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Provider
Resources

We believe the relationship between providers and patients is an integral part of any treatment plan. That's why we are committed to working with you to provide our members with the best quality of care possible.
 

AVA Provider Portal

If you are a contracted provider with Alignment Health Plan, you can log into our AVA Provider Portal for convenient and secure access to verify member eligibility, check claims status, submit prior authorization, and more.

AVA Provider Portal Login

Need access to the AVA Provider Portal? Create an Account

Alternatively, you can access the following self-service tools without an AVA Provider Portal account:


Information For Providers

PPO Plan Information >

Medicare Advantage PPO plans allow members to receive services from in-network providers and from out-of-network providers that participate in Medicare and agree to accept the plan. Like commercial PPO plans, providers do not have to be contracted with the Alignment Health Plan Medicare Advantage PPO plans to see our PPO members.

Non-contracted Provider (NCP) Appeals Request or Dispute Resolution Process for Part C Claims >

The Centers for Medicare & Medicaid Services (CMS) has established specific requirements for processing a request when a non-contracted provider disagrees with a Medicare Advantage (MA) plan's claim payment determination.

Prior Authorization >

Learn about Alignment Health's prior authorization tools and submission guidelines.

Compliance Information >

Learn about Alignment Health's Compliance Program, including offshore subcontracting, code of conduct, Medicare compliance and fraud, waste, and abuse (FWA) plan.

Provider Operations Manual >

Alignment Health's Provider Operations Manual contains information about our operational policy and procedures that support our programs and services. It also contains key contacts, addresses, phone numbers, and websites.

Provider Newsletter >

Alignment Health Plan's Provider Newsletter covers relevant and timely information to support our provider partners and their patients.

Special Needs Plan (SNP) Training >

Providers and staff who manage or have the potential to manage members enrolled in a Special Needs Plan (SNP) are required to complete Alignment Health's SNP and Model of Care (MOC) provider training within the first 60 days of employment and annually thereafter.

Electronic Data Interchange (Eligibility Inquiry)

Pursuant to the requirements of HIPAA, Alignment Health will exchange the standard transactions, such as the 270/271 eligibility inquiry and response, with any willing partner allowed under the HIPAA privacy provisions. There is provider specific setup and configuration required, which typically takes from 2-4 weeks to onboard a provider for this service.

If you are interested in exchanging any of the HIPAA standard transactions with Alignment Health, please contact your Alignment Health Provider Relations Representative. Alternatively, you can also contact our provider relations team using the information in the contact us section below.

Questions?

Send your questions, inquiries, or comments to ProviderRelations@ahcusa.com. If you need to make changes to your provider network, please send an email to ProvData@ahcusa.com.


Interested in working with us?

For contracting opportunities, please send an email to ProvContr@ahcusa.com and include:

  • Provider/entity name
  • Service(s) provided
  • State(s) where services are provided
  • County/counties where services are provided
  • Contact person and information
  • Letter of intent and W-9 (attachment)
  • National Provider Identifier number and Counsel for Affordable Quality Healthcare number (if applicable)

Contact Provider Relations

1-844-361-4712 (TTY: 711)

Available Monday to Friday, 8 a.m. to 8 p.m. PT / 11 a.m. to 11 p.m. ET.


 

Send Us A Message

Email us at ProvRelations@ahcusa.com or send us a secure message by submitting the form below.

Required fields are marked with an asterisk (*).