Frequently Asked Questions

In some cases, you may have a direct contract relationship with a network affiliate of I-AHC. If that occurs, we would prefer for you to file as instructed by I-AHC because it will strengthen our network and our ability to negotiate on your behalf. In a few cases, I-AHC may bring a higher fee schedule to you.

However, there may be a situation where you may have received a higher fee schedule several years ago than I-AHC is able to get today. If that is the case, and you feel strongly that filing that contract will have a negative impact on your practice, then you may opt out of that network affiliate contract within 30 days of the date we present the term summary sheet. By opting out, I-AHC will not list you as a provider with that particular network affiliate. To opt out, you must notify I-AHC in writing. Please state the reason for opting out.

Please be advised, that in some cases, our network affiliates may discontinue their direct contracts once they contract with I-AHC. That is their decision. If that is the case and you have opted out of a network affiliate relationship, you may be out of a network at in inopportune time. Also, by opting out of network affiliates you are basically competing with I-AHC and weakening our ability to negotiate fee schedules. If a network does not have a need for providers they tend to lower fee schedules. It is best for chiropractic that we are in as strong of a negotiating position as possible. For that reason, we encourage you to participate in all of our network affiliate relationships.

No, not unless you have a direct contract with the PPO, HMO or MCO. You are listed as a PPO, HMO or MCO participating provider through your affiliation with I-AHC. As such, you are recognized by the I-AHC tax identification number and billing address.

To change your address, it is necessary to complete the Provider Information Form, Location Information Form, and a W-9 form. The forms are also available in the credentialing documents

You may fax the completed forms to 770-455-6188 or mail to:

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

I-AHC offers an EDI solution for claims filing. I-AHC has partnered with a clearinghouse to work out an EDI solution that can be used for all claims, not just those filed though I-AHC. And best of all, in most cases there will be no additional cost for using I-AHC's EDI solution. If you are interested in a cost effective EDI solution, please go to network resources or contact us.

I-AHC has contracted with numerous networks throughout the Southeast. More than 20 contracts are currently in place. These networks are often referred to as managed care organizations (MCOs), preferred provider organizations (PPOs) or health maintenance organizations (HMOs). For a complete list, refer to our network affiliations.

In most cases, claims should be sent directly to I-AHC. In a few cases, the claims would be sent to the address on the insurance card. This is determined during the contracting process and specified on the term summary sheets.
I-AHC distributes a list of network affiliates with claims filing instructions several times a year. If you need an updated list or term summary sheets, please contact our office or visit our website at www.I-AHC.net.

By submitting claims through I-AHC you will receive in-network benefits. In most cases, this means lower deductibles and higher claims reimbursements. I-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 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. Some are very low, and the trend is to make them lower. This trend is being fueled by chiropractors who are continuing to agree to lower and lower fee schedules. For example, there are chiropractors who are willing to accept less than $17 for a code 98940. This is only about 2/3 of Medicare. The lowest fee schedule you accept will eventually be the best you will receive. So be careful in what you accept; you probably will not recoup the difference in volume.

We are seeing two trends for the future that are of great concern

First, there is a tremendous push to lower fee schedules or limit visits. In some cases, chiropractic benefits were poorly managed by the insurance companies. Now they are moving to the other extreme of severely limiting the benefits. here should be a middle ground. Managed care is here to stay, but chiropractors do have an option. Providers make the decision regarding which network they want to join. They can decline joining networks with unfavorable fee schedules or excessive utilization review. They can also voice their opinion to the employer groups or insurance companies. And providers can contact their state chiropractic association, the ACA or other organizations to coordinate an organized effort for change.

Secondly, we are seeing more managed care in auto liability. I would expect this to continue. I-AHC has refused some of these contracts. In other cases, we allow providers to opt out of the auto liability portion of the agreement. This goes back to closely reading term summary sheets and joining networks only after thoroughly researching them.

