Choose the appropriate category below to locate the AHCIP form(s) you require. You can also contact us directly to request a form, or obtain additional information.

Forms For Individual Use
Forms For Group Use
Claims Submission Resources/Forms

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/Forms
AHC0693	Out-of-Province Claim for Physician / Practitioner Services This claim form has two purposes. It is to be used by: 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 Alberta residents wanting to submit a claim to the Alberta Health Care Insurance Plan for physician/practitioner services they received in other parts of Canada	Print only
AHC0910	Facility Registration Application to register facilities and professionals providing services under the Alberta Health Care Insurance Plan.	Print only
AHC0911	Organization Information Application to register professional corporation or clinic providing services under the Alberta Health Care Insurance Plan.	Print only
AHC0912	Practitioner Information Form Application to register practitioners and professional corporations providing services under the Alberta Health Care Insurance Plan.	Print only
AHC0913	Business Arrangement (BA) Request Application to register as a contract holder or business arrangement providing services under the Alberta Health Care Insurance Plan.	Print only
AHC0914	Business Arrangement (BA) / Service Provider (SP) Relationship Application to register as a service provider or business arrangement providing services under the Alberta Health Care Insurance Plan.	Print only
AHC0916	Alternate Payment Plan Request Application to register an approved Alternate Payment Plan (APP) - physicians only	Print only
AHC0917	Sessional APP Request for Additional Business Arrangements (BA) Application for physicians associated with a Sessional APP to be paid individually	Print only
AHC0920	Claims Submission Resource Material / Form Request Form to request fee-for-service claims material.	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 RequestApplication 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
	Blue Cross Health Services Claim Form	Print only