Frequently Asked Questions

Please refer to the credentialing information or contact our office at (770) 455-0040. You may also contact us and request information. We will answer your questions and send you marketing information and the necessary forms for joining the network.

There are many advantages to being an AHC or I-AHC member. Some of these include:

• We are currently credentialing for over 30 Network Affiliates. This gives our network members access to about several million covered lives in the Southeast. You will only have to credential and pay one network, not 30.
• We handle the credentialing audits for you. This means we are interrupted by the network auditors, not you.
• We carefully reviews the contract terms. We then summarize the key points for you and put them into a one page Term Summary Sheet format.
• We find the best fee schedules for you.
• We are a resource to get answers about insurance issues and managed care. You can visit our website for the Frequently Asked Questions and resources or you can contact our office. Either way, we are here to help.

AHC is working very hard for its member providers. We do this as a group and on an individual basis. Our primary focus is to secure managed care contracts to ensure that patients are directed or steered to our member chiropractors. This is done by offering our chiropractic network to other comprehensive networks, i.e. MultiPlan, PHCS, First Health, and Coventry. We refer to these networks as our Network Affiliates. AHC works to obtain favorable fee schedules and contract terms. AHC is currently marketing to networks throughout the Southeast.

AHC credentials individual chiropractors on behalf of our network affiliates. This allows the provider to credential only one time and have the benefits of multiple networks. Also, if an individual chiropractor has a problem with one of our network affiliates, or vice a versa, AHC is there to serve as an intermediary to explain and resolve the issue.

These companies build a large group of preferred providers and sell the rights to access the providers to insurance carriers, third party administrators, and employee benefit plan administrators. The plan participants (or patients) of the employee benefit plans that are using these contracted networks refer to the PPO directory or provider list when they need to select a participating provider. If you are a member of AHC, your name is listed in the directory. In other words, you get more patients.

By submitting claims through AHC you will receive in-network benefits. In most cases, this means lower deductibles and higher claims reimbursements. AHC is not a billing service, but we provide a centralized billing service for your paper claims. You can contact us for claims status on numerous patients at one time as opposed to making several phone calls to multiple companies. We will communicate to you the information we receive from the carriers. We will provide a single, easy to read bulk pay remittance that summarizes the information on the various explanations of benefits we receive. If you have any questions, we are here to help.

A term summary sheet is the summarization of the key points to a contract between AHC and its network affiliates. The term summary sheets are actually a part of your Provider Agreement. As new contracts are acquired, a new term summary sheet is sent to you.

The main components of the term summary sheet include:

• Name of the company with whom we are contracting, i.e. our network affiliate Effective date
• Amount of administrative fee or AHC's charge to the provider, and how it will be charged
• Fee Schedule
• Type of coverage, i.e. PPO, HMO, Workers' Compensation or auto liability Where to send claims

A fee schedule is one of the primary points of a contract with a PPO network. The network will establish a fee schedule. It may be a fixed amount, i.e. $32 for a code 98940, or it may be based upon another schedule, i.e. a percentage of Medicare fee schedule. Each contract is different and there is a wide range of fee schedules.

Yes, there is a small administrative or access fee. We are offering you access to network plan participants through your affiliation with us. These fees are usually offset by higher claims reimbursements because of the increased in-network benefits.

Yes, a provider can refuse to accept a network affiliate. Notification must be received within 30 days of the date the term summary sheet is presented to the provider. If there is a change in the way one of our network affiliates does business or if there is an addendum to a contract, we will also allow for a provider to opt out of that network at that time.

AHC does not restrict providers from joining other networks. But there several points to consider. The large number of competitive networks is a driving force in lowering fee schedule. By supporting other networks, you are limiting AHC's ability to obtain fee schedules on your behalf. A network only exists because you join it. If AHC was the exclusive network for chiropractic, our ability to secure contracts on your behalf would greatly increase and many more carriers and clients would turn to us for access to you.

