Please send claims to the following address:

	Mail to:	ACI P.O. Box 4000 Collegeville, PA 19426-9000
	Fax:	610-293-9299
EDI Payor ID #:		22384

For Accident Claims:

•	Download the appropriate Claim Form from the Forms button
•	Fill out all sections of the Form
•	If the form requires, have the form signed by the appropriate Group Representative
•	Attach the Claim Form and proof of payment (described below) with your bills
•	Submit to the above address

Helpful information for submitting claims and expediting payment:

•	Complete Claim Information - ACI suggests providers submit standardized billing statements (“UB-04” for hospital charges and “CMS-1500” for Physician Charges).
•	Proof of Payment – Check copy of payment, Cash Receipt, or Credit Card Statement
•	Payment to Medical Providers – Unless Proof of Payment is submitted with the medical bill claim payment is sent directly to the medical providers.
•	Other Insurance - If a primary insurance carrier paid a portion of your claims include the Explanation of Benefits (EOBs) with your claim submission.
•	Accident Claims – Follow the instructions above

Need Assistance?

Any questions regarding benefits available under your Policy or you need guidance in how to submit your claim, please…

Call us at: 888-293-9229
Or Email us at: aciclaims@visit-aci.com

Hours of Operation: 8am – 8pm EST, Monday through Friday

	•   Submit your Claim to ACI
	• ACI Dates Receipt of Claim • ACI Verifies Claimant Eligibility • Claim file prepared for processing
	• Claims Examiner reviews claim • Claims Examiner requests any needed additional information • Claims Examiner makes a claim determination after all required documentation is received • Claims Examiner processes according to Policy terms
	• For payable claims, payments are issued to the Provider or Claimant with an Explanation of Benefits Statement • Explanation of Benefits Statement Issued to Claimant & Provider

HIPAA Authorization Form

The purpose and design of the HIPAA Authorization Form is to protect the health information of our insured members. The form provided is to allow you, the member, to authorize the release of your Protected Health Information to the individuals, representatives, and organizations you may wish to have access to your information.

ACI will not release your information to others who have requested it, verbally or in writing, without your signature on a completed HIPAA Authorization Form.

Create a Login
•	Click on the Claim Status button
•	Click on “Insured”
•	Enter the required information under "New Web User", from your ID Card
•	Click the “Register” button
•	Agree to the Terms and Conditions
•	Click “Claims” to view claim status

What is a PPO?

A PPO, Preferred Provider Organization, is a group of physicians, clinics, medical practices and hospitals who have agreed to discount their charges for individuals insured under their specified insurance plans. The medical providers who join into a Preferred Provider Organization have done so because the health care environment is competitive and they want to provide service to good customers like you.

About the PPO Networks

The PPO Networks ACI partners with are National Provider Networks, which provides you comfort in being able to locate a medical provider in the PPO Network when you are away from home in the U.S. These PPO Networks are nationally well-known Networks and are highly competitive with the discounts obtained for services rendered by the participating providers.

What a PPO means to You

If your plan pays benefits at different rates for In-Network and Out-of-Network charges, this is called a Captive PPO and you have come to the right place on the ACI website. Finding an In-Network Medical Provider is critical in avoiding unwanted and unnecessary large balance due bills from providers. Selecting a participating PPO provider will ensure you are maximizing the benefits of your insurance plan because if your claim is payable, you will receive the highest coinsurance benefit AND a lower overall balance due to the provider since the charges will be discounted.

If your plan does not have different rates for In-Network and Out-of-Network charges you can still take advantage of PPO discounts if you choose a physician within the PPO Network identified on your ID Card. If no PPO Network has been identified, please choose a physician under the Multiplan Network logo to the left.

When receiving treatment at a PPO Network provider, be sure to identify yourself as a subscriber to the PPO Network identified on your insurance ID Card. If being referred to another physician, request a PPO Network provider in your plan identified Network.

Discounts will be applied at the time ACI receives the claim from the provider. Medical Providers are not permitted to balance bill you the difference between their standard charge and their discounted charge. However, there may be minimal balances due the provider due to co-pays and deductibles contained in your policy. Please review your plan for the benefit structure of your policy.

