Frequently Asked Questions - Providers - General

Please refer to the credentialing information or contact our office at (770) 455-0040. You may also contact us and request information. We will answer your questions and send you marketing information and the necessary forms for joining the network.

There are many advantages to being an AHC or I-AHC member. Some of these include:

  • We are currently credentialing for over 30 Network Affiliates. This gives our network members access to about several million covered lives in the Southeast. You will only have to credential and pay one network, not 30.
  • We handle the credentialing audits for you. This means we are interrupted by the network auditors, not you.
  • We carefully reviews the contract terms. We then summarize the key points for you and put them into a one page Term Summary Sheet format.
  • We find the best fee schedules for you.
  • We are a resource to get answers about insurance issues and managed care. You can visit our website for the Frequently Asked Questions and resources or you can contact our office. Either way, we are here to help.

AHC 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. MultiPlan, PHCS, First Health, and Coventry. We refer to these networks as our Network Affiliates. AHC works to obtain favorable fee schedules and contract terms. AHC is currently marketing to networks throughout the Southeast.

AHC credentials individual chiropractors on behalf of our network affiliates. This allows the provider to credential only one time and have the benefits of multiple networks. Also, if an individual chiropractor has a problem with one of our network affiliates, or vice a versa, AHC is there to serve as an intermediary to explain and resolve the issue.

These companies build a large group of preferred providers and sell the rights to access the providers to insurance carriers, third party administrators, and employee benefit plan administrators. The plan participants (or patients) of the employee benefit plans that are using these contracted networks refer to the PPO directory or provider list when they need to select a participating provider. If you are a member of AHC, your name is listed in the directory. In other words, you get more patients.

By submitting claims through AHC you will receive in-network benefits. In most cases, this means lower deductibles and higher claims reimbursements. AHC is not a billing service, but we provide a centralized billing service for your paper claims. You can contact us for claims status on numerous patients at one time as opposed to making several phone calls to multiple companies. We will communicate to you the information we receive from the carriers. 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 AHC and its network affiliates. The term summary sheets are actually a part of your Provider Agreement. As new contracts are acquired, a new term summary sheet is sent to you.

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 AHC'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

A fee schedule is one of the primary points of a contract with a PPO network. The network will establish a fee schedule. It may be a fixed amount, i.e. $32 for a code 98940, or it may be based upon another schedule, i.e. a percentage of Medicare fee schedule. Each contract is different and there is a wide range of fee schedules.

Yes, there is a small administrative or access fee. We are offering you access to network plan participants through your affiliation with us. These fees are usually offset by higher claims reimbursements because of the increased in-network benefits.

Yes, a provider can refuse to accept a network affiliate. Notification must be received within 30 days of the date the term summary sheet is presented to the provider. If there is a change in the way one of our network affiliates does business or if there is an addendum to a contract, we will also allow for a provider to opt out of that network at that time.

AHC does not restrict providers from joining other networks. But there several points to consider. The large number of competitive networks is a driving force in lowering fee schedule. By supporting other networks, you are limiting AHC's ability to obtain fee schedules on your behalf. A network only exists because you join it. If AHC was the exclusive network for chiropractic, our ability to secure contracts on your behalf would greatly increase and many more carriers and clients would turn to us for access to you.

If you must join other networks, be careful in deciding which you join. We frequently hear providers complain about low reimbursements or excessive utilization review from other networks. These networks have the contracts they have only because providers join them and support them. Sometimes these networks offer lower fee schedules than those already contracted with AHC. Remember, you will be reimbursed at the lowest fee schedule. Pay close attention to the AHC list of network affiliates. This will help you avoid joining duplicate networks.

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