Make a Payment Required Fields All fields begining with an (asterisk) are required and must be completed prior to hitting the Pay Now button. Payment Sources As part of Advanced Home Care’s continuing effort to streamline the patient experience, Advanced Home Care now accepts online payments from Discover, MasterCard, Visa & American Express. Need Help? If you need help with this form, please call 1 (800) 255-2321 and select option #1 or email ahcpaymentcenter@advhomecare.org. An Advanced Home Care representative will be happy to assist you, and is available Monday — Friday 9:00am — 5:00pm. Security Advanced Home Care takes your security to heart. We have been verified by Authorized.Net. Credit Card Merchant Services Patient Information * Account # * Patient First Name * Patient Last Name * Patient Phone Number Patient Email Card Account Information Same As Patient * Cardholder First Name * Cardholder Last Name * Card Number * Expiration Select Month 01 02 03 04 05 06 07 08 09 10 11 12 Select Year 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 * Security Code (CCV) * Card Billing Zip Code * Amount $ Sign Up for AutoPay Cardholder Email (receipt sent to this address) © 2019 Advanced Home Care, Inc. | Privacy Policy