1
what's covered?
full coverage for medically necessary physician services, and some dental and oral surgical health services.
Someone calls and tell you "they have a bill" what are some probing questions you may ask
From who? SOA? Doctors office? AHS?
Do you know what for?
Dates when the service occurd
"im calling from a doctors office and we have recently moved clinics i need to update the address" who do we refer?
Prac forms
Jack is calling and states he has SOA, upon bringing up his account you see he has permanently left AB to BC on 20210131 he says the date of service on his SOA is 20220210 what does jack have to do to?
Sam is calling about a bill he received for a recent ambulance ride he took is it covered who does he speak with?
No, AHS Billing Dept
The Alberta government provides funding to Alberta Health Services to deliver what specific services?
hospital services, mental health and addiction services, physiotherapy, midwifery services, cancer services, home care and more.
Bills in collections should be referred to who?
AHS
Contact facility/AHS
A letter outlining the need for the MRI/CT scan and treatment and the timelines;
A copy of the MRI/CT scan report; and
A copy of the invoice from the diagnostic centre where the MRI/CT scan was completed.
Spencer fell in Ireland and cracked his head opened on the pavement, unfortunately he ended up in the hospital he wants to know how to submit a claim
OOC Health services claims form, AB is very limited when traveling outside of Canada did you have travel insurance?
what are some partially covered services?
Dental, Podiatry
"Is the HPV shot covered by AHCIP?"
Refer to AHS
Where does an SOA come from?
Statement of accounts are generated through AHCIP via reflections (ie. retro cancelling)
Diane is calling and notifying she went to the doctors office last week and they sent her a bill how does she move forward? (you fix what needed to be done in reflections she is a resident)
To be reimbursed back for all insured health services expenses made, contact the service providers or physicians to send the claims electronically to Alberta Health within 365 days from the date of service of each and they should indicate Pay-To Code as RECP (recipient), so that the reimbursed fund can come directly to the patient.
Ted is calling he needs a new walker he is 94 years old and on income support who can you refer him to?
AADL
Who should someone contact first before going to AHCIP Claims?
Physican/Surgeon
"I want to follow up with the claim I sent 3 weeks ago i was at the doctors in SK"
Check to see what dates claims are working on/give oop/ooc email
"Im 67 years old is my eye exam covered?"
Yes 1 complete eye exam a year is covered for persons over 65 and under 18
How must one get a denial letter sent in order for their private insurance to cover the bill?
Send in to claims
Ryan needs help with Dental coverage and mentions he is not working at all right now he cant afford insurance where can you refer him to?
Alberta Works/ Alberta Adult Health Benefits
OOP Claims form for physician/practioner service
"I would like to inquire about if a very specific heart surgery and type of anesthetic i need for an up coming surgery would be covered" How do we refer?
In province claims email, requesting a call back with all info provided
A letter then request through IVR to state how much they have left for podiatry services
Dan wants to know where he can get help with physiotherapy
Funding through AHS/ Contact rehab advice line
Susan needs new glasses she mentions she is 78 and cant afford to pay for them on her own, who would you refer her to?
AB Supports/Seniors Financial Assistance Program