Member Services

Claim Reimbursement

First, you need to obtain a copy of your Major Medical EOB (Explanation of Benefit) and Itemized Statement from your healthcare provider, showing procedures performed.

1. The EOB can be found online via your primary insurance carrier’s portal or you will receive it via mail.
2. The Itemized Statement (or HCFA) can be obtained from your physician’s office/hospital of care.
3. You will also need to complete a ACI Reimbursement Form; download by clicking the button below.

ACI Member Portal

Once you have obtained these items and completed the Reimbursement Form, you may file the claim to ACI via fax or mail:

Member Customer Service