Today, health plans assign identification numbers to health care providers -- individuals, groups, or organizations that provide medical or other health services or supplies. The result is that providers who do business with multiple health plans have multiple identification numbers.

The NPI is a unique identification number for health care providers that will be used by all health plans. Health care providers and all health plans and health care clearinghouses will use the NPIs in the administrative and financial transactions specified by HIPAA. The NPI was proposed as an 8-position alphanumeric identifier. However, many commenters preferred a 10-position numeric identifier with a check digit in the last position to help detect keying errors.

The NPI contains no embedded intelligence; that is, it contains no information about the health care provider such as the type of health care provider or state where the health care provider is located.

You should only submit claims for patients affiliated with the I-AHC contracted networks. Most of our contracts require you to submit claims through I-AHC. A few of the contracts provide for direct billing from you to the payor. Those contracts are identified on our list of current network affiliations.

The NPI must be used in connection with the electronic transactions identified in HIPAA. In addition, the NPI may be used in several other ways:

(1) by health care providers to identify themselves in health care transactions identified in HIPAA or on related correspondence;

(2) by health care providers to identify other health care providers in health care transactions or on related correspondence;

(3) by health care providers on prescriptions (however, the NPI could not replace requirements for the Drug Enforcement Administration number or State license number);

(4) by health plans in their internal provider files to process transactions and communicate with health care providers;

(5) by health plans to coordinate benefits with other health plans;

(6) by health care clearinghouses in their internal files to create and process standard transactions and to communicate with health care providers and health plans;

(7) by electronic patient record systems to identify treating health care providers in patient medical records;

(8) by the Department of Health and Human Services to cross reference health care providers in fraud and abuse files and other program integrity files;

(9) for any other lawful activity requiring individual identification of health care providers, including activities related to the Debt Collection Improvement Act of 1996 and the Balanced Budget Act of 1997.

A contract has many different components. Most contracts are over 20 pages in length. All contracts have a statement of purpose, definitions of terms, responsibilities of parties involved and the fee schedule(s). While the fee schedule is often the most important provision to the contract, there are other provisions which must be watched. The provisions cover points such as utilization review, cost, and balance billing of patients. If the language is vague or unfavorable, we work to clear it up. Almost every contract requires some sort of modification.

There are several results from claims not being sent to I-AHC. These include:

• Lower reimbursements
  
• Higher out of pocket expense for patients
  
• Frustrated providers and patients when they try to correct the claims
  
• Delayed reimbursements
  
• Increased cost
  
• Lower fee schedules will be proposed by network affiliates to I-AHC
  
• Opportunity for less provider friendly companies to secure contracts

After the standard is announced in the Final Rule in the Federal Register, the NPS will begin assigning NPIs to health care providers based on information they supply on NPI applications. Because there are so many providers, HHS recommended in the Notice of Proposed Rule Making that assignment of the NPI be done in phases. We expect that providers that conduct any of the transactions specified in HIPAA would be among the first to be enumerated.

Two years after the adoption of this proposed standard, the NPI must be used by health plans, health care clearinghouses, and those health care providers that conduct electronic transactions specified by HIPAA. Small health plans have 3 years to comply.

Yes, in most cases. There are several different models under which we operate, but in most cases we have a small administrative fee per claim. We are offering you access to network plan participants through your affiliation with us. In several cases we have been able to have the fee schedule increased to allow for this fee. In some cases, we are paid by the network affiliate. If that is the case, an administrative fee will not be deducted.

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

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The two most viable options are described below. The Notice of Proposed Rule Making welcomes feedback on these options, as well as on alternate solutions. Because the data needed to enumerate Medicare providers is already available in HCFA files, that information will be loaded into the National Provider System and NPIs will be assigned automatically to Medicare providers under either option described below. Medicare providers, therefore, would not have to apply for an NPI.

Option 1: A Federally-directed registry would be the enumerator of all health care providers.

