Welcome Providers

America's 1st Choice Health Plans, Inc. is a heath plan with a Medicare contract, offering non-network Private Fee-for-Service (PFFS) plans in select counties of Georgia.

Non-Network PFFS Plan Highlights

• To participate, medical providers only need to:

1. Be eligible to participate in Medicare; and
2. Agree to accept our plan’s terms and conditions of payment (located below) each time they see our Presidential (PFFS) and Presidential Plus (PFFS) members, except in cases of urgent and emergent care.

• PFFS plan benefits do not require authorizations, referrals, or other pre-cert notifications. 

• PFFS plans with prescription drug coverage do require the use network pharmacies (except in emergencies or urgent situations).

• A Medicare Private Fee-for-Service Plan is not the same as the Original Medicare Plan offered by the Federal government. It also is not the same as a Medigap (Medicare Supplement Insurance) policy, Medicare SELECT, or Medicare Prescription Drug Plan.

Use the information in this section to expedite your claims payments by submitting all required information.

Electronic Claims Submissions

Electronic claims submission is available through EMDEON using payer ID number 20553.  For more information, download the EDI Information Sheet.

EDI Information Sheet »

EDI Submission Tips

• Ensure that your clearinghouse can remit information to our trading partner, EMDEON.
• Use the billing name and address on the electronic billing format that matches our records. Please notify our office of any name and address changes in writing.
• Field NM1 relates to box 33 of a CMS 1500 or the UB04 for all electronic claims transmissions and 837’s.
• The member/subscriber number should not include the suffix. Ex. For Member N00001234-01, the -01 is not included.
• Contact EMDEON with any transmission questions at 1-800-845-6592.

Electronic Payments

America’s 1st Choice has partnered with PaySpan Health to provide you with a practical solution to receive HIPAA compliant EFTs and ERAs. Following a fast online enrollment, you will be able to receive ERAs and import the information directly into your Practice Management or Patient Accounting System, eliminating the need to re-key remittance data from paper advices. The service is free, download the instruction sheet below to get started.

PaySpan Health Information Sheet »

Paper Claims Submissions

Paper claims should be mailed to:

America’s 1st Choice Health Plans, Inc.
P.O. Box 210769
Columbia SC, 29221-0459

Claim Appeals

Submit your appeal to the address below for claim denials regarding untimely filing, incidental procedures, bundling, unbundling, unlisted procedure codes, non-covered codes, etc. Claims must be submitted to America’s 1st Choice Health Plans, Inc. within 90 days of date of denial from EOB.

America’s 1st Choice Health Plans, Inc.
Attn: Claims Department
P.O. Box 210769
Columbia SC, 29221-0459

Questions? Providers can contact our Provider Relations team, Claims center, or Customer Service at Click Here.

Thank you for your interest in working with America's 1st Choice.

PFFS Terms and Conditions
What Health Care Providers Need To Know About Private Fee-For-Service Plans
PFFS Claims and Reimbursement Information
Pharmacy Information
How To Contact Us
Newsletters

Conflict of Interest Policy and Requirements
View Conflict of Interest Policy and Requirements document.

Compliance - Provider/Vendors Training Management System
View and download our FWA Training document; Compliance Training; Conflict of Interest Policy; Standards of Conduct document; and complete the FDR Attestation for mandatory CMS compliance.

Forms

DS Health Assessment Tool »
Health Assessment Tool »