EDI Enrollment for I-AHC

To enroll in EDI, download and complete the paperwork below. Complete the three required documents and mail them to:

Attn: EDI
Integrated-ActivHealthCare, LLC
1926 Northlake Parkway, Suite 100
Tucker, GA 30084

Required enrollment documents

Do not send these three required enrollment forms to Office Ally.Send them directly to Integrated-ActivHealthCare. Your claims will not be processed properly unless your enrollment paperwork is processed by Integrated-ActivHealthCare first. This does not apply to the optional enrollment documents.
I-AHC EDI Provider Agreement Addendum
Additional document required with the Agreement.
Office Ally Enrollment Form
The enrollment form required for set-up for electronic claims processing.
Office Ally Business Associate Agreement

Optional Enrollment Documents:

AHC provides Medicare enrollment forms on the website for your convenience. You may download the documents and mail them as specified on the individual applications. AHC is not involved with the processing of Medicare, Medicaid, BCBS, or other non-I-AHC claims. DO NOT MAIL THESE OPTIONAL FORMS TO INTEGRATED-ACTIVHEALTHCARE.


North Carolina

North Carolina Medicare Instructions
North Carolina Medicare Customer Profile
North Carolina Medicare Enrollment Form
North Carolina Blue Cross Blue


South Carolina

South Carolina Medicare Enrollment Form


Tennessee

Tennessee Medicare Enrollment Form Part A
Tennessee Medicare Enrollment Form Part B
Tennessee Blue Cross Blue Shield Enrollment Form