In most cases, claims should be sent directly to AHC. In a few cases, the claims would be sent to the address on the insurance card. This is determined during the contracting process and specified on the term summary sheets.
AHC distributes a list of network affiliates with claims filing instructions several times a year. If you need an updated list or term summary sheets, please contact our office or visit our website at ActivHealthCare.com.
Sometimes, depending on what was not paid and the reason.
For example, patients are responsible to pay you for co-pays, deductibles and coinsurance portions that are not paid by the insurance carrier. The patient may also be billed for items that are specifically not covered by the insurance plan, i.e. vitamins, cervical pillows, massages, etc. However, you must let the patient know in advance and in writing that certain items may not be covered and will be the patient's financial responsibility.
No, they probably will not. Remember, we contract with the PPO, HMO or MCO network. We do not contract directly with the claims payor. The PPO, HMO or MCO has the contract with the claims payor. For example, the claims payor normally does not know that NovaNet uses AHC chiropractors. There are several hundred companies paying NovaNet claims throughout the country. By contracting with AHC, your name is placed in the directories of all the NovaNet PPO plan participants.
You would call the number on the insurance card to verify coverage and obtain a description of benefits. In some cases the insurance carrier will ask for your tax identification number to determine if you are a participating provider. If that happens, you should provide them with AHC's tax identification number.
You should only submit the claims for patients affiliated with the AHC contracted networks. Most of our contracts require you to submit the claims through AHC. A few of the contracts provide for direct billing from you to the payor. Those contracts are identified on our list of current contracted networks.
No, not unless you have a direct contract with the PPO, HMO or MCO. You are listed as a PPO, HMO or MCO participating provider through your affiliation with AHC. As such, you are recognized by the AHC tax identification number and billing address.
If the patient's coverage uses an affiliated network, but the claims payor or insurance carrier does not recognize you as a participating provider contact the AHC customer service department.
The employer or insurance carrier will identify the PPO which the patients should use by placing either the name or logo of the MCO or PPO on the insurance identification card. If it is not on the identification card, you should ask for the name of the PPO network when you verify insurance coverage.