Preparing Your Management Software for EDI

To file claims electronically, you will only need a computer with Internet service. While computerized claims processing software is desirable, it is not required. If you do not have claims management software, but would like to file claims electronically, you may use Office Ally's Online Entry Tool.

The following information is required to use EDI.

• Enrollment is required. If you have not enrolled refer to the EDI main page for enrollment instructions and forms or contact us for more information.
  
  
• You will need the username and password provided by Office Ally after enrollment.
  
  
• A pin number is required in box 33 of the CMS-1500. If the payor requires a pin, use the payor assigned pin number; otherwise, use the doctor’s license number. This will need to be set up in your software.
  
  
• You will need to know how to print your claim “to file” from your software. If you can print a claim, you have this capability. Contact your software vendor if you need assistance with this step.
  
  
• Once you print a claim to file, you will need to know where to locate this file on your computer for uploading.
  
  

To determine which claims should be submitted as ActivHealthCare in-network claims, review AHC network affiliations. If a network or employer is included in the affiliations or employer list, the patient's claim should be submitted as an AHC in-network claim to receive the in-network fees.

If you have the same payor that is filed both as an AHC in-network claim and an out-of-network claim, then you will need to set up two payers in your software (one with the AHCØ1 prefix and one without). See the AHC in-network claim submission for more information on the AHCØ1 requirements.

To learn more about EDI, please view our frequently asked questions or contact us.