Member Services
Alliance Secondary HealthClaims Process
One of the unique advantages of Alliance Secondary Health 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.
Claim Reimbursement
First, you need to obtain a copy of your Major Medical EOB (Explanation of Benefits) and Itemized Statement from your healthcare provider, showing procedures performed.
- Typically, the EOB can be found online via your primary insurance carrier’s portal and/or may be receive via mail.
- The Itemized Statement (or HCFA) can be obtained from your physician’s office/hospital of care.
- You will also need to complete an OptiMed Claim Form which can be downloaded by clicking the button below.
Once you have obtained these items and completed the OptiMed Claim Form you may file the claim to OptiMed via fax or by mail:
File via Fax
(215) 968-6301
File via Mail
OptiMed Health Plan
3145 Avalon Ridge PL Suite 300
Peachtree Corners, GA 30071-1543
