For claim services provided on or after January 1, 2023, please submit claims to:

Health First Health Plans
P.O. Box 830698
Birmingham, AL 35283-0698
Claimsnet Payer ID: 95019

The most current forms for your use are below.
 

Claim Forms

• Dispute Process
• Provider Claim Dispute Request
• Provider Claim Dispute Request – Second Level
• Provider Claim Inquiry 
• Corrected Claim Flyer
• Medical Reimbursement Form
• Timely Filing Guidance
• Waiver of Liability
• Claim Submission for Unlisted Procedure

Last updated 4/5/2022