Provider Services
Alliance Secondary HealthBenefits to Providers
For services eligible under the patients’ primary health insurance, the Alliance Secondary Health plan administrator, United Group Programs, processes the claims for the patients’ out-of-pocket expenses such as copays, deductibles, and coinsurance. Claims are paid directly to the healthcare provider (unless the insured elects to not assign benefits to the provider). Alliance Secondary Health can offer many benefits to healthcare providers such as, but not limited to:
Timely direct deposit payments.
Reduction in Accounts Receivable.
Reduction in the volume of patient services that are delayed or avoided.
Increase in patient utilization.
Improvement in patient’s physical and financial wellbeing.
Claims Process
One of the unique advantages of Alliance Secondary Plan 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
Inpatient – Physicians & Facilities
Maternity Services
Emergency Room Services
Outpatient – Physicians & Facilities
Outpatient Surgeries
Home Healthcare
Mental & Behavioral Health Services
Substance Abuse Treatment
Dependent Pregnancy
HSA Compatibility
Labs, X-rays, Testing, Pathology
Major Diagnostic & Imaging
Physical Therapy
Chiropractic Services
Ambulance Services
Durable Medical Equipment
IV Therapies & Infusions
Chemo & Radiation Therapy
In-Office Physician Procedures
No Exclusion for Pre-Existing Conditions
Non-Covered Services
Office Copays/Physician Consult Fees
Rx Copays: Tier 1, 2, 3 & 4
Services Excluded from Major Medical
Preventative Wellness Services (Covered by Major Medical)
Provider Portal
Click the button below to verify coverage or register to the provider portal:
Claim Filing
Provider filing claim must include 1) itemized bill or HCFA form and 2) copy of the Primary carrier EOB:
Provider Verifying Coverage
OptiMed Phone Number:
(800) 836-6036
customersupport@carynhealthms.com
US Mail Claims Submissions
OptiMed Health Plans
3145 Avalon Ridge PL Suite 300
Peachtree Corners, GA 30071-1543
EDI Claims Submissions
Clearing House: Change Healthcare
Payor ID: 96277
Phone Number: (800) 836-6036
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.
Electronic filings are made to OptiMed with clearing house Smart Data Solutions Payor ID# UGP19 and mailed claims are made to OptiMed Health Plans; 4 Terry Drive, Suite 1; Newtown, PA 18940. With all available methods, healthcare providers must include a copy of the Primary Carrier EOB and Itemized Statement or HCFA.
What is Alliance Secondary Health’s fee schedule and how do we join the network?
There is no network with the Alliance Secondary Health product and the insured may go to any provider. There is no required contract between healthcare providers and the Alliance Secondary Health product.
What is the Fee Schedule?
There is no fee schedule. The plan administrator, United Group Programs, processes the patient’s portion of the claim (i.e., copays, deductible, and coinsurance), subject to the plan’s limitations and exclusions. The amount that the patient owes is determined by the underlying primary insurance carrier’s policy 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 return to your practice for care. From a claims perspective, it could reduce the amount of uncollected Accounts Receivable.
What does the future hold for healthcare providers?
With the affects of Healthcare Reform, one thing is for certain, your patient’s out-of-pocket expenses will likely be increasing. This could further increase the amount of Accounts Receivable in the form of deductibles, copays, and coinsurance. Alliance Secondary Health may help you reduce this uncertainty.