EDI Enrollment

To enroll in EDI, complete the steps below by clicking on the underlined form name.

    Step 3: Complete the optional Medicare documents below if you wish to include Medicare in
      your Office Ally processing.
Your claims will not be processed properly unless your enrollment paperwork is faxed directly to ActivHealthCare. This does not apply to the optional Medicare enrollment documents.


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 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 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

South Carolina Medicare Part B Enrollment Form
South Carolina Medicaid Enrollment Form


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.
Tennessee Blue Cross Blue Shield Pre-Enrollment Form