Hardship Payment Requests

Alliance is committed to supporting the communities impacted by the devastating effects of Tropical Storm Helene by ensuring that our providers receive payment for services provided to our health plan members in those affected areas, even when they are unable to submit claims to us for reasons including technology issues or catastrophic events such as Helene.

Providers can request a hardship payment by submitting this form. Providers must fill out the form in its entirety and submit the form to NetworkRelations@AllianceHealthPlan.org. Incomplete forms will not be accepted. Hardship payments will not be considered for any revenue disruption less than 30 calendar days, staff turnover, vacancies, vacation, or sick time, or for inaccurate NCTracks provider information resulting in claim denials. Hardship payments only apply to Medicaid claims. Hardship payments will not be considered for non-Medicaid or non-UCR funding.