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EDI Enrollment
Complete These Steps
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Step 1: Complete the Office Ally Enrollment (link is external) on the Office Ally website by clicking on the underlined link.
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Step 2: Complete the AHC EDI Provider Agreement Addendum by clicking on the underlined link. Fax the completed form to (470) 514-3697.
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Step 3: Complete the optional Medicare documents below if you wish to include Medicare in your Office Ally processing.
Optional Enrollment Documents
AHC provides Medicare and Medicaid enrollment forms on the website for your convenience. You may download the documents by clicking on the form name and mail them as specified on the individual applications. These forms are not required. AHC is not involved with the processing of Medicare, Medicaid, BCBS, or other non-AHC claims. DO NOT MAIL THESE OPTIONAL FORMS TO ACTIVHEALTHCARE.
Georgia
Georgia Medicare Part A Provider Application for EDIThis form must be completed to electronically file Medicare claims through Office Ally. You do not need to complete this form if you will not be processing Medicare claims.
Georgia Medicare Part B Provider Application for EDI
This form must be completed to electronically file Medicare claims through Office Ally. You do not need to complete this form if you will not be processing Medicare claims.
Georgia Medicaid Application for EDI
This form must be completed to electronically file Medicaid claims through Office Ally. You do not need to complete this form if you will not be processing Medicaid claims.
South Carolina
Tennessee
Tennessee Medicare Enrollment Form Part A
Tennessee Medicare Part B Provider Application for EDI
This form must be completed to electronically file Medicare claims through Office Ally. You do not need to complete this form if you will not be processing Medicare claims.