If you must join other networks, be careful in deciding which you join. We frequently hear providers complain about low reimbursements or excessive utilization review from other networks. These networks have the contracts they have only because providers join them and support them. Sometimes these networks offer lower fee schedules than those already contracted with AHC. Remember, you will be reimbursed at the lowest fee schedule. Pay close attention to the AHC list of network affiliates. This will help you avoid joining duplicate networks.

To change your address, it is necessary to complete all three of the following forms. You can find these forms on our Forms page under Address Change Forms.

• Provider Information Form
  
• Location Information Form
  
• W-9 form.

You may fax the completed forms to 678-990-1124 or mail to:

Credentialing Department
ActivHealthCare, Inc.
1926 Northlake Parkway, Suite 100
Tucker, GA 30084

These changes are NOT done in the Credentialing Center, but as a separate change between credentialing cycles.

To change your tax ID, it is necessary to complete a W-9 form.

You may fax the completed form to (678) 990-1124 or mail to:

Credentialing Department
ActivHealthCare, Inc.
1926 Northlake Parkway, Suite 100
Tucker, GA 30084

To enroll, you will need to "Opt In". Do this by completing the Participating Provider Enrollment Form, which can be accessed by going to the Forms section of the website. Once the form is completed, fax your form back to (470) 514-3697.

All fee schedules and term summary sheets can be found on the Provider Portal.

Visit our website, www.ActivHealthCare.com for extensive information on claims processing. It is essential for Provider Staff to review and understand the Provider Staff Training that is available on our website.

There are a few training presentations, with Provider Staff Training being the most important. Almost every question asked of us can quickly be answered and almost every mistake made by a CA can easily be avoided by using resources available at www.ActivHealthCare.com.

Ambetter has a specific process for filing a corrected claims, which must be followed. Please click here for that process. There are three steps:

1. Handwrite "Corrected Claims" at the top of the CMS1500.
2. Put a 7 in box 22 under Resubmission Code and the original claim number in box 22 under Original Ref No. These numbers cannot be written, they must be printed on the form.
3. Send the form to ActivHealthCare so we can attach a copy of the original Explanation of Payment to the form and send it to Peach State Health Plan.
OR, you can submit the correction electronically as an 837P. Refer to the Peach State Health Plan document memo for more instructions.

If you wish to submit an appeal, you will need to follow Ambetter procedures. In order to file an appeal with Ambetter, a provider must complete a Provider Request for Reconsideration and Claim Dispute Form which can be obtained from the Ambetter website.

There are two items on the form which need to be explained:

1. Provider Tax ID # - This would be the Activ Tax ID #. (The only other time you may use it.)
2. Control/Claim Number - This would be the Peach State Health Plan (Ambetter) claim number. Within the next week, ActivHealthCare will begin placing the Ambetter claim number on your Remittance Advice. it will be labeled PSHP Clm# and will display on the right-hand side. Until then, you will need to contact ActivHealthCare for that number.

If you have any questions on the process, please do not hesitate to contact ActivHealthCare at (770) 455-0040.

Claim Status can be tracked through the ActivHealthCare Provider Portal.

Peach State Health Plan follows CMS guidelines with respect to modifiers. Providers are expected to use modifiers appropriately. The Provider Manual and Billing Manual, which is available on the Ambetter website under Provider Resources, will give additional information. It can be accessed through the following link: https://ambetter.pshpgeorgia.com/provider-resources.html.

The improper use of modifier 59 will probably result in the denial of a claim. You may need to file an appeal with medical records in order for the claim to be reconsidered. For example, do not use a modifier 59 when submitting for CPT code 98943. It is not required. Claims submitted with the modifier have been bundled by PSHP with the 98941 code and no additional benefits were allowed.

For additional Information on Ambetter, please visit their website:
https://ambetter.pshpgeorgia.com/provider-resources.html.

