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Electronic Filing with Office Ally & ActivHealthCare01/20191926 Northlake Pkwy, Suite 100 ٠ Tucker, GA 30084 ٠ 770-455-0040 ٠ 888-635-0459 ٠ www.ActivHealthCare.com
EDI ClaimsElectronic Data Interchange (EDI)is a transfer of data between twocompanies using the Internet.AHC offers this service forelectronic claims processing toyou, FREE, through a partnershipwith Office Ally (OA).*ActivHealthCare only accepts EDI claims through Office Ally!2
EDI Claims - BenefitsWhy consider Office Ally? Low monthly fees Faster Payments Quick and easy Online access to claim status, history and summary reports Online claims correction capability Reduced costs for postage, printer cartridges and claimforms Improved accuracy in claims processing Only acceptable proof for timely filing*If 50% of your monthly electronic submittals are Medicare or Non-Par, Office Ally will charge 35 for that month.3
EDI EnrollmentEnrollment is easy! Download and complete the enrollment forms fromwww.ActivHealthCare.com: Mail the original and signed enrollment forms to ActivHealthCare:ActivHealthCareAttn: EDI1926 Northlake Pkwy, suite 100Tucker, GA 30084Do not send formsto Office Ally!4
EDI Enrollment (continued)***** IMPORTANT *****If you are already enrolled with Office Ally beforejoining ActivHealthCare or if you enrolled directlywith Office Ally, you must still enroll throughActivHealthCare.Office Ally must link your account toActivHealthCare. If they do not do this, claims willnot be processed correctly and ActivHealthCare willnot receive a copy of your claims.5
EDI Enrollment (continued)Allow up to 30 days for enrollment. Office Ally willcontact your office for training, uploading and withyour username and password. OA will provide technical support in addition to trainingon how to upload claims AHC will work with OA and your office during the start-upphase6
Office Ally Online Tools Patient Look-UpView Claim HistoryInventory ReportingCode SearchClaim FixEligibility Request7
Claims Follow-UpCritical Step – Checking Your Claim’s Status!Within 24 hours of upload, your file summary is ready. This report lists thestatus of all claims received by OA. This acts as your receipt that yourclaims have been entered into the OA system. Log into www.officeally.com and click DOWNLOAD FILE SUMMARY Click the appropriate day on the calendar Below the calendar, click VIEW and then click OPENPlease note: ANSI 837 users may receive an ERR Report in place of their filesummary. You should contact OA if you receive this report.8
ID Card Example – Peach State Health PlanPrimary Network isPeach State HealthPlan. Productname is AmbetterAHC01 Peach State Health PlanPayer ID# 68069P.O. Box 5010Farmington, MD 63640-5010HCFA Box 11c: PSHP or full namePayor or “Mail To“address9
ID Card Example – MHPPrimary NetworkAHC01 CoreSourcePayer ID# CB624PO Box 105Arnold, MD 21012HCFA Box 11c: MHPPayor or “Mail To“address10
AHC01 prefixIt is extremely important for the prefix to be correctly place andformatted. Please not, the prefix is AHCzero1. It is not the letter“O”. If you do not put AHC01, the claim will not be processed asin network. This may result in no payment on a claim.The AHC01 prefix triggers special programming by Office Allywhen used it properly. It tells Office Ally to send a copy of theclaim to ActivHealthCare. This allows us to pay the correctprovider when the payment is received from the insurancecompany.11
NPI Numbers - requiredNPI numbers are not an option, they are required.NPI numbers must be placed in the following locations of theCMS1500 form: Box 24.j (treating provider’s NPI required) Box 32.a Box 33.aFailure to properly place NPI numbers on claims may result on adenial, delay or return of the claim.12
AHCØ1 Payor Name from ID CardPayor Address from ID CardPayor City, State, work NameDoctor’s NPINumber14322895876Service Address & NPI #TINServiceProviderJohn Chiropractic Center4455 Highway 84Tucker, GA 30084-70691932992610John Chiropractic Center4455 Highway 84Tucker, GA 30084-706914322895876Address/NPI numberfor who checks arepayable to13
If Mailing Paper Claims, Send Claims To:All Claims forNetworks(Alliant, Beech Street, FirstHealth, etc)ActivHealthCare1926 Northlake Pkwy,Suite 100Tucker, GA 30084Note: See Network Affiliate sheet. This applies to the networks that are tobe submitted through Activ.14
If Filing EDI through Office Ally, Address Claims using this format:All Claims forNetworks(Peach State Health Plan,Alliant, MHP, First Health, etc)AHCØ1 “Name of Payor”“Insurance co. payer ID”AddressCity, State, Zip15
Setting Up PayorsSome payors may necessitate that you set up the payor twice in yourmanagement software. For example, Aetna will pay claims for AHC and nonAHC employer groups.1AHCØ1 Payor Name2(no prefix) Payor NamePay close attention to the network and payor information. Failure toproperly identify the payor information at the top of the CMS-1500 willmost likely result in your claim being processed out-of-network, creatingadditional work for your office staff and patients.16
Contact InformationActivHealthCare1926 Northlake Pkwy, suite 100Tucker, GA 30084Phone: 770-455-0040General Fax: 770-455-6188We are here to help you and your doctors with any questions or problems.17
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Electronic Filing with Office Ally & ActivHealthCare 01/2019 1926 Northlake Pkwy, Suite 100 ٠Tucker, GA 30084 ٠770-455-0040 ٠888-635-0459 ٠www.ActivHealthCare.com. EDI Claims Electronic Data Interchange (EDI) is a transfer of data
