CA's Corner

For the benefits of payor’s, providers and managed care organizations, AHC utilizes a fully automated claims management system that enables timely processing of claims, accuracy of payment and flexible management reporting capabilities.

By submitting claims through AHC, network members receive in-network benefits. In most cases, this means lower deductibles and higher claim reimbursements. You can contact us for questions on numerous patients at one time as opposed to making several phone calls to multiple companies. Some of the features of our claims administration program include:

  • PPO contract management
  • EOB analysis, translation, and benefit disbursements for PPO claims
  • Claims administration for HMO claims
  • HMO eligibility verification and utilization review
  • Centralized billing for payors
  • Electronic claims submission
  • HIPAA compliance
  • Customer service assistance for network members
  • Detailed management reports (available upon request)

Please view our instructions on how to file a claim, AHC or I-AHC, for information on proper claim submission. We provide a single, easy to read Bulk Pay Remittance that summarizes the information on the various carrier explanations of benefits (EOBs) we receive.

Additional Resources:

To learn more about ActivHealthCare please view our frequently asked questions.