The Ambetter website offers easy access to Ambetter specific information, including:

• Provider Manual
• Prior Authorization Guidelines
• Prior Authorization tool - very easy to use

There are many options for submitting claims electronically. ActivHealthCare researched several clearinghouses before deciding to use Office Ally. We decided on Office Ally for four reasons:

1. Recommendation from a trusted source;
2. Low cost for our network Providers and us;
3. Technical knowledge and ability to meet our needs; and,
4. Providers can use Office Ally for almost all claims.

Office Ally did custom programming for ActivHealthCare, which allows claims to reach the insurance payer the same day it reaches us. Over the past several years, Office Ally has modified that programming to account for NPI verification which reduces claim rejections by payers. Last month, Office Ally programmed the Taxonomy Code to meet the Peach State Health Plan requirements.

If you are using any clearinghouse other than Office Ally, we are unable to accept your claims electronically. Other clearinghouses will not be able to run your claim through the special programming done by Office Ally and required by ActivHealthCare. They must be submitted on paper to us, which is much slower.

No, but if you use a clearinghouse other than Office Ally for your ActivHealthCare claims, you will need to submit paper claims to ActivHealthCare. Otherwise, the claims may be processed as out of network and denied.
Our website training at www.ActivHealthCare.com thoroughly covers how to format the address. If you have questions, call (770) 455-0040.

• If you submit claims on paper, be sure to review the training presentations to avoid unnecessary delays.
• If you use Office Ally, the format example in the "How do I submit claims?" FAQ for the correct Peach State Health Plan (Ambetter or Allwell" formatting.
• If you use a billing service, be sure they are properly trained. Most of the claim problems we see originate with billing services not knowing how to work with ActivHealthCare.

There are several reasons to join through ActivHealthCare, even if you already have a direct contract:

1. The Activ fee schedule is higher
2. Activ will be a voice and advocate for our members
3. If you are enrolled through Activ, we can help if you have any issues
4. Simplify your credentialing by only credentialing with Activ

Claims should be submitted through Office Ally, as stated in our EDI training at https://activhealthcare.com/network-resources/training/edi-references, with the following format:

For Ambetter, it would be as follows:

AHC01 Peach State Health Plan (Ambetter)
EDI Payer ID 68069
P.O. Box 5010
Farmington, MO 63640-5010

IMPORTANT BILLING INFORMATION - Taxonomy Code - Claims must be submitted with the Provider Taxonomy Code in box 24J. Please make sure it is loaded in your software. The code for Chiropractor is 111N00000X. Claims will be rejected if the Taxonomy Code is not included. Additional instructions and training presentations can be found on our website, www.ActivHealthCare.com, under Network Resources.

Benefits can be verified either by calling the number on the insurance ID card or by using Availity.com. We have tested Availity and it works. The deductible and copays are the main variables. All other benefits will be the same. Below are two examples of insurance ID cards. On the top card, there is a $5 co-pay for Specialist (Chiropractors). The deductible will not apply on exams, adjustments or modalities. It may apply on X-rays. On the bottom card, the deductible applies to everything. Notice the wording difference on the card. Once you verify coverage on one or two patients, it will become easy.

AHC website has two password protected areas:

1) Provider Portal – The Provider Portal has a User ID and Password for your office to use to retrieve EOB’s. You may need to call AHC to be reminded or set up a new password. User Id’s cannot be changed.
2) Credentialing Center – the Credentialing Center has a different User ID and Password for EACH provider in your office to store their personal Credentialing information. A User Id and password is set up upon original Credentialing and will be needed to access the account every 3 years for re-credentialing. You may need to call AHC to be reminded or set up a new password. User Id’s cannot be changed.

If you have Internet Explorer 10, you may have a problem viewing certain information. Some of the drop down menus may not work. You can easily resolve this issue by turning on you Compatibility View. You can turn it on or off through your tools or it may be located at the end of the address field at the top of your screen. See below. It looks like a piece of paper torn in half. Click on it to turn it on or off. If you still have a problem, give us a call.

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.

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.

