Claim forms – Health Care Insurance Plan
Claim submission resources and forms
New and revised forms and brochures are posted on the form pages on a regular basis. To avoid using an outdated form, we recommend you do not save any form. If you need a form, check this page to ensure you have the most current version of the form.Important: Due to the sensitive nature of the information required, DO NOT return forms via e-mail. Electronic submission is not available. Print and return your application by mail, fax or in person.
| Claims Submission Resources and Forms | ||
| AHC0693 | Out-of-Province Claim for Physician / Practitioner Services  This claim form has two purposes. It is to be used by:1. Alberta physicians (for services that can not be billed through the medical reciprocal billing process) and other practitioners providing services to residents from other parts of Canada. 2. Alberta residents wanting to submit a claim to the AHCIP for physician services they received in other parts of Canada. |
Print only |
| AHC0910A | Facility Registration (Replaces form AHC0910) Application to register facilities and professionals providing services under the AHCIP. |
Print only |
| AHC0911 |
Organization Information |
Print only |
| AHC0912 | Practitioner Information Form Application to register practitioners and professional corporations providing services under the AHCIP. |
Print only |
| AHC0913 | Business Arrangement (BA) Request Application to register as a contract holder or business arrangement providing services under the AHCIP. |
Print only |
| AHC0914 |
Business Arrangement (BA) / Service Provider (SP) Relationship |
Print only |
| AHC0916 | Alternate Relationship Plan Request Application to register an approved Alternate Relationship Plan (ARP) – physicians only. |
Print only |
| AHC0917 | Sessional ARP Request for Additional Business Arrangements (BA) Application for physicians associated with a Sessional ARP to be paid individually. |
Print only |
| AHC0934 | Claims Form for Out of Country Health Services Application to claim practitioner services and facility services outside Canada. |
Print only |
| AHC1143 | Electronic Funds Transfer Request Application for direct deposit of claims. |
Print only |
| AHC2095 | Application for Submitter Role Application to become an accredited submitter. |
Print only |
| AHC2096 | Submitter/Client Relationship for Electronic Claim Submission Application for an accredited submitter to submit claims electronically on behalf of a service provider. |
Print only |
| ABC20039 | Blue Cross Health Services Claim Form |
Fill & Print |