After the initial load of Medicare provider data and assignment of NPIs to Medicare providers, all the remaining health care providers would apply directly to the registry for an NPI. The registry could be operated by an agent or contractor. The registry would enter the provider's data into the National Provider System; the National Provider System would assign an NPI, and the registry would notify the provider of the NPI.

Option 2: A combination of Federal programs (health plans), Medicaid State agencies, and a registry would be enumerators.

Federal programs and Medicaid State agencies would enumerate their own health care providers by entering provider data into the National Provider System; the National Provider System would assign NPIs to the providers. Each health care provider participating in more than one Federal or Medicaid health plan could choose the one by which it wishes to be enumerated. All other health care providers would apply directly to a Federally-directed registry for an NPI.

There are several reasons for filing through I-AHC. The first reason is that I-AHC is providing a service. There is a cost for that service. When providers join I-AHC they agree to pay for that service and to file the appropriate claims through I-AHC, from which we can obtain the necessary revenue (administrative fees) to continue operations. Other reasons for filing through I-AHC include:

• In most cases, providers are added to the networks under I-AHC's group information. If you file direct, you will not be recognized as an in-network provider.
  
  
• Filing through I-AHC ensures that the patient receives the benefit of going to an in-network provider. In many cases, the patient will select their provider because of a network affiliation. It is a disservice to your patient to file the claims improperly, which may result in high out of pocket cost for the patient.
  
  
• By filing properly though I-AHC, we are able to establish a provider-patient relationship from the HCFA. In some cases, I-AHC will receive the EOB and payment even if you file direct. However, we may not know to whom to send the payment. In those cases, the payment will be delayed until the provider can be identified.
  
  
• Our network affiliates monitor claims volume. They report the information to I-AHC and make contract decisions base upon the data collected. If providers of not filing correctly, it devalues I-AHC's negotiating abilities. This can lead to lower fee schedules or even jeopardize the contract.
  
  
• Filing properly through I-AHC the first time is much quicker and less expensive than trying to get claims reprocessed because I-AHC was bypassed.
  
  
• By filing properly through I-AHC, you are ensuring that I-AHC is able to continue working to bring more contracts to you.

No, they probably will not. Remember, we contract with the PPO or MCO network. We rarely contract directly with the claims payor. The PPO or MCO has the contract with the claims payor. For example, the claims payor normally does not know that First Health or American PPO uses I-AHC chiropractors. There are several hundred companies paying claims for each PPO throughout the country. By contracting with I-AHC, your name is placed in the directories of all the contracted PPO plan participants.

Currently, I-AHC does not have any contracts in place that require UM. However, if we secure a contract that requires UM, I-AHC will implement a UM program. Generally, I-AHC will not be involved in UM unless I-AHC is the final claims payor. This would probably be an HMO administrative services contract, not a PPO contract. The UM, if applicable, for our PPO contracts would be determined by the claims payor or employer group.

NPIs would be issued by the National Provider System (NPS) based on information entered into the NPS by one or more organizations known as

Sometimes, depending on what was not paid and the reason.

For example, patients are responsible to pay you for co-pays, deductibles and coinsurance portions that are not paid by the insurance carrier. The patient may also be billed for items that are specifically not covered by the insurance plan, i.e. vitamins, cervical pillows, massages, etc. However, you must let the patient know in advance and in writing that certain items may not be covered and will be the patient's financial responsibility.

The patient is not responsible for the portion of the claim that is denied due to PPO or network discounts. As a participating provider, you are agreeing to a fee schedule that is set by the PPO network and is approved by I-AHC. If your charge for a particular CPT code is over the fee schedule, the insurance carrier or claims administrator may deny a portion of your claim. You cannot bill the patient for the portion of the claim denied for this reason.