Be sure to ask about co-pays, deductible, coinsurance percentages, effective dates, chiropractic benefits and the other information listed on your insurance verification form. If the claim is for an accident, be sure to let the carrier know at the point of insurance verification. Your goal in the verification process is to obtain an accurate estimate of what will be allowed and paid by the carrier and what financial responsibility the patient will have to you.

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.

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.

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.

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.

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.

The patient is not responsible for the portion of the claim that is denied due to PPO or network discounts. As a participating provider, you are agreeing to a fee schedule that is set by the PPO network and is approved by AHC. If your charge for a particular CPT code is over the fee schedule, the insurance carrier or claims administrator may deny a portion of your claim. You cannot bill the patient for the portion of the claim denied for this reason.

However, benefit plans often have limits on chiropractic care. Some plans limit the maximum benefit payable per visit, some limit the number of visits per benefit year and some limit both. You can bill the patient for claims that exceed the plan limits, up to the fee schedule amount for the services rendered. For example, if the services add up to $75 and the fee schedule for the services adds up to $58, the plan limit might be only $50 per visit. The patient is still responsible for the additional $8, if you choose to hold them responsible for it. Again, you should let the patient know in advance and in writing that they may be responsible for certain items and for services that exceed their plan limits. Our bulk pay remittance will distinguish between PPO or Network discounts and plan limits.

Some insurance plans require pre-certification of treatments, especially HMOs. You have an obligation to follow the rules of the patient's insurance plan. If you fail to obtain pre-certification and it is required, your claim might be denied. The patient and the plan will expect you to write off this type of denial. With that in mind, be sure to get clear answers to questions when verifying benefits.

And finally, some patients will change carriers and not notify you. They may provide you with the incorrect information. While you have an obligation to file claims in a timely manner, you cannot do so without the patient providing correct information. If the claim is denied because the patient did not provide accurate information, but you acted in good faith, you should balance bill the patient.

There are several results from claims not being sent to AHC. These include:

• Lower reimbursements
• Higher out of pocket expense for patients
• Frustrated providers and patients when they try to correct the claims
• Delayed reimbursements
• Increased cost
• Lower fee schedules will be proposed by network affiliates
• Opportunity for less provider friendly companies to secure contracts

To enroll, complete the enrollment paperwork.

Mail the original signed documents to:

ActivHealthCare, Inc
1926 Northlake Parkway, Suite 100
Tucker, GA 30084

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

For providers without billing software, Office Ally (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.

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.

Your claims will be converted to the required format by OA before they are sent to the payor. It is not necessary to upgrade or purchase new software.

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.

Most users send claims to OA as follows:
1. Create a claim file using your current billing software.
2. Log into www.officeally.com and click UPLOAD HCFA1500.
3. Click SELECT FILE.
4. Find your file and click OPEN.
5. Click UPLOAD.

Office Ally also supports FTP transfers and offers an online entry tool. They will walk you through this process step-by-step during your set-up appointment.

Review the list of Network Affiliates, or PPOs, found on this website. If the patient is covered by a benefit plan or carrier that uses one of the Network Affiliates, and the instructions on the corresponding Term Summary Sheet says to submit claims to AHC or I-AHC, then you should identify the claims to OA by placing the AHCØ1 (for AHC) or AHCØ2 (for I-AHC) prefix in front of the payer name on the CMS-1500.

We have included a list of the network logos on our website to help. If you see one of these logos on an identification card, then the claim should be submitted with AHCØ1 (AHC) or AHCØ2 (I-AHC) in front of the payer name at the top of the CMS-1500.

This step is critical. If it is not done properly at the provider office level, there may be numerous payment errors or delays in payment to your office.

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.

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

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

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.

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.

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.

Office Ally does accept the HIPAA compliant ANSI 837 format. However, if your software does not produce this format, text files, print-image files and NSF format files are also accepted.

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.

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.

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.

