Information for Providers

Thank you for your participation and/or interest in our provider network. Below you will find a list of information and materials on variety of topics. If there is additional information or materials that you would like to see on this page please let us know on our “Contact Us” page.

For Providers

AHF processes clinical and utilization review of all authorization and referral requests. To refer a program-eligible client to network specialists, primary care providers (PCPs) or specialists must complete a Specialty Services Authorization Request form. There are three different referral forms; medical, dental and home health/hospice . Please be sure to use the appropriate form. Authorization submission details will be based on the county and will be provided to you during your provider orientation as well as included in your provider manual.

The Specialty Services Authorization Request forms include instructions for where and how to submit Authorization request. The forms are available on the website. Routine authorization requests are rendered within two (2) business days; medically urgent requests are rendered within (1) business day. Please refer to the appropriate provider manual for questions regarding the authorization request process.

The Ryan White Specialty Services Program does not authorize retro requests. If a procedure is performed that is not listed on the authorization, or the CPT codes authorized do not match what was performed, you must submit an authorization request for modification on the same day as the procedure in order for the claim to be paid. CPT codes submitted on the claim must match what has been authorized.

Authorizations are required for reimbursement. As such, please follow these guidelines:

All services must be pre-authorized to receive payment.
Authorization should be submitted via fax (Please refer to the appropriate provider manual for specific details.
Authorization forms can be found in the FORMS sections of this website.
All authorization requests for medical and dental services must include the appropriate CPT and/or CDT codes.
Authorizations are valid for 90 days from the date issued or up to eligibility termination date, whichever comes first.
Include your fax number so the response can be returned to you.
All authorization requests must be legible and completely filled out. Failure to submit a complete authorization may delay processing.

Providers must submit supporting clinical documentation to support medical necessity and link the request to the patient’s HIV/AIDS condition.

All authorization request received by AHF for eligible clients are either approved, denied, partially approved or deemed incomplete and returned to the requesting clinic.
Authorization determinations are made within the grantor’s set time frames, please visit the grant specific page to confirm decision turnaround time. Authorization response details are below:

Approved – The requesting clinic is responsible for contacting the specialty provider to schedule an appointment and to provide them with the approved authorization, including authorization number.
Denied – Except for dental, all services must be HIV-related. In addition, see the approved list of services and respective used to verify you are requesting an authorization for an approved/covered service. If you want more information about a denied request, please refer to the appropriate Specialty Network provider manual
Partially approved – One or more services requested might be approved but not everything on the referral may be covered or HIV-related. In this case, the referral should be updated to include only those services for which the service request is approved.
Incomplete – Along with the returned request will be an explanation of what information is missing and must be provided in order to process the referral. Once the request is re-submitted with the missing information provided, the request will be reviewed again to determine if it can be approved. This additional review will occur within two business days.

AHF uses Language Line Solutions as our vendor for interpreter services as needed to communicate with members who have limited English proficiency. Providers are expected to have access to interpreter services to accommodate their non-English speaking clients. If you do not have access to interpreter services to accommodate a non-English speaking client who was referred to you under the Ryan White Specialty Services Program, AHF will provide such access. Please contact AHF’s Member Services at (800) 263-0067 to request assistance.

AHF is committed to be respectful of and responsive to the cultural and linguistic needs of our members. The US Department of Health & Human Services, Office of Minority Health, has issued national culturally and linguistically appropriate services (CLAS) standards. AHF is committed to a continuous effort to perform according to those standards.

Contracted Providers are expected to provide services in a culturally competent manner that includes, but is not limited to, removing all language barriers to service, and accommodating the special needs of the ethnic, cultural, and social circumstances of the patient. Providers must also meet the requirements of all applicable state and Federal laws and regulations as they pertain to provision of services and care including, but not limited to, Title VI of the Civil Rights Act of 1964, the Age Discrimination Act of 1975, the Americans with Disabilities Act, and the Rehabilitation Act of 1973.

Clients receiving program services may file a complaint or an appeal anytime about the quality of care and service they receive from Ryan White Specialty Services Program network providers by contacting AHF Member Services at (800) 263-0067 Monday through Friday, 8:30 a.m. to 5:30 p.m. or utilize the formal complaint process. This process can be initiated by clicking the Formal Complaint & Appeals Tab and filling out the required information.

AHF Provides a written acknowledgement letter to the patient within five (5) business days of receipt and a final resolution letter within thirty (30) calendar days of receipt.

Expedited Complaints and Appeals

At the request of the patient, AHF will review the complaint or appeal for expedited status when the standard process has the potential to cause harm to the patient’s health condition. If upon review, AHF determines the expedited status is valid and approves the abbreviated time frame, a resolution or decision will be made as quickly as possible in accordance with the patient’s health condition but no later than seventy-two (72) hours from the time of receipt.