However, benefit plans often have limits on chiropractic care. Some plans limit the maximum benefit payable per visit, some limit the number of visits per benefit year and some limit both. You can bill the patient for claims that exceed the plan limits, up to the fee schedule amount for the services rendered. For example, if the services add up to $75 and the fee schedule for the services adds up to $58, the plan limit might be only $50 per visit. The patient is still responsible for the additional $8, if you choose to hold them responsible for it. Again, you should let the patient know in advance and in writing that they may be responsible for certain items and for services that exceed their plan limits. Our bulk pay remittance will distinguish between PPO or network discounts and plan limits.

Some insurance plans require pre-certification of treatments, especially HMOs. You have an obligation to follow the rules of the patient's insurance plan. If you fail to obtain pre-certification and it is required, your claim might be denied. The patient and the plan will expect you to write off this type of denial. With that in mind, be sure to get clear answers to questions when verifying benefits.

Finally, some patients will change carriers and not notify you. They may provide you with the incorrect information. While you have an obligation to file claims in a timely manner, you cannot do so without the patient providing correct information. If the claim is denied because the patient did not provide accurate information, but you acted in good faith, you should balance bill the patient.

I-AHC is a partnership between the NCCA's IPA, Integrated Healthcare of NC, and the Georgia Chiropractic Associations IPA, ActivHealthCare. The respective state associations are composed of chiropractic members. This is one of the unique characteristics about I-AHC that sets it apart from other chiropractic networks operating in the Southeast. I-AHC is owned by the chiropractic membership of the state associations, working on behalf of chiropractors and our profits are returned to the respective state associations to promote chiropractic. I-AHC is your network!!!


By forming a partnership, the two organizations were able to establish a regional presence with approximately 20 network affiliates. This makes for a stronger network that is able to market over a wider geographic area.

NPIs would be given to health care providers that need them to submit claims or conduct other transactions specified by HIPAA. A health care provider is an individual, group, or organization that provides medical or other health services or supplies. This includes physicians and other practitioners, physician/practitioner groups, institutions such as hospitals, laboratories, and nursing homes, organizations such as health maintenance organizations, and suppliers such as pharmacies and medical supply companies. This does not include health industry workers, such as admissions and billing personnel, housekeeping staff, and orderlies, who support the provision of health care but do not provide health care services.

I-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, Beech Street, NPPN, First Health, American PPO, etc. We refer to these networks as our Network Affiliates. I-AHC negotiates the fee schedule and contract terms. I-AHC is currently marketing to networks throughout the Southeast.

I-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, I-AHC is there to serve as an intermediary to explain and resolve the issue.

Administrative fees are based on a percentage of the allowed amount on a claim. The percentage will vary depending upon the business model of the contract and it may not apply to every contract. The typical contracted fee is 10%, but this actually works out to about 8.75% overall due to certain discounts on the fee. A discounted fee may be applied when coordination of benefits or Medicare is involved, or if part or the entire claim is applied to the deductible. We will not carry a fee forward from one claim to the next.

In some cases the fees are reduced to either 8% or 6%. In these cases, you will receive an invoice for the fee. It will not be deducted from the claim. The term summary sheet will explain the actual amount of the fee.

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 I-AHC, your name is listed in the directory. In other words, you get more patients.

The employer or insurance carrier will identify the PPO which the patients should use by placing either the name or logo of the managed care organization (MCO) or PPO on the insurance identification card. If it is not on the identification card, you should ask for the name of the PPO network when you verify insurance coverage.


I-AHC has a list of its contracted networks on the website. We will also be mailing the list to you periodically. The list will contain logos, names and claims filing instructions.

No, they probably will not. Remember, we contract with the PPO or MCO network. We rarely contract directly with the claims payor. The PPO or MCO has the contract with the claims payor. For example, the claims payor normally does not know that First Health or American PPO uses I-AHC chiropractors. There are several hundred companies paying claims for each PPO throughout the country. By contracting with I-AHC, your name is placed in the directories of all the contracted PPO plan participants.