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

An examination and review of the credentials of individuals meeting a set of educational or occupational criteria and therefore being licensed in their field. Strict credentialing is required by both hospital and managed care accreditation bodies. The process is conducted periodically because of the responsibility of the organization for any claims of malpractice by its staff. Credentialing is done on a 3 year cycle. Re-Credentialing must be completed before the 3rd year anniversary in order to stay compliant.

ActivHealthCare is a delegated credentialing network which is contracted with multiple insurance Networks. By credentialing with AHC, you will have access to various networks through a single source. Some of our clients do not accept providers unless they are credentialed by AHC. In other cases, you may find the AHC fee schedule more favorable than what you can get through a direct contract with our Network Affiliates.

AHC is required to follow NCQA and URAC standards for credentialing providers. Each Provider is individually credentialed.

The Credentialing Board meets monthly. We request that all paperwork be to AHC by the 1st of the anniversary month. Once the completed paper work has been received by AHC, it takes 30 days to be credentialed and approved by the Credentialing Committee. Once approved, AHC will send you an acceptance letter and forward pertinent information to our network affiliates. It takes up to 90 days for the network affiliates to add you to the participation provider rosters of their contracted claims payors.

In order to ease the credentialing process AHC has created an on-line credentialing center. We have taken the State Credentialing Application and have removed any questions that do not pertain to the Chiropractic profession. We have also removed the need to duplicate information in the forms, such as writing your name and address multiple times.

Once you create an online credentialing account at the AHC website, you can re-credential every 3 years by updating this original application. This is for Credentialing purposes only. Do not use to update your information between credentialing cycles.

The Provider Agreement is AHC contract that needs to be signed by the provider. Please do not fill in the effective date, as that date will be when the Board meets and agrees accept your Credentialing/Re-Credentialing application.

The Business Associate Agreement or BAA is required by HIPAA, the Health Insurance Portability and Accountability Act. The primary focus of this agreement is to stress the importance of confidentiality as it pertains to Protected Health Information or PHI. The Business Associate Agreement is not referring to you having a business partner and has nothing to do with your business.

The providers needs to sign the last page but not fill in the effective date as that will be when the Board meets and agrees to accept your Credentialing/Re-Credentialing application.

1) Complete the online credentialing application. Go to ActivHealthCare.com and select Credentialing then your state and then select Create an Account – if you already have an account see Re-Credentialing.

2) W-9 - This form can be downloaded from Credentialing or Forms on AHC website. Please complete the W-9 with the information that the IRS has listed with the Tax ID number you will be filing your claims under. This may be your company name and TIN or it may be your individual name and your S.S. number.

3) Release Authorization – this document is signing that everything that you stated on the online application is correct and accurate.

4) Provider Agreement – this document is ActivHealthCare’s contract

5) Network Option Form – This document is required to select whether you wish to enter AHC contract with each network listed. Select Opt In or Opt Out for each network.

6) Ambetter Option Form – The form is required to join Ambetter.

7) EFT (Electronic Funds Transfer) – This document is required to directly deposit checks from AHC to your back account.

8) Certificate of Malpractice Insurance – One page showing your Name, Coverage Amounts (minimum coverage is 1M/3M) and expiration date. Adding AHC as a certificate holder will prevent your office from having to update this annually.

ActivHealthCare will Primary Source your license, so there is no need to send a copy in annually.

AHC must have verification insurance is current. The simplest way to do this is as follows:

Insurance – Add AHC as a certificate holder to your malpractice and liability insurance policies. The carrier will then automatically update AHC when your coverage changes or renews.

Re-Credentialing for Chiropractors is every 3 years from the anniversary date of starting with AHC. You will be notified in writing about 3-6 months prior to your anniversary date, so we have ample time to get all the paperwork, verifications, and medical review and then present you to the AHC Credentialing Board for approval. This all needs to be done before your membership expires or you will need to start the Credentialing process at the beginning.

The NPI is the standard unique health identifier for health care providers. The NPI was mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Providers may request an NPI electronically at the following site: https://nppes.cms.hhs.gov/.

