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.

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 Activ'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

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.

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.

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

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

• We credential for multiple Network Affiliates which gives our members access to hundreds of thousands of covered lives in the Southeast. You will only have to credential one time to have access to multiple insurance payers.
  

• We handle credentialing audits for you. This means we are interrupted by the network auditors, not you.
  

• We carefully review the contract terms. We then summarize the key points for you and put them into a one-page Term Summary Sheet format.
  

• As a large group, we can secure the best fee schedules possible.
  

• We can complete the credentialing process much quicker than many of the insurance companies. This allows you faster access to patients.
  

• We are a resource to get answers about insurance issues and managed care. You can visit our website for Frequently Asked Questions and resources, or you can contact our office. Either way, we are here to help.
  

• Most importantly, as a large group we can work as your advocate and represent our providers to the insurance payors.

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.

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.