If there is ever a disagreement with any UM program or review that may be implemented, and there currently is not such a program for I-AHC, then the provider may communicate with the reviewing chiropractor, I-AHC, or the board of directors. Communications may be made by e-mail or phone.

I-AHC does not design the UM of its network affiliates, but the network affiliates are required to provide us with a copy of their program. In most cases, UM guidelines are fairly broad. If there are questions, a provider may be required to submit notes. If there are problems, a provider should contact our office for help. Most of our network affiliates are not involved in UM and we have rarely been contacted regarding problems of this nature. If a network affiliate has a UM policy that is considered too restrictive I-AHC will not accept it.

Yes, a provider can refuse to accept a network affiliate. This must 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.

I-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 I-AHC's ability to negotiate fee schedules on your behalf. A network only exists because you join it. If I-AHC was the exclusive network for chiropractic, our ability to negotiate 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 I-AHC. Remember, you will be reimbursed at the lowest fee schedule. Pay close attention to the I-AHC list of network affiliates. This will help you avoid joining duplicate networks.

If a UM program is required to be implemented for I-AHC, the program will be approved by the board of directors of Integrated Healthcare of NC which are appointed by the NCCA and the board of directors of ActivHealthCare which are appointed by the GCA. The board members are practicing chiropractors who are members of the network. They will be subject to the same guidelines as everyone else.

Utilization management was implemented to ensure that services provided are medically necessary. Insurance policies and benefit plans usually have language that prohibits coverage for services that are not deemed medically necessary for the treatment of illness or injury. Once a patient reaches maximum medical improvement, the services may no longer be covered. This is sometimes difficult to tell without notes. The average claims examiner is not trained to review or make a determination on medical necessity and most claims do not clearly indicate that the patient is on maintenance care.


Unfortunately, over the past twenty years or so, UM has changed from its original form. Today UM is sometimes used to discourage the submission of claims that should be covered. We all know of carriers and networks that require excessive amounts of paperwork to be completed or tell you that your average number of visits per patient is high.


I-AHC vision of UM is consistent with the UM described in the first paragraph. If we are required to implement a plan, it will be to ensure that services provided are medically necessary and are within the framework of a particular plan or policy. Any paperwork required will be from the provider's office, which is necessary for communication.

If the patient's coverage uses an affiliated network, but the claims payor or insurance carrier does not recognize you as a participating provider contact the
I-AHC customer service department.

A term summary sheet is the summarization of the key points to a contract between I-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 I-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

If a UM program is required, and treatment forms are requested, the guidelines will set a general framework for the office administrative personnel to follow. The initial review will be made by a member of the office staff who is trained to apply the guidelines. That person will have the authority to approve visits. If a request for visits is outside of his/her parameters, the form will be referred to a licensed chiropractor approved by the board of directors to do the review. The chiropractor will be paid a nominal flat rate per review to encourage objectivity in the review. He/She will never be paid based on saving.

Please refer to the credentialing information or contact our office at 1-866-374-9558. 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 I-AHC member. Some of these include:

• I-AHC is currently credentialing for over 20 Network Affiliates. This gives our network members access to about several million covered lives in the southeast.
• I-AHC handles the credentialing audits for you. This means we are interrupted by the network auditors, not you.
• I-AHC carefully reviews the contract terms. We then summarize the key points for you and put them into a one page Term Summary Sheet format.
• I-AHC negotiates the fee schedules for you. We then post them to our website for you to review. If the schedule is unacceptable, we do not accept the contract.
• I-AHC is 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.

Benefits are verified by calling the specified phone number on the patient's insurance identification card. In some cases, you will need to call I-AHC to verify benefits. This can be determined by the term summary sheets.

In some cases the insurance carrier will ask for your tax identification number to determine if you are a participating provider. If that happens, you should provide them with Integrated-ActivHealthCare's tax identification number.

