EDI Enrollment

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

Attn: EDI
Integrated-ActivHealthCare
P. O. Box 969
Lilburn, GA 30048

Adobe Acrobat Reader
	Download Adobe Acrobat Reader Adobe Acrobat or Adobe Acrobat Reader is required to open the .PDF files listed below.
Required enrollment documents
SEND THESE THREE REQUIRED ENROLLMENT FORMS DIRECTLY TO INTEGRATED-ACTIVHEALTHCARE. DO NOT SEND THEM TO OFFICE ALLY. 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 EDI Business Agreeemnt Agreement between the Provider and Office Ally to provide electronic claims processing.
	Office Ally Enrollment Form The enrollment form required for set-up for electronic claims processing.
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 Medicare Instructions
	North Carolina Medicare Customer Profile
	North Carolina Medicare Enrollment Form
	North Carolina Blue Cross Blue
South Carolina Medicare and BCBS are currently in the testing phase. Enrollment documents will be placed on the website when they become available.
	Tennessee Medicare Instructions
	Tennessee Medicare Customer Profile
	Tennessee Medicare Enrollment Form
	Tennessee Blue Cross Blue Shield Enrollment Form
For more information on Medicare forms, please visit http://www.cignagovernmentservices.com/partb/forms/index.html.