Participating Provider Claims Submission Guidelines 

For accurate claim(s) filing, follow the submission instructions on the patient’s ID card. Most of our enrollees’ claims are submitted directly to The Alliance®, unless otherwise indicated on the ID card. 

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Electronic Claims Filing

Sending and receiving claims via Electronic Data Interchange (EDI) is a great way to ensure more timely payments. With EDI claims, we’re able to reprice and send the claim on to the Third-Party Administrator (TPA) in just a few hours. We work with several clearinghouses for electronic claims submissions.

The Alliance payer identification numbers are as follows:

RelayHealth (McKesson): Payer ID # 2712 (CMS-1500) and # 1935 (UB)
Emdeon/Optum EDI/most others: Payer ID # 88461

Get connected!

Contact us if you’d like EDI connectivity or to use an electronic submitter not listed.

Paper Claims Filing

Filing paper claims? Please send these to:

The Alliance
P.O. Box 44365
Madison, WI 53744-4365

Corrected Claims Filing

Corrected Claims can be submitted by EDI or on paper. For paper corrected claims, please remember to do the following:

At the top of the claim form, indicate “Corrected Claim” (without this indication, claims may be denied: mistaken as a duplicate claim).

Submit the entire original claim with all line items and not just the line being corrected (we replace the entire claim with the corrected claim to forward to the payer).

Tips for Quick Claims Turnaround

  • Electronic claims submission are required for new contracts. Claims submitted electronically gain higher priority and are filed (and paid) faster than paper claims.
  • Include provider name and degree in Box 31 of all CMS forms. The degree or education level of the servicing health care provider is required to reprice most claims.
  • Confirm Alliance network status at each visit. Check a patient’s health plan ID card at each visit to ensure there haven’t been any changes in eligibility or employment status. A sample Alliance ID card provides a detailed explanation of the information to look for. See an example of an Alliance ID card. Click to download PDF on this page
  • Enter names exactly as they appear on the ID card. Entering nicknames, such as “Shelly” when the ID card says “Michelle,” can cause an electronic claim to be rejected. Another common mistake is entering a name without punctuation, for example “John Smith Jones” when the ID card says “John Smith-Jones.”
  • Enter member numbers exactly as they appear on the ID card. If your organization normally adds a two-digit suffix, please remove it before submitting the claim.
  • If you don’t already, consider sending and receiving claims electronically. It’s the most efficient way to ensure you’re paid in the timeliest manner.

How to Determine the Status of a Claim

Need to determine the status of a previously submitted claim? Please do not submit a duplicate claim – it won’t result in returning the status of the claim and adds more costs and resources to the claims process.

Please proceed with one of the following options instead (in order of effectiveness):

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Have a question about claim submissions or want to offer feedback on the process?

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