ACI Web Site Privacy Statement

ACI strongly believes in maintaining the privacy of nonpublic personal information we collect from individuals who visit our web sites. We want you to understand how and why we collect, use and disclose the personal information about you on our web sites. ACI’s practices and procedures are in compliance with privacy laws and/or regulations such as the federal Gramm-Leach-Bliley Act (GLBA). All information collected from our web site and our companies in general that is subject to the applicable privacy laws and regulations will be handled according to our ACI Privacy Statement. This Web Site Privacy Statement supplements the ACI Privacy Statement by providing you with information concerning ACI’s practices and procedures as they relate specifically to information we collect at this web site.

PERSONAL INFORMATION WE COLLECT AND USE AT THIS WEB SITE

We do not collect any personal information about you at our web sites unless you choose to provide it to us voluntarily. We define “personal information” as information that is unique to you and might include your phone number, name, age, address or Social Security number. If you encounter a screen or page that requests information you do not want to share with us, do not enter the information and do not proceed with that screen or page.

If you do provide us with personal information, we will only use it for the purposes described where it is collected, and we will not sell, license, transmit or disclose this information outside of ACI unless (1) you expressly authorize us to do so, (2) it is necessary to allow our contractors or agents to provide services for us, (3) in order to provide our products or services to you, (4) it is disclosed to entities that perform marketing services on our behalf or to other entities with whom we have joint marketing agreements, or (5) otherwise as we are required or permitted by law.

EMAIL

We appreciate your questions and comments about our web site and services and welcome your email messages to mailboxes listed on our web sites. We will share your messages with those within our organization who are most capable of addressing the issues contained in your message. We will keep a copy of your message until we have had an opportunity to address your concerns. We may archive your message for a certain period of time or discard it, but your email address will not be used for any other purpose.

CONFIDENTIALITY AND SECURITY

We restrict access to personal information collected about you at our websites to our employees, our affiliates' employees, or others who need to know that information to provide services to you or in the course of conducting our normal business operations. We maintain appropriate physical, electronic, and procedural safeguards to protect personal information.

THE RIGHT TO VERIFY THE ACCURACY OF INFORMATION WE COLLECT

Keeping information accurate and up to date is important to us. An individual may see and correct their personal information that we collect except for information relating to a claim or a criminal or civil proceeding. Contact us at the address provided below if you wish to verify your personal information.

LINKS TO OTHER SITES

For your convenience we may provide links to other web sites and web pages that we do not control. We cannot be responsible for the privacy practices of any web sites or pages not under our control and we do not endorse any of these web sites or pages, the services or products described or offered on such sites or pages, or any of the content contained on those sites or pages.

USE OF “COOKIES” OR OTHER DATA COLLECTION TOOLS

A cookie is a piece of information which a web server may place on your computer when you visit a web site. Cookies are commonly used by web sites to improve the user experience and have not been known to transmit computer viruses or otherwise harm your computer. Many cookies last only through a single web site session, or visit. Others may have an expiration date, or may remain on your computer until you delete them.

We may use cookies for a number of purposes - for example, to maintain continuity during a user session, to gather data about the usage of our web site for research and other purposes, to store your preferences for certain kinds of information and marketing offers, or to store a user name or encrypted identification number so that you do not have to provide this information every time you return to our web site.

Our cookies will track only your activity relating to your online activity on this web site, and will not track your other Internet activity. Our cookies do not gather personally identifiable information.

You can decide if and how your computer will accept a cookie by configuring your preferences or options in your browser. However, if you choose to reject cookies, you may not be able to use certain of our online Products and Services or Web Site features.

We may occasionally use other companies to set cookies on our web sites and gather cookie information for us. In some cases we may also use another company to operate web servers for our web site. We use the cookie information gathered by these companies in the same manner as stated above.

In addition to the information we collect from cookies, we also obtain information which you provide to us online - for example, when you use our tools and calculators or when you submit an application or otherwise communicate with us. In some cases, we retain both the cookie information and/or the information you provide to us online - for example, to complete a transaction you requested or to keep historical records of your past transactions. In other cases - for example, when you use our tools and calculators - we only retain the cookie and/or online information you give us if you request us to do so for your use in subsequent sessions.

