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 |
| Do not send these three required enrollment forms to Office Ally.Send them directly to Integrated-ActivHealthCare. 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 Enrollment Form |
| |
|
|
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. |