Frequently Asked Questions - Providers/CA - EDI

To enroll, complete the enrollment paperwork.

Mail the original signed documents to:

    ActivHealthCare, Inc
    1926 Northlake Parkway, Suite 100
    Tucker, GA 30084

Please allow up to 30 days for us to process your enrollment. Once we submit the enrollment form to OA, OA will email a user name and password for uploading claim files. An OA enrollment specialist will contact you to set up an appointment with one of their technical staff for training

For providers without billing software, Office Ally (OA) offers a free, online entry tool. This tool allows you access to a blank, electronic HCFA on the OA website. You type data into it the same way you would a paper HCFA. Additionally, this tool allows you to store patient, facility and provider information so you do not have to re-type the same information over and over.

No, the Office Ally website will interface with all practice management software packages. All you need is Internet access. The OA technicians will assist and train your office staff on set-up and the use of the Office Ally tools.

OA's ability to accept a print-image file means that we are compatible with nearly every practice management system. Essentially, if your software allows you to print claims in your office, you can send claims to Office Ally.

Your claims will be converted to the required format by OA before they are sent to the payor. It is not necessary to upgrade or purchase new software.

By enrolling with Office Ally, you are automatically set-up to send to all payers on the OA Payer List except those with asterisks next to their name. Those payers require you to go through a pre-enrollment process before we can send your claims electronically to them.

Most users send claims to OA as follows:
1. Create a claim file using your current billing software.
2. Log into and click UPLOAD HCFA1500.
4. Find your file and click OPEN.
5. Click UPLOAD.

Office Ally also supports FTP transfers and offers an online entry tool. They will walk you through this process step-by-step during your set-up appointment.

Review the list of Network Affiliates, or PPOs, found on this website. If the patient is covered by a benefit plan or carrier that uses one of the Network Affiliates, and the instructions on the corresponding Term Summary Sheet says to submit claims to AHC or I-AHC, then you should identify the claims to OA by placing the AHCØ1 (for AHC) or AHCØ2 (for I-AHC) prefix in front of the payer name on the CMS-1500.

We have included a list of the network logos on our website to help. If you see one of these logos on an identification card, then the claim should be submitted with AHCØ1 (AHC) or AHCØ2 (I-AHC) in front of the payer name at the top of the CMS-1500.

This step is critical. If it is not done properly at the provider office level, there may be numerous payment errors or delays in payment to your office.

Call the customer support team for OA at (949) 464-9129 or send an e-mail to Customer service or technical support is available 24 hours a day, 7 days a week, at no additional charge.

You may submit all of your medical claims through Office Ally. This includes AHC payors, I-AHC payors, Medicare, and other claims that would not involve AHC or I-AHC. AHC is NOT responsible for your relationship with Office Ally and the processing of Medicare, BCBS, Medicaid, and other out-of-network claims. You should contact OA with any questions regarding non-AHC claims.

If there are no processing delays, a typical claim may be paid as early as 10 business days.

You must notify AHC so that we may contact OA to indicate AHC on your enrollment. This is important so your AHC claims are not processed out-of-network. You will also need to submit a check for the set-up fee along with the two AHC enrollment forms.

You are welcome to file Medicare claims through Office Ally, but it is not required. AHC is NOT responsible for your relationship with Office Ally and the processing of Medicare, BCBS, Medicaid, and other non-AHC claims. You should contact OA with any questions regarding non-AHC claims.

Office Ally offers many features including tools for tracking claims, running reports based on your own specifications, checking eligibility, verifying codes (ICD9, CPT, POS, Modifiers), fixing claims right on the website, entering claims online, and sending attachments electronically. OA continually adds new features and upgrades existing services to meet your EDI needs.

Office Ally does accept the HIPAA compliant ANSI 837 format. However, if your software does not produce this format, text files, print-image files and NSF format files are also accepted.

Yes, OA is certified HIPAA compliant. The Trading Partner's Agreement details the HIPAA policies and procedures that are followed to protect your private health information as well the security measures used in the computer systems to ensure privacy.

No, the law allows providers to submit in a non-HIPAA compliant format to a clearinghouse. The clearinghouse must convert the claims into the 837 HIPAA compliant format prior to transmission to the insurance company or claims payer. It is against the law for a provider to submit directly to an insurance company in a non-compliant format.

To get started on the pre-enrollment for those payers who require pre-enrollment, when you are filling out the OA Enrollment Form, list any of the listed payers that you would like to pre-enroll for. OA will start the pre-enrollment process for the companies you've selected and get any necessary paperwork to you. There is no cost for pre-enrollment.

Pre-enrollment for most commercial payers is usually complete within one week. Pre-enrollment for Medicare and CHAMPUS varies from 1 to 6 weeks.