Please note that electronic applications allow providers to supply and identify current proprietary identifiers of multiple payors. As many providers provide service to insureds covered by multiple related payors such as multiple state Medicaid’s it is important to associate each proprietary identifier with an individual state.

Individuals identified in any covered electronic healthcare transaction must obtain an NPI that remains associated with the individual for life. All healthcare providers, defined under the regulation as providers who access claims information or benefits via the Internet are also covered entities.

The broad definition of healthcare "provider" provided in the regulation encompasses all who provide healthcare services: individuals (including physicians and all other practitioners) as well as organizations (such as hospitals, pharmacies, clinics and medical supply companies).

Legal entities must obtain at least one NPI. The organization may obtain additional NPI’s through enumeration of subparts.

Yes. If you have a practice association (PA) or a limited liability corporation (LLC), and it holds any contracts with payers, or if payment is ever made to the PA or LLC, or in the name of the PA or LLC, then it needs to acquire a Type 2 NPI in addition to your individual Type 1 NPI.

Even if the practice association is an S corporation or a "disregarded entity" (i.e., tax return can be filed in the physician's name), the above applies. From an NPI perspective, an S corporation is no different from a limited liability corporation or any other type of corporation; if the PA receives payments, it must have its own Type 2 NPI.

The number (NPI) is 10 positions (9 plus the check-digit) all numeric.

The NPI does not convey information about the provider. Accordingly, providers do not have to change NPI when they change geographical locations or change their type of entity.

• Inclusive information on the NPI is available from CMS at http://www.cms.hhs.gov/NationalProvIdentStand or you may call The CMS HIPAA hot line at 1-800-465-3203.

• CMS NPI Viewlet provides an overview of the NPI, a walkthrough of the NPI application process and a live link to the NPPES website. The Viewlet is available under the above website. Just look under Educational Resources.

• Medicaid will post information regularly at http://www.emedny.org and share information in the Medicaid Update publication.

• Additional questions should be referred to the CSC call center at 800-343-9000.

Providers can obtain an authorization form from their ActivHealthCare customer service representative or download a form from our website ActivHealthcare.com. It is located in the Forms section (from the left menu) of the website.

The form must be completed, uploaded to the Provider Portal or faxed to (678) 736-8186. Note, the request form will ask for you to designate if the deposit will be made into a checking account or savings account. Please be sure to double check and make sure your have put the correct bank routing and account numbers on the form.

Electronic Funds Transfer (EFT) provides for electronic payments and collections. EFT is safe, secure, efficient, and less expensive than paper check payments and collections

All contracted ActivHealthCare in-network providers are eligible.

Providers receive claim payments faster and the payments are directly & securely deposited into the provider’s bank account.

Providers may contact their Customer Service Representative or may email your question to info@ActivHealthCare.com or you may use the contact us area of our website.

It will take approximately 30 days after ActivHealthCare receives the authorization form until the EFT service is operational. The provider must go through a pre-notification process with the bank to test that the setup is accurate.

An EFT draft will be produced and will be available via our Provider Portal, which can be accessed from our website.

A deposit transaction will appear on the monthly bank statement for each separate transaction.

ActivHealthCare cannot retrieve funds from a provider’s bank account, except for an EFT reversal. To ensure that funds cannot be retrieved, the provider can contact their bank and request that a debit block be put on their bank account. However, EFT deposits can be reversed if the reversal is requested within 5 business days. This is only done in extreme limited situations, and only if the EFT transaction is found to be incorrect. The reversal can only be for the amount of the original EFT transaction.

Each provider can only select one account into which to have payments deposited.

Yes and No, ActivHealthCare does not charge the provider for the EFT service, but the provider may be charged a small transaction fee by their bank. On the EFT provider authorization form, each provider is advised to verify with their bank any banking service fees that may be incurred.

Paper checks will be issued until the EFT setup and testing are completed.

Yes.