When verifying benefits, if it is not indicated on the patient's identification card, you should ask for the name of the PPO network that is used. If the network is one of I-AHC's network affiliates, follow the claims filing instructions on the term summary sheet. In most cases, that means sending the claims through I-AHC. If you are unsure, call I-AHC for instructions. The claims payors probably will not know who I-AHC is. We contract with networks, not payors. Therefore they will not know that you should be filing with I-AHC.

Be sure to ask about co-pays, deductible, coinsurance percentages, effective dates, chiropractic benefits and the other information listed on your insurance verification form. If the claim is for an accident, be sure to let the carrier know at the point of insurance verification. Your goal in the verification process is to obtain an accurate estimate of what will be allowed and paid by the carrier and what financial responsibility the patient will have to you.

Benefits are verified by calling the specified phone number on the patient's insurance identification card. In some cases, you will need to call I-AHC to verify benefits. This can be determined by the term summary sheets.

In some cases the insurance carrier will ask for your tax identification number to determine if you are a participating provider. If that happens, you should provide them with Integrated-ActivHealthCare's tax identification number.

When verifying benefits, if it is not indicated on the patient's identification card, you should ask for the name of the PPO network that is used. If the network is one of I-AHC's network affiliates, follow the claims filing instructions on the term summary sheet. In most cases, that means sending the claims through I-AHC. If you are unsure, call I-AHC for instructions. The claims payors probably will not know who I-AHC is. We contract with networks, not payors. Therefore they will not know that you should be filing with I-AHC.

Be sure to ask about co-pays, deductible, coinsurance percentages, effective dates, chiropractic benefits and the other information listed on your insurance verification form. If the claim is for an accident, be sure to let the carrier know at the point of insurance verification. Your goal in the verification process is to obtain an accurate estimate of what will be allowed and paid by the carrier and what financial responsibility the patient will have to you.

Although we offer one of the largest networks in the state, we are not able to accept every chiropractor. If your chiropractor is not a member of Integrated-ActivHealthCare, and you do not see a member chiropractor on our provider locater nearby, there are a couple of things you can do.

1. You can let your chiropractor know that he is not on your insurance PPO list. Mention Integrated-ActivHealthCare to him and ask him to contact us about membership.
   
   
2. You can contact Integrated-ActivHealthCare and ask us about contacting your chiropractor. If we do not have one in your area, we certainly want to enroll one. We will contact the chiropractor to determine their interest and eligibility.

There are many ways to do this. Our job at ActivHealthCare is to provide a network of qualified chiropractic providers. Although we cannot guarantee the specific outcome of your treatment (no one can), we do require that every provider in our network meet stringent credentialing guidelines.

Having said that let me give you a more practical answer. Our website includes a Provider Locator function. You can search by zip code to find a provider near your home or work.

Unfortunately, this sometimes happens. There are many reasons for it. If that happens, you can use our online provider locator function to locate a new chiropractor.

This generally is not a problem, but you should make sure your benefit plan does not have any special rules regarding changing doctors. You can do this by calling the customer service number on your insurance identification card.

There are some things to consider when making a change:

• Changing chiropractors does not mean your benefits for the year start over. Be sure to let the new chiropractor know that you were treated by another doctor. This will help them to accurately determine your financial obligation.

• Ask your previous chiropractor to provide your new chiropractor with a copy of your medical records and x-rays. This can save you money and help the new chiropractor treat you more effectively.

• Be sure to clarify the effect of the change on your benefits. Your insurance carrier can advise you of this information.

You can use our on-line provider locator to help you select a new chiropractor.

This is a great question. It should be easy to answer, but it is not. Every benefit plan is different. Some have chiropractic benefits, some do not. Some plans have a limit on the number of visits, some limit the amount paid or allowed per visit, and some limit both.

To get an accurate answer to this question, you should do two things:

1. Consult your Plan Summary Description or Benefit Plan Booklet. Read it carefully, paying close attention to what is not covered under the Plan Exclusions. In many cases, these booklets are just summaries. If they are complete they are often difficult to understand, even if you work within the insurance industry.
   
