisition Chain
Understanding First Health Network insurance ownership is necessary for determining:
- Who handles credentialing applications
- Where First Health Network claims go
- Which payer IDs apply
According to the official SEC filings, the following are important milestones in First Health Network’s ownership history:
- January 28, 2005: Coventry Health Care acquired First Health Group Corp. after a merger agreement.
- August 2012: Aetna announced plans to acquire Coventry Health Care.
- May 2013: Aetna finalized the acquisition, bringing Coventry and First Health Network under its ownership.
- November 2018: CVS Health acquired Aetna in a deal valued at about $70 billion, making the PPO network part of CVS Health.
Today, First Health Network operates within Aetna’s network structure under CVS Health ownership. So, provider participation and credentialing workflows for First Health are generally administered through Aetna systems.
First Health Network’s Payer ID
Electronic Data Interchange (EDI) ID (also known as a payer ID) is an identifier assigned to an insurance payer by a clearing house. Billing teams include this unique 5-digit ID on electronic claim submissions to direct the claim to the appropriate payer or claims processor for adjudication. It is a routing address informing the clearing house which payer to send the claim to.
First Health Network operates as a third-party partner, connecting patients and providers to around 260 insurance payers. Meaning, in its network, it has approximately 1.67 million providers and 1.1 million individuals who rely on various insurance payers for healthcare coverage and rightful reimbursements.
Health First Health Plan, operating within the First Health Network, relies on payer ID 95019 for electronic claims submitted to it. It is a health insurance company in central Florida and has over 5,500 providers on its panel. It offers and processes Medicare Advantage, as well as commercial plans.
Generally speaking, payer IDs, like those assigned to First Health Network payers, consist of 5 characters that can be numeric, alphanumeric, or alphabetic, depending on the insurer. Every insurer has a payer ID, which is periodically revised based on clearinghouses and payer updates.
How to Check the First Health Network Payer ID?
You can check the payer ID for insurers within the First Health Network using one of the methods listed below:
Check the Health Insurance Card
The patient’s health insurance card includes all the relevant information, including the payer ID. So, providers can check the copy of the patient’s insurance card to determine the payer ID and use that identifier to initiate electronic claims.
However, if the First Health Network payer’s ID is not mentioned on the card, you can proceed to:
Contact the Payer by calling the Helpline
At the back of every medical insurance card, there is a helpline number that can be used to communicate with the payer. You can dial that number to speak to a representative and ask them about their payer ID. They should help you in this matter.
Or, you can:
Visit the Availity Portal (If Applicable)
Many insurance carriers provide their payer ID and other claim routing details on dedicated portals. For instance, Aetna uses the Availity Essentials portal (which operates as a clearinghouse) for provider transactions, including payer ID verification. Billing teams can use this portal to search for First Health Network payers’ IDs. This can be done for every PPO network encounter before the billing team submits a claim.
First Health Network Payer IDs & Examples
As mentioned earlier, multiple plan sponsors are on the First Health Network, and IDs are assigned according to the plan structure. The following table explains key plan categories and their claim routing.
| Plan Type | Claim Processor | Payer ID Guidance |
|---|---|---|
| Fully insured Aetna plan with First Health access | Aetna | Use Aetna’s payer ID through Availity or your clearinghouse. |
| Workers’ comp or auto liability with First Health | First Health / Aetna-administered | Verify payer ID with the sponsor or TPA. |
| Self-funded employer plan with First Health access | Third Party Administrator (TPA) | Confirm with the TPA or review the patient’s insurance card. |
| Health Net PPO using First Health network | Health Net | Use Health Net’s payer system to submit claims. |
Source: Aetna
Important Note: Submitting the request with an incorrect payer ID is a likely cause of claim rejection in multi-payer PPO billing.
Examples of First Health Network Payers and IDs
Aetna commonly uses payer ID 60054, while UnitedHealthcare frequently uses 87726 for electronic claims submission. However, payer IDs can vary by:
- Clearinghouse
- Plan type
- Region
So, billers should always verify the payer ID directly from the patient’s insurance card, clearinghouse directory, or payer portal. The following table covers some of the insurers within the First Health Network and their payer IDs:
| First Health Network Payer | Payer ID |
|---|---|
| Aetna | 60054 |
| Caresource Medicare Advantage Kentucky | KYCS1 |
| Health Net Medicare Advantage | 68069 |
| AARP Medicare Complete | 87726 |
| First Health Network (PPO Oklahoma) | 73159 |
| First Health, The Lewer Agency | 96708 |
| El Paso First Health Plans CHIP | EPF03 |
| Delaware First Health | 68069 |
| Benveo | 76251 |
| Health First Health Plan | 95019 |
Disclaimer: Payer IDs are subject to change annually. Therefore, they should always be verified before usage.
Verification Checklist for a First Health Network Claim
Before submitting a claim to a payer with access to the First Health Network, verify the following details:
Prior Authorization Requirements
Always review authorization requirements under the patient’s specific plan before services are rendered. Remember, this pre-authorization requirement may vary depending on the patient’s plan type and the service category involved.
Plan Sponsor Identity
Confirm whether the patient is fully insured or self-funded. Fully insured plans may route through Aetna, while self-funded plans are often administered by a third-party administrator (TPA).
In-Network Status
Confirm the billing provider’s in-network status with First Health Network (depending on the patient’s plan) and the sponsor’s contract.
Active Coverage
Confirm that the patient’s current plan includes active network access.
Common Challenges with First Health Network Billing
As mentioned earlier, since First Health Network functions as a PPO access network rather than a direct payer, claims are typically routed to the insurer or TPA administering the member’s plan.
However, generally speaking, PPO billing poses common operational challenges that providers and billing teams face, as discussed in the table below:
| Challenge | Key Issue |
|---|---|
| Incorrect Payer ID | First Health is not a direct payer, and claims may be sent to the wrong payer ID, particularly with TPA-administered or self-funded plans. |
| Wrong Credentialing Path | Provider credentialing for First Health participation is generally handled through Aetna. Missing this requirement may result in claims being processed as out-of-network. |
| Misidentified Plan Sponsor | Billing teams must verify the plan sponsor, claims routing instructions, and whether a TPA is involved before claim submission. |
| Missing Authorizations | Authorization requirements vary depending on the vendor, applicable to: ImagingRadiation therapySleep studies Missing authorizations may result in claim denials or payment delays. |
Ace First Health Network Payer ID with MediBillMD
Understanding First Health Network payer IDs is essential to submitting electronic claims and avoiding payment delays. However, if your practice doesn’t have dedicated billing specialists familiar with PPO network billing, it can be a source of consistent trouble.
Fortunately, with MediBillMD’s medical billing services, you can navigate multi-payer complexity, even for PPO network billing.
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