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.
	Medicare Part B Provider Application for NC This form must be completed to electronically file Medicare claims through Office Ally. This completed form should be mailed directly to Office Ally.
	Blue Cross Blue Shield of North Carolina This form must be completed to electronically file BCBS of NC claims through Office Ally. Fax the completed form directly to BCBS at the number on the top of the form.
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 Enrollment Instructions
	Tennessee Medicare Part B Provider Application for EDI This form must be completed to electronically file Medicare claims through Office Ally. You do not need to complete this form if you will not be processing Medicare claims.
	Tennessee Blue Cross Blue Shield Pre-Enrollment Form