How to File an I-AHC Claim

One of the most critical functions in a provider’s office is insurance claims submission. Integrated-ActivHealthCare (I-AHC ) understands the importance of this task and is here to assist you in the claims submission process. One of the first tools you will need is the I-AHC Network Affiliates sheet. This sheet provides you with a list of I-AHC ’s network affiliations and the network logos which may be on the patient’s insurance identification card. Also, the network affiliate sheet is divided into two categories. The bottom portion of the network affiliate sheet is a list of clients to which you would send claims directly to the payor listed on the insurance identification card. The top portion of the network affiliate sheet is a list of clients which should be sent directly to (through) I-AHC . This instruction page is addressing the claims for network affiliates on the top portion of the sheet.

Most insurance claims can be submitted electronically through Office Ally. It is important that you keep up to date with the latest version of the Office Ally Payer List which can be found at www.OfficeAlly.com. Also, be sure to complete both, the Office Ally training and the I-AHC training so you can properly utilize the tools available and follow the proper billing procedures and format.

For a few insurance payors, it is necessary to submit the claims for your patients’ services on paper and through U.S. mail. To facilitate those claims, mail them directly to I-AHC and provide I-AHC with the insurance address from the patient’s insurance identification card on the top portion of the CMS1500 form. (See step 3 below.) By doing this, I-AHC will know where to forward the claim.

The steps for claims submission are as follows:

Step 1 - Verify patient’s insurance coverage through insurance payor. Be sure to verify the PPO network, claims submittal address and patient’s benefits

Step 2 - Using your practice management software, thoroughly complete the Health Insurance Claim Form. This is referred to as a CMS-1500. Be sure to pay attention to the requested information. The following boxes are often completed incorrectly on the CMS-1500:

1a.     Insured’s ID Number
4. Insured’s Name
8. Full-Time Student (if appropriate & child is 18 or over)
9a-d. Other insurance information (if applicable)
10a-c. Patient’s Condition Related To: (extremely important)
11. Insured’s Policy Group or FECA # (see ID card)
11a. Insured’s date of birth & sex
11b. Employer Name (see ID card)
11c. Insurance Plan Name (list PPO network name) (Obtain from the ID card)
14. Date of Current Illness or Injury
31. Provider’s name (this should be a signature)
32. Name & Address of Facility (put office address here)
33. Physician’s Suppliers Billing Name (we will replace your information in this field with the I-AHC information)

The list above in not comprehensive, but these are the fields that are often left blank or completed incorrectly. Please be sure to become familiar with the form and the process your office follows for completing it. If the form is not completed it will either slow down the claims process or result in the claim being denied by the insurance payor.

Step 3 - The upper right hand corner (above box 1a.) of the CMS-1500 form has a blank space. Many providers use this place to print the name and address of the insurance payor. If the claim is sent to I-AHC for processing, some providers will place our name and address in this field. Although that helps you know to send the claim to I-AHC, it does not help I-AHC know where to send the claim for payment.

For Electronic and Paper claims - Obtain the insurance payor’s information from the insurance identification card. In order to identify the name and the address of the ultimate insurance payor and route the claim to the correct address, we request that you complete this field in the following format:
  AHCØ2 Insurance Payor's Name
  Insurance Payor's Street Address or P.O. Box
  Insurance Payor's City, State & Zip Code

Electronic Claims - In most cases, the claims can be submitted electronically through Office Ally. The above format is necessary for electronic claims submission. Office Ally looks for the AHCØ2 prefix in the specific format as shown above. When it is there, a copy of the claim is sent to I-AHC . Also, the claims is submitted as an in-network claim. If the prefix is missing or in an incorrect format, the claim will probably not be processed correctly.

Paper Claims - By placing the AHCØ2 prefix in FRONT of the insurance payor’s name, you will know to send the claim to the I-AHC office. This format will expedite the processing of your claims by providing I-AHC with the Payor’s address on the CMS-1500. View the Example. Remember, we get the insurance payor’s information from you. By working together, we can recover every benefit dollar possible.

If we do not know the billing address of the insurance claims payor or the name of the PPO network (box 11c), we will have to send the claim back requesting a copy of the insurance ID card from you.

Step 4 - Send the claim to the I-AHC office. I-AHC processes some claims in house, but most claims must be sent to a third party for processing. If the claim form is completed properly, I-AHC will send your claim to the appropriate insurance payor within 24 hours after receiving the claim. We will also enter or log the claim into our centralized billing system.

Step 5 - In most cases the insurance claims payor will process the claim and send I-AHC an explanation of benefits within 30 days. We will promptly process the claim through our system and issue a bulk pay remittance to you summarizing all claims processed for your office during the week.

Step 6 - In some cases, the carrier may not process a claim promptly. If the carrier needs additional information, they may respond to you directly or to I-AHC. If they request the information from I-AHC, we will relay that request to you.

It is the responsibility of each individual provider’s office to follow-up on claim status. I-AHC is not a billing service. If you do not receive a response from a claim within a reasonable time period, please contact the payor to determine the status. You may also review your list of outstanding claims on the I-AHC Customer Service Center, but it only shows you if I-AHC received the claim. It does not confirm that the payor received the claim. Office Ally provides tools to monitor claim receipt by the payor.

If you verify the claim has not been received by the payor, please do the following:

  • Verify that you submitted the claim properly. It should have the correct payor address and format. If you find you did not submit it properly, please resubmit. If it is less than 90 days, be sure to turn off the duplicate filter setting on the Office Ally website so the claim can go through.

  • Check your Office Ally reports to verify that you received a message confirming the payor received and accepted the claim. If you did not receive this confirmation, you need to contact Office Ally to find out why you did not receive it or you may need to correct something on the claim.

  • If there is not a problem with the submission address or Office Ally, please contact I-AHC and we will assist you to determine why the claim has not been processed. See the “Contact Us” page easy contact instructions.