Frequently Asked Questions

By submitting claims through Activ you will receive in-network benefits. In most cases, this means lower deductibles and higher claims reimbursements. Activ is not a billing service, but the contracts we execute with our Network Affiliates are Group Provider Agreements. In most cases, the contracts are completed under a single Tax Identification Number (TIN). This requires the claims to be submitted as instructed by Activ in the How to File Claims documents. The payors will generally issue a bulk payment to Activ. Once we receive the remittance advice from the payors, 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.

Activ 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. Ambetter, MultiPlan, PHCS, First Health and others. We refer to these networks as our Network Affiliates. Activ works to obtain favorable fee schedules and contract terms.

Activ credentials individual chiropractors on behalf of our network affiliates. This allows a provider to credential one time and have the benefit of multiple networks. Also, if an individual chiropractor has a problem with one of our network affiliates, Activ is here to serve as an intermediary to explain and resolve the issue.

Activ has successfully represented its providers to challenge claim denials, reduce utilization management burdens, increase chiropractic reimbursements, and implement chiropractic benefits into insurance plans. We are your voice in the managed care arena and work to support our members.

Our Network Affiliates are comprised of insurance companies and PPO networks. They build a large group of preferred providers for their PPO directory. The plan participants (or patients) of the insurance companies or employee benefit plans are referred to the PPO directory or provider list when they need to select a participating provider. If you are a member of Activ, your name is listed in the directory. In other words, your name will be put in front of people seeking care from an in-network provider.

There are many advantages to being an Activ member. Some of these include:

A term summary sheet is the summarization of the key points to a contract between Activ and its network affiliates. The term summary sheets are a part of your Provider Agreement. As new contracts are acquired, a new term summary sheet is posted on our Provider Portal for you to access.

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

No, there is no cost to credential. However, there is a small administrative or access fee that is charged on claims for which a payment is issued. This fee is generally built into the fee schedules offered to us by the payor for providing the network. In some cases, the fee schedules are increased by much more than the administrative fee. We are offering you access to network plan participants through your affiliation with us. If there is no payment by the insurance payor on a claim, there is no fee.

Yes, a provider will be given the option to opt-in or opt-out of participation with network affiliates during the credentialing process by completing a Network Option Form. You may also update your selections if you wish to do so. We will update your selections during our monthly credentialing updates notification we send to our network affiliates. Most clients will remove you within about 60 days, but some may take up to 180 days to remove you from a network. If Activ contracts with a new network Affiliate, we will notify our member providers and allow them the opportunity to opt out of the new agreement. If we do not receive an updated Network Option Form, the provider will be placed into the new contract directory.

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

You should only submit the claims for patients affiliated with the Activ contracted networks, our Network Affiliates. Most of our contracts require you to submit the claims through Activ. Some of the contracts may provide for direct billing from you to the payor. Those contracts are identified on our list of current Network Affiliates.

There are three ways to verify benefits:

1. You can 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 Activ's tax identification number. Calling is time consuming, but, in most cases, you can ask questions. Please remember that information obtained over the phone is not binding.

2. For many payors, you can verify eligibility through Availity or maybe your clearinghouse. This is quick, but you will receive limited information.

3. The most efficient way to verify eligibility is generally through a payor’s website or portal. This is especially true for Ambetter. For Ambetter you can download the Summary of Benefits and verify the most current eligibility. Since we have a group contract you may need to use our TIN when you enroll for access to their Portal. You can contact us for assistance.

Please refer to Activ’s How to File Claims instructions and the Network Affiliates sheet.

The employer or insurance carrier will identify the PPO which the patients should use by placing either the name or logo of the network 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. You will need to be familiar with or refer to our list of Network Affiliates, which can be found on our website.

No, they probably will not. Remember, we contract with the carrier, PPO, HMO or MCO network. We deal with the contracting department, not the Provider Relations or Customer Relations departments who will take calls. They will simply look you up by NPI or TIN. That is why it is important for you to provide the Activ TIN when you are calling a payor. They see us as a group of providers under one Tax ID number. A group like First Health Network or PCHS deals with hundreds of different payors and thousands of employer groups. They furnish the payors with your information with the Activ TIN. However, if we tell you to submit the bill directly to a payor, like we do for Prime Health, they will have your TIN.

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 Activ. As such, you are recognized by the Activ tax identification number and billing address. But you are also found by your individual NPI and Practice address.

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.

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.

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, then you should identify the claims to OA by placing the AHCØ1 (for AHC) prefix in front of the payer name on the Form 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) in front of the payer name at the top of the Form 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 (OA). This includes AHC payors, Medicare, and other claims that would not involve 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.

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.

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

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.

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.

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.

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.

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.

Although we offer a large network, 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.