Why should providers file claims to <font face="century schoolbook">I</font>-AHC versus filing direct?
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.