CHANGES TO OUR WEB SITE PRIVACY STATEMENT

We may change this Statement at any time and from time to time. The most recent version of the Statement is reflected by the version date located at the bottom of this Statement. This Statement is not intended to and does not create any contractual or other legal right in or on behalf of any party.

ACI GENERAL PRIVACY STATEMENT

Below is the ACI Privacy Statement in accordance with privacy laws and/or regulations such as Title V of the federal Gramm-Leach-Bliley Act that is sent to all customers who purchase an insurance product that is used primarily for personal, family or household purposes.

ACI PRIVACY STATEMENT

ACI strongly believes in maintaining the privacy of information we collect about individuals. We want you to understand how and why we use and disclose the collected information. The following provides details of our practices and procedures for protecting the security of nonpublic personal information that we have collected about individuals.

INFORMATION WE COLLECT

The information we collect will vary depending on the type of product or service individuals seek or purchase, and may include:

•	Information we receive from individuals, such as their name, address, age, phone number, social security number, assets, income, or beneficiaries;
•	Information about individuals’ transactions with us, with our affiliates, or with others, such as policy coverage, premium, payment history, motor vehicle records; and
•	Information we receive from a consumer reporting agency, such as a credit history.

INFORMATION WE DISCLOSE

We do not disclose any personal information to anyone except as is necessary in order to provide our products or services to a person, or otherwise as we are required or permitted by law.

We may disclose any of the information that we collect to companies that perform marketing services on our behalf or to other financial institutions with whom we have joint marketing agreements.

THE RIGHT TO VERIFY THE ACCURACY OF INFORMATION WE COLLECT

Keeping information accurate and up to date is important to us. Individuals may see and correct their personal information that we collect except for information relating to a claim or a criminal or civil proceeding.

CONFIDENTIALITY AND SECURITY

We restrict access to personal information to our employees, our affiliates' employees, or others who need to know that information to service the account or in the course of conducting our normal business operations. We maintain physical, electronic, and procedural safeguards to protect personal information.

Last Updated: April, 2013

HIPAA Compliance

Administrative Concepts, Inc. (ACI) is in full compliance with the regulations set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), including Privacy, Security and Electronic Data Interchange. ACI will not disclose Protected Health Information to an entity other than to another Covered Entity or Business Associate and only for the limited and express purpose of performing insurance services, including claims processing or administration, data analysis, utilization review, quality assurance, and repricing. Protected Health Information shall not be further used or disclosed other than as permitted or required By Law. ACI maintains appropriate safeguards to prevent unauthorized use or disclosure of such Protected Health Information.

Claim Appeal Procedure

At ACI, we want to ensure your claim is processed according to the terms of the policy you purchased. If you, the member or the provider of service received a denial of your claim and you would like your claim reviewed or have questions regarding the reason for the denial, please contact our Customer Service Team at 888-293-9229 or direct an email to claims@visit-aci.com. Our Customer Service Team will review the claim with you and provide responses to any questions you may have at that time.

If for any reason we are unable to assist you over the phone, please feel free to file a written appeal to our office, to which ACI will respond formally in writing. If submitting a written appeal, please provide the following information:

•	Any additional documentation which may support your claim
•	Insured Name (if a dependent, the Dependent Name also)
•	Insured Current Contact Information: Address, Phone Number, E-mail
•	Group Name
•	Policy Number

Your appeal will be reviewed by an individual other than the Claims Examiner who processed the claim and a decision in regards to the appeal will be provided to you within 30 days. If there are any delays in responding to your appeal, ACI will notify you of the progress of the review and inform you when you may anticipate a decision to your appeal.

ACI
P.O. Box 4000
Collegeville, PA 19426-9000

Fax: 610-293-9299

ACI Contact Information

ACI P.O. Box 4000 Collegeville, PA 19426-9000
Email:	aciclaims@visit-aci.com
Phone:	610-293-9229
Fax:	610-293-9299
Toll Free:	888-293-9229

Hours of Operation: 8am – 8pm EST, Monday through Friday