How to File an AHC Claim

One of the most critical functions in a provider’s office is insurance claims submission. ActivHealthCare (Activ) understands the importance of this task and is here to assist you in the claims submission process. One of the first tools you will need is the ActivHealthCare Network Affiliates sheet. This sheet provides you with a list of Activ’s network affiliations and the network logos which may be on the patient’s insurance identification card. Also, the network affiliate sheet is divided into two categories. The bottom portion of the network affiliate sheet is a list of clients to which you would send claims directly to the payor listed on the insurance identification card. The top portion of the network affiliate sheet is a list of clients which should be sent directly to (through) Activ. This instruction page is addressing the claims for network affiliates on the top portion of the sheet.

Most insurance claims can be submitted electronically through Office Ally. It is important that you keep up to date with the latest version of the Office Ally Payer List which can be found at Also, be sure to complete both, the Office Ally training and the ActivHealthCare training so you can properly utilize the tools available and follow the proper billing procedures and format.

For a few insurance payors, it is necessary to submit the claims for your patients’ services on paper and through U.S. mail. To facilitate those claims, mail them directly to ActivHealthCare and provide Activ with the insurance address from the patient’s insurance identification card on the top portion of the CMS1500 form. (See step 3 below.) By doing this, Activ will know where to forward the claim.

The steps for claims submission are as follows:

Step 1      Verify patient’s insurance coverage through insurance payor. Be sure to verify the PPO network, claims submittal address and patient’s benefits.

Step 2 Using your practice management software, thoroughly complete the Health Insurance Claim Form. This is referred to as a CMS-1500. Be sure to pay attention to the requested information.

Step 3 The upper right hand corner (above box 1a.) of the CMS-1500 form has a blank space. Many providers use this place to print the name and address of the insurance payor. If the claim is sent to Activ for processing, some providers will place our name and address in this field. Although that helps you know to send the claim to Activ, it does not help Activ know where to send the claim for payment.

  For electronic and paper claims - Obtain the insurance payor’s information from the insurance identification card. In order to identify the name and the address of the ultimate insurance payor and route the claim to the correct address, we request that you complete this field in the following format (See Example 1):
   AHCØ1 Insurance Payor’s Name
   Insurance Payor’s Street Address or P.O. Box
   Insurance Payor’s City, State & Zip Code

  Electronic Claims - In most cases, the claims can be submitted electronically through Office Ally. The above format is necessary for electronic claims submission. Office Ally looks for the AHCØ1 prefix in the specific format as shown above. When it is there, a copy of the claim is sent to Activ. Also, the claims is submitted as an in-network claim. If the prefix is missing or in an incorrect format, the claim will probably not be processed correctly..

  Paper Claims - By placing the AHCØ1 prefix in FRONT of the insurance payor’s name, you will know to send the claim to the Activ office. This format will expedite the processing of your claims by providing Activ with the Payor’s address on the CMS-1500 (See Example 1). Remember, we get the insurance payor’s information from you. By working together, we can recover every benefit dollar possible.

  If we do not know the billing address of the insurance claims payor or the name of the PPO network (box 11c), we will have to send the claim back requesting a copy of the insurance ID card from you..

Step 4 If you do not use Office Ally, or if the payor is not on the Office Ally payor list, send the paper claim to the Activ office. If the claim form is completed properly, Activ will send your claim to the appropriate insurance payor. We will also enter or log the claim into our centralized billing system, allowing you to view the status of the claim on our Provider Portal. If we need additional information, we will let you know.

Step 5 In most cases the insurance claims payor will process the claim and send Activ an explanation of benefits within 30 days. We will promptly process the claim through our system and issue a bulk pay remittance to you summarizing all claims processed for your office.

Step 6 In some cases, the carrier may not process a claim promptly. If the carrier needs additional information, they may respond to you directly or to Activ. If they request the information from Activ, we will relay that request to you.

It is the responsibility of each individual provider’s office to follow-up on claim status. Activ is not a billing service. If you do not receive a response from a claim within a reasonable time period, please contact the payor to determine the status. You may also review your list of outstanding claims on the Activ Provider Portal, but it only shows you if Activ received the claim. It does not confirm that the payor received the claim. Office Ally provides tools to monitor claim receipt by the payor.

If you verify the claim has not been received by the payor, please do the following:

  • Verify that you submitted the claim properly. It should have the correct payor address and format. If you find you did not submit it properly, please resubmit. If it is less than 90 days, be sure to turn off the duplicate filter setting on the Office Ally website so the claim can go through.

  • Check your Office Ally reports to verify that you received a message confirming the payor received and accepted the claim. If you did not receive this confirmation, you need to contact Office Ally to find out why you did not receive it or you may need to correct something on the claim.

  • If there is not a problem with the submission address or Office Ally, please contact Activ and we will assist you to determine why the claim has not been processed. See the “Contact Us” page easy contact instructions.