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Sample EOP

In our continued efforts to assist you in identifying First Choice Health Network participants, FCH will post samples of their remittance advice (RA) or Explanation of Payment (EOP). To start, we have obtained copies of our top payors based upon volume (employee lives) for your reference. It is our expectation that by providing these examples on our Web site, you will be better able to populate your claim forms (HCFA & UB) more completely. We will continue to work with our payors to keep these copies current and up-to-date. If you find that the examples below are not up-to-date or if you would like to see an example of an EOP/RA that we don’t have posted, please feel free to notify the Provider Relations Department at 1-800-231-6935 extension 2103.

• Employee Benefit Management Services (EBMS)
• First Choice Health Administrators
• FirsTier Administrators
• Government Employees Health Association
• International Longshore & Warehouse Union (ILWU)
• Group Health Options
• KPS Health Plans
• Operating Engineers Locals 302 & 612
• Northwest Sheet Metal Workers
• Northwest Iron Workers Health & Security Trust
• Principal Financial Group
• Providence Health Plan
• Puget Sound Electrical Workers (PSEW)
• Retail Drug Employees Welfare Trust
• Trusteed Plans Service Corporation (TPSC)
• Washington State Health Insurance Pool (WSHIP)
• Coventry Health Care

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