Frequently Asked Questions - EDI

There will not be any monthly charges paid to AHC. However, according the agreement, OA offers an optional service that includes additional fees for of $0.35 per claim to print and mail any HCFAs that cannot be sent electronically (i.e. the insurance company is not on our payer list or your pre-enrollment is not completed for that insurance company). Also, if Medicare claim volume exceeds 50% of overall claims submitted, OA charges a flat monthly fee of $19.95 for any month exceeding the 50%.

To get started on the pre-enrollment for those payers who require pre-enrollment, when you are filling out the OA Enrollment Form, list any of the listed payers that you would like to pre-enroll for. OA will start the pre-enrollment process for the companies you've selected and get any necessary paperwork to you. There is no cost for pre-enrollment.

Most users send claims to OA as follows:

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ol> 1) Create a claim file using your current billing software
2) Log into www.officeally.com and click,

For providers without billing software, OA offers a free, online entry tool. This tool allows you access to a blank, electronic HCFA on the OA website. You type data into it the same way you would a paper HCFA. Additionally, this tool allows you to store patient, facility and provider information so you do not have to re-type the same information over and over.

No, the Office Ally website will interface with all practice management software packages. All you need is Internet access. The OA technicians will assist and train your office staff on set-up and the use of the Office Ally tools.

No, the law allows providers to submit in a non-HIPAA compliant format to a clearinghouse. The clearinghouse must convert the claims into the 837 HIPAA compliant format prior to transmission to the insurance company or claims payer. It is against the law for a provider to submit directly to an insurance company in a non-compliant format.

Yes, OA is certified HIPAA compliant. The Trading Partner's Agreement details the HIPAA policies and procedures that are followed to protect your private health information as well the security measures used in the computer systems to ensure privacy.

By enrolling with Office Ally, you are automatically set-up to send to all payers on the OA Payer List except those with asterisks next to their name. Those payers require you to go through a pre-enrollment process before we can send your claims electronically to them.

Review the list of AHC Network Affiliates, or PPOs, found on this website. If the patient is covered by a benefit plan or carrier that uses one of the AHC Network Affiliates, and the instructions on the corresponding Term Summary Sheet says to submit claims to AHC, then you should identify the claims to OA by placing

Call the customer support team for OA at (949) 464-9129 or send an e-mail to support@officeally.com. Customer service or technical support is available 24 hours a day, 7 days a week, at no additional charge.

If there are no processing delays, a typical claim may be paid as early as 10 business days.

Pre-enrollment for most commercial payers is usually complete within one week. Pre-enrollment for Medicare and CHAMPUS varies from 1 to 6 weeks.

No, dial-up Internet access will also work.

Office Ally offers many features including tools for tracking claims, running reports based on your own specifications, checking eligibility, verifying codes (ICD9, CPT, POS, Modifiers), fixing claims right on the website, entering claims online, and sending attachments electronically. OA continually adds new features and upgrades existing services to meet your EDI needs.

You are welcome to file Medicare claims through Office Ally, but it is not required. AHC is NOT responsible for your relationship with Office Ally and the processing of Medicare, BCBS, Medicaid, and other non-AHC claims. You should contact OA with any questions regarding non-AHC claims.

OA's ability to accept a print-image file means that we are compatible with nearly every practice management system. Essentially, if your software allows you to print claims in your office, you can send claims to Office Ally.

You may submit all of your medical claims through Office Ally. This includes AHC payors, Medicare, and other claims that would not involve AHC. AHC is NOT responsible for your relationship with Office Ally and the processing of Medicare, BCBS, Medicaid, and other non-AHC claims. You should contact OA with any questions regarding non-AHC claims.

You must notify AHC so that we may contact OA to indicate AHC on your enrollment. This is important so your AHC claims are not processed out-of-network. You will also need to submit a check for the set-up fee along with the two AHC enrollment forms.

Please allow up to 30 days for us to process your enrollment. Once we submit the enrollment form to OA, OA will email a user name and password for uploading claim files. An OA enrollment specialist will contact you to set up an appointment with one of their technical staff for training