This form serves a dual purpose. It allows both members and non-members to alert the ACA to insurer/network abuses, which we will investigate for the good of the entire profession. This form also allows ACA members to request assistance and ask coding, billing, insurance and Medicare related questions.
If you have not located the information you are seeking on our website, please submit your insurance/Medicare-related information and/or question using the form below including as much detail as possible. If you have an inquiry that is not insurance related, please email it to memberinfo@acatoday.org. If you prefer to print our comment form and fax it to us, you can download it by clicking here: Data Form. |
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| If you are an ACA member, check here. |
| If you are sending this information for ACA's records only, check here. |
| If you are an ACA member requiring assistance on this issue and would
like a response from ACA, check here.
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| We typically need backup documentation to investigate concerns or complaints. Check here to indicate that you will be faxing backup documentation. Please fax it to (866) 575-8615. |
| *Please remember to remove ALL information that could identify any patient(s). |
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Please select the category below which best represents your concerns. The category chosen will determine the staff member to whom your inquiry will be sent. For this reason, only one category can be chosen. Please submit separate inquiries for different categories. |
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| Comments: |
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| Your assistance in helping us make positive changes in insurance relations for the chiropractic profession is greatly appreciated! |
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