EDI Claims Processing

There are different ways to file claims depending on the situation. If the instructions below do not answer your questions, please view our frequently asked questions or contact us.

Claims Submission Instructions:

For successful EDI processing, you need to complete the Form 1500 accurately. Please review the How to File Claims to be sure you have complied with the EDI and AHC requirements. There are four different types of claims processing you need to understand that affect your AHC claims. Below are instructions for all four types of claims processing.

  1. Instructions for AHC in-network claim submission. If you are not sure which claims should be processed as in-network claims, view the network affiliations. If a payor appears on the network affiliations, then their claims should be filed according to these instructions.

  2. Claims that are not included in the network affilations list may still be filed electronically.