   
2. Call the customer service or insurance verification phone number located on your insurance identification card. Do not rely on a co-worker or supervisor for answers on this issue. They may be wrong. Ask the company administering the benefits. Be sure to tell them your problem and, if an accidental injury, how it happened. Benefits often vary depending on the reason for the treatment.

You want to clarify your financial responsibility. Ask about deductibles, co-pays, in-network benefits, and plan limitations. Obtaining this information before incurring treatment will help you avoid frustration later.

When you show up for treatment or schedule an appointment, the chiropractor's office will usually verify this information also. You can ask them questions to make sure you have the same answers.

Yes, most of the time. It is very rare for a benefit plan to pay for everything. The network chiropractor provider is agreeing to accept the network fee schedule, but you are still responsible for deductibles, co-pays, claims that exceed the plan limits and services that are specifically excluded by your plan. Also, if you provide incorrect insurance information to the provider, the entire claim may be your responsibility.

It is best to determine your financial obligation up front. The chiropractor's office assistant will be happy to help you with this question.

Unfortunately, sometimes people have complaints about medical services. The problems can take many forms. They may be related to customer service, insurance issues, chiropractic office issues or treatment issues.

No matter what the issue, we encourage you to first address it with your chiropractor. In most cases, once you have brought the problem to your chiropractor it will be resolved.

In very rare situations, you may feel the need for additional help. If the problem cannot be resolved between you and your chiropractor, please contact us at ActivHealthCare and we will try to help. We will do everything we can to work out a resolution or point you in the right direction.

When you are filling out the OA enrollment form, list any of the payors for which you would like to pre-enroll. OA will start the pre-enrollment process for the companies you've selected and get any necessary paperwork to you. Those companies requiring pre-enrollment are identified on the OA Payor List. There is no cost for pre-enrollment.

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

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 directly on the website, entering claims online and sending attachments electronically. OA continually adds new features and upgrades existing services to meet your EDI needs.

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 payor. It is against the law for a provider to submit directly to an insurance company in a non-compliant format.

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

OA 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.

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.

By enrolling with Office Ally, you are automatically set up to send to all payors on the OA Payor List except those with asterisks next to their name. Those payors require you to go through a pre-enrollment process before I-AHC can send your claims electronically to them. To view the Office Ally Payor List, go to www.officeally.com.

Please allow up to 30 days for us to process your enrollment. Once your enrollment form is submitted to OA, OA will email you 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.

You must notify I-AHC so that we may contact OA to indicate I-AHC on your enrollment. This is important so your I-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 I-AHC enrollment forms.

Most users send claims to OA as follows: 1. Create a claim file using your current billing software. 2. Log into www.officeally.com and click UPLOAD HCFA1500. 3. Click SELECT FILE. 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.

No, dial-up Internet access will also work.

Review the list of I-AHC network affiliates, or PPOs, found on the I-AHC website. If the patient is covered by a benefit plan or carrier that uses one of the I-AHC network affiliates or employers, and the instructions on the corresponding term summary sheet advises you to submit claims to I-AHC, then you should identify the claims uploaded to OA by placing AHC

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

OA's ability to accept a print-image file means they 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.

For providers without billing software, OA offers a free, online entry tool. This tool allows you access to a blank, electronic CMS-1500 on the OA website. You type data into it the same way you would a paper CMS-1500. 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.

There will not be any monthly charges paid to I-AHC. However, according the agreement, OA offers an optional service that includes additional fees for of $0.35 per claim to print and mail any HCFAs that cannot be sent electronically (i.e. the insurance company is not on our payer list or your pre-enrollment is not completed for that insurance company). Also, if Medicare claim volume exceeds 50% of overall claims submitted, OA charges a flat monthly fee of $19.95 for any month exceeding the 50%.

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

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 use of the Office Ally tools. If you do not have practice management software, you may use OA's online entry tool.

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