Filing A Claim:

Electronic payer ID: 59231

Mail: PO Box 10269 Jacksonville, FL 32247

Customer Service: (855) 292-9526 option 1

Claims Fax: (877) 596-2244

Inquiring About An Existing Claim:

Please complete the form below To be contacted by our team.

Provider Name

Provider Tax ID #

Inmate ID #

Patient Name

First Name

Last Name

Patient/Inmate DOB

Date Of Service From

Date Of Service To

Charge Amount

Your Company

Your Name

Your Email

Your Phone

(###)

###

####

Your Fax

(###)

###

####

Special Inquiry

Change Healthcare Response:

ACH accepts paper HCFA-1500 and UB-04 (previously)UB-92 claims forms. You can send them via mail, email, or fax.

Mail: American Correctional Healthcare

PO Box 10269 Jacksonville, FL 32247

Email: kim@americancorrectional.com

Fax: 877-596-2244

Templates of fillable CMS Forms HCFA-1500 and UB-92 can be found here:

HCFA-1500:

HCFA-04 (previously HCFA-92)