All claims must be for authorized services to be considered for payment.
The authorized service must be provided during the approved authorization period. If services are delayed and fall outside the authorization period, a new authorization request must be submitted prior to the completion of services.
CPT codes submitted on the claim must match what has been authorized. I.
Ryan White Program’s generally have a contract period with defined end dates that must coincide with claims submission. Based on county and/or grant specifics, AHF will alert providers annually via written notice of this deadline and the final date of which claims can be submitted for the coinciding contract year. For example, the 2025 contract year ends on February 28th, 2026. Claims with a date of service between March 1st, 2025 thru February 28, 2026 must be submitted no later than March 31st, 2026.
Claims received outside of the submission timeframe will be denied and not considered for reimbursement; unless valid proof of timely filing is submitted.

Electronic claims:

Electronic submission of claims is required to ensure accurate and timely payments. Claims may be submitted electronically through any clearinghouse. The Payer ID is 95433. Dental claims should be submitted to Payer ID 95411.

The claim must include the following:

☑ Patient Name	☑ Place of Service	☑ Date of Service
☑ Patient Address	☑ Physician Name	☑ Billed Charges
☑ Patient Date of Birth	☑ NPI Number	☑ CPT Code(s)
☑ Patient Insurance Name	☑ Provider License Number	☑ Applicable ICD Codes
☑ AHF Patient ID Number	☑ Tax ID Number	☑ HCPCS Codes

For claims status, contact the Claims Department at claims@positivehealthcare.org or (888) 662- 0626.

Paper claims:

Providers may submit claims via paper. Authorized specialty services provided to program-eligible clients by network providers must be sent to the following address:

AIDS Healthcare Foundation
Attn: Claims
P.O. Box 46160
Los Angeles, CA 90046

All paper claims must be received at the address above prior to the County contract year end date with AHF. Claims must be submitted on a properly completed CMS1500, UB92, or UB04 claim form

Electronic Payment Methods via Change Healthcare

Ryan White Specialty Pools Program partnered with Change Healthcare and Echo Health, Inc to provide the following new electronic payment methods.

Virtual Card Services:
EFT Payments: To sign up for EFT, through Settlement Advocate for AHF only, visit;

https://enrollments.echohealthinc.com/EFTERADirect/AIDShealthcarefoundation/ No Fees apply.

Medical Payment Exchange (MPX): If you are not enrolled with us to receive payments via electronic funds transfer (EFT) and you opt-out of virtual card, and have enrolled for MPX with another payer, you will continue to receive your payments in your MPX portal account. Otherwise, you will receive a paper check via print and mail. (County Specific)
Paper Check: To receive paper checks and paper explanation of payments (EOP), you must opt out of the Virtual Card Services by visiting; https://echovcards.com/letter. To access this site, use your Tax ID and verification access. New providers will not have a client ID/verification access but can contact ECHO directly for assistance.

835 Electronic Remittance Advice (ERA):

Providers who enroll for EFT payments will continue to receive the associated ERAs from ECHO with the Change Healthcare Payer ID. If you have not already, please make sure that your Practice Management System is updated to accept the Change Healthcare Payer ID: 95433 for Ryan White programs. All generated ERAs will be accessible to download from the ECHO provider portal (providerpayments.com).
Changes to the ERA enrollment or ERA distribution can be made by contacting the ECHO Health Enrollment team at (440) 835-3511.
In addition, we want to make you aware of another enhancement. You can now log into providerpayments.com to access a detailed explanation of payment for each transaction.
If you have any difficulty with the website or have additional questions, please call Echo Healthcare, Inc at (800) 886-5918. You can also reach out to your Provider Relations team for assistance.

A provider dispute is a written notice challenging, appealing or requesting reconsideration of a claim that has been denied, adjusted or contested. All provider disputes should be submitted on a Provider Dispute Resolution form. Written disputes must be submitted within 60 days from AHF’s action that led to the dispute for services rendered.

Providers may submit their dispute to claims@positivehealthcare.org or via mail:

AIDS Healthcare Foundation
Attn: Claims
P.O. Box 46160
Los Angeles, CA 90046

For inquiries regarding the status of a dispute or to obtain the Provider Dispute Resolution form, please call (888) 662-0626 or email claims@aidshealth.org or CAPR@ahf.org.

The Contracting and Provider Relations Department is the liaison between the program’s network providers and AHF. The Contracting department negotiates contracts for new and existing specialty providers. The Provider Relations department provides education of program policies and procedures as well as resolves provider concerns in a timely manner.

AIDS Healthcare Foundation
Attn: Provider Relations
1710 N. La Brea Ave
Los Angeles, CA 90046