Frequently Asked Questions

Questions & Answers From A-G Administrators

Let us help you navigate the claims process with our crucial insurance FAQ. If your question is not answered below, please call us for immediate assistance.

What is required to file a claim?

All claims require an Accident Claim Form, Itemized Bill, and the corresponding Explanation of Benefits (EOB) from the patient’s primary medical insurance (if policy is secondary) in order to process payment. Submitting an incomplete claim file, may cause a delay in processing. You will be contacted by the Claim Examiner if information is missing.

Please make sure all attachments are clear and legible. PDF attachments are the easiest for our Document Center to view and upload into our system. Illegible documentation may cause a delay in processing.

What is an Accident Claim Form?

A completed Accident Claim Form is required to open a new claim in our system, and we cannot process payments without one. It verifies the date of injury, body part that was injured, and how the injury occurred. It also includes required signatures from the athlete/participant (or guardian) and from the school or organization official. Please view our Document Library for electronic copies of the Accident Claim Form.

What is an Itemized Bill?

An itemized bill is a detailed billing form that includes date of service, billed amounts, CPT Codes (Current Procedural Terminology), Diagnosis Codes, Provider Tax ID Number and Address, along with patient information. This information is required, and we cannot process payment from statements that are not itemized.

Itemized bills can be accessed from your provider. A CMS 1500 form is common form from a physician, and the UB 04 form is a common form from a hospital or facility. These forms will have all of the necessary information A-G Administrators requires to satisfy the itemized bill requirement for each charge.

What is an Explanation of Benefits (EOB)?

Because our policies are excess accident, all charges must first be submitted through the patient’s primary insurance. To verify that each charge has been submitted through your primary insurance, and show how they have processed the charge, we also require an Explanation of Benefits (EOB). The EOB breaks down each charge by date of service and CPT Code and includes the total billed amounts, discounts, adjustments, and payments made.

The easiest way to access your EOB’s is through your primary insurance’s online portal. Almost all major insurance companies have electronic EOB’s accessible to participants online for prior treatments. You may also receive hard copies of the EOB’s in the mail, or can receive copies through your provider.

If you or your child does not have primary medical insurance, or have a Medicaid/Medicare Plan, A-G Administrators may act as the primary insurance. Please submit documentation stating you do not have any other insurance or your Medicaid/Medicare Insurance Card for review.

How do I submit the required claim documentation?

A-G Administrators provides a variety of methods for submitting claim documents. Please refer to the Claim Submission page for full details.

Do I need to preauthorize treatment?

A-G Administrators does not pre-authorize or guarantee benefits, and all claims are reviewed upon receipt. Benefits are paid at Usual, Customary, and Reasonable (UCR) rates.

How do I confirm eligibility and benefits?

Please contact customerservice@agadm.com or (610) 933-0800 and have the patient name, patient date of birth, date of injury, and school or organization they belong to ready. Benefits and eligibility are based on the school or organization they belong to, and the injury that occurred.

What if I already made payments on the claim?

If you have already made payments, you may be reimbursed for covered charges. We will still need the itemized bill and corresponding EOB for each charge, in addition to your proof of payment (receipt, copy of check, etc.). If proof of payment is not submitted prior to processing, payment will be issued directly to the provider, and you will need to contact the provider for reimbursement.

How long do I have to submit a claim?

The timely filing deadline for each policy may vary, however we recommend submitting claims within 90 days from the date of service. A-G Administrators will always review a claim submission, so please submit the complete claim documentation for final determination.

When will my claim be paid?

Once the completed Accident Claim Form, Itemized Bills and Corresponding EOB’s are submitted and legible, the processing time of a claim is approximately 5-10 business days. If additional information needs to be requested, this will delay the process.

How can I check on the status of a claim?

To check the status of a claim, complete the short form on the Check Claim Status page or call A-G Administrators directly at (610) 933-0800 (M-F 8:30am-6pm EST). We will return your call or respond to your form submission as soon as we are able.

A-G Administrators, A-G for ‘Always Game’. The team led by Dixon and Jake, are always game for a challenge, always game for performance at the highest level, and most importantly based on my experience and one who considers A-G a trusted partner of the University of Pennsylvania, always game for positive results and outcomes. A-G Administrators focus is client centric.

Benjamin Evans

Associate Vice President- Office of Risk Management and Insurance

The University of Pennsylvania

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