The provider must give a written 30-day notice of any changes to the EFT service. If there is a change, please complete a new EFT form and fax it to (678)736-8186. Please indicate the form is changing information by writing a note on the fax cover sheet or margin of the form that you are changing information on the form.

This is a great question. It should be easy to answer, but it is not. Every benefit plan is different. Some have chiropractic benefits, some do not. Some plans have a limit on the number of visits, some limit the amount paid or allowed per visit, and some limit both.

To get an accurate answer to this question, you should do two things:

Consult your Plan Summary Description or Benefit Plan Booklet. Read it carefully, paying close attention to what is not covered under the Plan Exclusions. In many cases, these booklets are just summaries. If they are complete they are often difficult to understand, even if you work within the insurance industry.

Call the customer service or insurance verification phone number located on your insurance identification card. Do not rely on a co-worker or supervisor for answers on this issue. They may be wrong. Ask the company administering the benefits. Be sure to tell them your problem and, if an accidental injury, how it happened. Benefits often vary depending on the reason for the treatment.

You want to clarify your financial responsibility. Ask about deductibles, co-pays, in-network benefits, and plan limitations. Obtaining this information before incurring treatment will help you avoid frustration later.

When you show up for treatment or schedule an appointment, the chiropractor's office will usually verify this information also. You can ask them questions to make sure you have the same answers.

This generally is not a problem, but you should make sure your benefit plan does not have any special rules regarding changing doctors. You can do this by calling the customer service number on your insurance identification card.

There are some things to consider when making a change:

• Changing chiropractors does not mean your benefits for the year start over. Be sure to let the new chiropractor know that you were treated by another doctor. This will help them to accurately determine your financial obligation.
  
  
• Ask your previous chiropractor to provide your new chiropractor with a copy of your medical records and x-rays. This can save you money and help the new chiropractor treat you more effectively.
  
  
• Be sure to clarify the effect of the change on your benefits. Your insurance carrier can advise you of this information.

You can use our online provider locator to help you select a new chiropractor.

Yes, most of the time. It is very rare for a benefit plan to pay for everything. The network chiropractor provider is agreeing to accept the network fee schedule, but you are still responsible for deductibles, co-pays, claims that exceed the plan limits and services that are specifically excluded by your plan. Also, if you provide incorrect insurance information to the provider, the entire claim may be your responsibility.

It is best to determine your financial obligation up front. The chiropractor's office assistant will be happy to help you with this question.

Unfortunately, this sometimes happens. There are many reasons for it. If that happens, you can use our online provider locator function to locate a new chiropractor.

There are many ways to do this. Our job at ActivHealthCare is to provide a network of qualified chiropractic providers. Although we cannot guarantee the specific outcome of your treatment (no one can), we do require that every provider in our network meet stringent credentialing guidelines.

Having said that let me give you a more practical answer. Our website includes a Provider Locator function. You can search by zip code to find a provider near your home or work.

Although we offer one of the largest networks in the state, we are not able to accept every chiropractor. If your chiropractor is not a member of ActivHealthCare, and you do not see a member chiropractor on our provider locater nearby, there are a couple of things you can do.

1. You can let your chiropractor know that he is not on your insurance PPO list. Mention ActivHealthCare to him and ask him to contact us about membership.
   
   
2. You can contact ActivHealthCare and ask us about contacting your chiropractor. If we do not have one in your area, we certainly want to enroll one. We will contact the chiropractor to determine their interest and eligibility.

Unfortunately, sometimes people have complaints about medical services. The problems can take many forms. They may be related to customer service, insurance issues, chiropractic office issues or treatment issues.

No matter what the issue, we encourage you to first address it with your chiropractor. In most cases, once you have brought the problem to your chiropractor it will be resolved.

In very rare situations, you may feel the need for additional help. If the problem cannot be resolved between you and your chiropractor, please contact us at ActivHealthCare and we will try to help. We will do everything we can to work out a resolution or point you in the right direction.