Claim Submission Guidelines

Follow the claim submission instructions on the patient’s ID card for the most accurate claim filing information. Most Alliance enrollee’s claims are submitted directly to The Alliance, unless otherwise indicated on the ID Card.

EDI – Filing Claims Electronically

Sending and receiving health care claims via Electronic Data Interchange (EDI) is a great way to ensure more timely payments. With EDI claims we are able to reprice and send the claim on to the third party administrator (TPA) in just a few hours. The Alliance works with several clearinghouses for electronic claims submissions.

The Alliance payer identification numbers are as follows:

RelayHealth (McKesson): Payer ID # 2712 (HCFA) and # 1935 (UB)
Emdeon/Optum EDI/Most others: Payer ID # 88461

Get Connected! If you currently don’t have EDI connectivity with The Alliance or would like to use an electronic submitter not listed above, please contact Dave Sell, senior programmer analyst, by email Dave Sell or phone, 608.210.6656, to learn more.

Paper Claims Filing

Send Paper Claims to:  Sample Claim Forms:
The Alliance
PO Box 44365
Madison, WI 53744-4365
CMS 1500 – Health Insurance Claim Form

CMS 1450 – UB-04 Uniform Bill

Corrected Claims Filing

Corrected Claims can be submitted by EDI or on paper. For paper corrected claims, the top of the claim form must clearly indicate Corrected Claim.” Additionally, you must submit the entire original claim with all line items (not just the line being corrected) as The Alliance replaces the entire claim with the corrected claim and forwards it to the payer as a corrected claim. Without the “Corrected Claim” indication, claims may be denied as a duplicate claim in error. Please follow this process to avoid additional claim administration delays and/or denials.

Tips for Quick Claims Turnaround!

Here are a few tips to make sure your claim is handled as quickly as possible:

  • 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.

sample ID card
pdf iconRead more about ID Cards

  • Enter names exactly as they appear on the ID card: Entering nicknames, such as “Shelly” when the ID card references “Michelle,” can cause an electronic claim to be rejected. Another common mistake is entering a name without punctuation. For example, “John Smith-Jones” is not the same as “John Smith Jones”.
  • Enter the exact number on the front of the ID card:  The member number must exactly match what is listed on the member ID card. If your organization normally adds a two-digit suffix, please remove it before submitting the claim to us electronically.
  • If you don’t already, learn more about sending and receiving health care claims electronically: It’s the most efficient way to ensure you’re paid in the timeliest manner.

Questions? Feedback? Contact us at 800.223.4139