Benefits to Providers

For services eligible under the patients’ primary health insurance, Alliance ACA Health Supplement pays the patients’ out-of-pocket expenses such as deductibles and coinsurance. Claims are paid directly to the healthcare provider via our third party administrator MWG Administators.  Alliance ACA Health Supplement provides many benefits to healthcare providers such as, but not limited to:

 

  • Timely direct deposit payments.
  • Reduction in Accounts Receivable.
  • Reduction in the volume patient services that are delayed or avoided.
  • Reduction in bad debt.
  • Increase in patient utilization.
  • Improvement in patient’s physical and financial wellbeing.

Claims Process

One of the unique advantages of Alliance ACA Health Supplement is that healthcare providers are able to file all of the claims for patients via an electronic payer code that is clearly labeled on the member’s secondary insurance card (note providers can also file US mail). Here is how the claims process works:

1

Member Shows
Both Cards

Provide both primary & secondary cards at visit. 

2

Provider
Verification

Provider verifies coverage with both primary and secondary insurance. Verification Information shown on the back of member ID Card.

3

Provider Files
the Claim

Once the primary insurance has processed the claim, the provider will submit the claim to the secondary insurance by filing electronically or by mail.

4

Alliance Pays
Provider

Secondary insurance processes the claim. The claim will be sent to the provider and the member.

Standard Covered Services

N

Inpatient - Physicians & Facilities

N

Maternity Services

N

Emergency Room Services

N

Outpatient - Physicians & Facilities

N

Outpatient Surgeries

N

Home Healthcare

N

Mental & Behavioral Health Services

N

Substance Abuse Treatment

N

Dependent Pregnancy

N

HSA Compatibility

N

Labs, X-rays, Testing, Pathology

N

Major Diagnostic & Imaging

N

Physical Therapy

N

Chiropractic Services

N

Ambulance Services

N

Durable Medical Equipment

N

IV Therapies & Infusions

N

Chemo & Radiation Therapy

N

In-Office Physician Procedures

N

No Exclusion for Pre-Existing Conditions

Non-Covered Services

M

Office Copays/Physician Consult Fees

M

Rx Copays: Tier 1, 2, 3 & 4

M

Services Excluded from Major Medical

M

Preventative Wellness Services (Covered by Major Medical)

Provider Portal

Click the button below to verify coverage or register to the provider portal:

Provider Portal

Claim Filing

Provider Verifying Coverage

MWG Administrators:
(888) 888-2519

 

Submit Electronic Claims To:

Change Healthcare
Payer ID: 64090
www.changehealthcare.com

SoftCare
Payer ID: 01757
www.softcare.com

 

US Mail Claims Submissions

AmFirst Insurance Company

P.O.  Box 211747
Eagan, MN 55121

 

Provider Filing Claims Must Include

  1. Itemized Bill or HCFA Form
  2. Copy of Primary Carrier EOB

Frequently Asked Questions

How do I file a claim?
First, a claim for services performed must be filed with patient’s primary insurance provider. Once the healthcare provider receives the Primary Carrier EOB, they may then submit the claim via electronically filing, by fax, or by mail. For claim adjudication, filings must include a copy of the Itemized Bill or HCFA and the Primary Carrier EOB.
What is Alliance ACA Health Supplement's fee schedule and how do we join the network?
Alliance ACA Health Supplement does not have a set network and does not require a contract between the healthcare provider and Alliance ACA Health Supplement.
What is the Fee Schedule?
There is no fee schedule. We pay the patient’s portion of the claim (i.e., copays, deductible, and coinsurance) directly to the providers on a dollar-for-dollar basis. The amount that the patient owes is determined by the underlying primary insurance carrier’s contract and can be found on the primary carrier’s EOB.
Why should I want to file this claim?
Most importantly, it will keep your patients happy and insure that they continue to return to your practice for care.  From a claims perspective, it will reduce the amount of uncollected Accounts Receivable by shifting the claims to a highly rated insurance company verses an individual.
What does the future hold for healthcare providers?
With the affects of Healthcare Reform beginning to trickle down, one thing is for certain, your patient’s out-of-pocket expenses are increasing. This is going to further increase the amount of Accounts Receivable in the form of deductibles, copays, and coinsurance. Alliance ACA Health Supplement will help you reduce this uncertainty.