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.
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
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:
P.O. Box 44365
Madison, WI 53744-4365
Corrected Claims Filing
to The Alliance to report modifications to a previously submitted claim. The preferred manner for submitting corrected claims is via EDI.
To ensure that corrected claims are processed by The Alliance appropriately, please report claims as follows:
- For electronic 837 files: The Claim Frequency Code reported in Loop 2300 CLM05-3 should be reported as “7”
- For paper submitted claims: Indicate “Corrected Claim” at the top of the claim form
Additionally, please report the data fields as follows:
- UB Claims: Use the Type of Bill field with the 3rd digit reported as “7”
- CMS 1500 Claims: Field 22 should be reported as “7”
Failure to follow these guidelines may cause the claim to process and deny as a duplicate claim submission. Also submit the entire original claim with all line items and not just the line being corrected.
The Alliance will apply the contract provisions to the reported corrected claim and forward to the relevant TPA for processing.
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. Download an example of an Alliance ID card 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):
- Contact the Third-Party Administrator (TPA) indicated on the patient’s ID card.
- Contact The Alliance Customer Service at 800.223.4139.
- Utilize The Alliance provider claims portal.