For Providers | AmeriHealth Caritas Next (2024)

Change Healthcare System Interruption

Change Healthcare, our electronic data interchange (EDI) clearinghouse for claims and payment cycle management, continues to address their network interruption related to a security incident. Below are updates for our systems and processes:

1. Electronic remittance advice (ERA/835) files: IMPORTANT UPDATE: AmeriHealth Caritas Next is pleased to inform you that a solution has been developed in collaboration with Change Healthcare/Optum to provide the detailed payment recovery information missing from the provider remittance advice. This solution will provide payment recovery details on the remittance advice or 835 you receive with your payments for claims processed on and after May 6, 2024.
   For claims processed February 21, 2024, through May 5, 2024, AmeriHealth Caritas Next has generated a comprehensive claims recovery report available in the NaviNet provider portal. For more details for accessing this report see the Remittance Advice Payment Recovery Details Now Available! provider notice (PDF).
   Providers can view and download an electronic remittance PDF via the NaviNet provider portal. Providers may also access the ERA/835 file through ECHO Health. For additional information, please see the 835 Access provider notice (PDF).
2. Claims payments: Providers who were unable to successfully submit claims during the outage may now submit them either through Availity or PCH Global, or through Change Healthcare once connectivity is restored. We have extended the claims timely filing deadline for claims that would have been rejected due to untimely filing during the service interruption. For more details, see the Claims Timely Filing Deadline Extensionprovider notice (PDF).
3. Electronic claims submission through Availity: If you or your clearinghouse do not currently use Availity to submit claims, you must register with Availity at: https://www.availity.com/Essentials-Portal-Registration. Please choose the registration option that aligns with your business: Healthcare or Atypical Provider. For registration process assistance and other resources, access the training site link on the Availity registration page. If you are currently registered with Availity for another payor, or if you use another clearinghouse, you must request that they route your electronic claims for AmeriHealth Caritas Nextto Availity.For additional information and resources, see the recent Additional Information for Availity provider notice (PDF).
   
4. Submitting claims through Change Healthcare – Although AmeriHealth Caritas Next has not reconnected directly to Change Healthcare, providers may submit claims to AmeriHealth Caritas Next through Change Healthcare.
   • Providers may use Relay Health or iEDI (the two clearinghouses being offered today by Change Healthcare/Optum) for submitting claims to AmeriHealth Caritas Next. Claims submitted through these clearinghouses will be routed to us via Availity until we reestablish direct connectivity to Change Healthcare.
   • To use Relay Health or iEDI, you will have to establish new connectivity with these clearinghouses.
   • For new connectivity requirements, you will need to reach out to your Change Healthcare account representative.
   • If you do not know who your account representative is, you can submit an inquiry via the Change Healthcare General Inquiry form.
5. Manual claims submission through PCH Global: To enroll for claims submission through PCH Global, please go to https://pchhealth.global and click the Sign-Up link in the upper right-hand corner to register. Complete the registration process and log into your account. You will be asked how you heard about PCH Global; select Payer, then AmeriHealth. Access your profile by clicking on Manage User and then My Profile. You will need to complete all the profile information. When you go to the Subscription Details screen, select the More option on the right-hand side to see how to enter the promo code Exela-EDI.When you are ready to submit claims, use the following information to search for our payer information:
1. Payer name: AmeriHealth
2. P.O. Box:7344

For a detailed walk through of the registration process, refer to the PCH Global Registration manual, found on the PCH Global website in the Resource Menu.

4. Electronic remittance advice (ERA/835) files: Providers can view and download an electronic remittance pdf via the NaviNet provider portal. Providers may also access the ERA/835 file through ECHO Health. For additional information, please see the recent 835 Access provider notice (PDF). NOTE: Due to the Change Healthcare security incident, remittance advices generated after February 21, 2024 may not include all of the information previously provided. As Change Healthcare continues to restore services, this information will become available.
5. Prior authorization submission and processing: The prior authorization systems continue to operate normally.
6. Eligibility verification, claim status inquiry, and authorization inquiry: These capabilities continue to be available via NaviNet. If you do not have access to NaviNet provider portal, please visit https://register.navinet.net/ to sign up.

Please note, in the interim, our Provider Services Department will not be able to assist with processing of your payments or obtaining your 835 files any sooner. If you have other questions, you may contact Provider Services at 1-833-983-3577.

We thank you for your partnership and patience, We will continue to provide updates as we work to resolve the downstream impacts of Change Healthcare’s service interruption.

Claims submission alert:

Please note that there are three different AmeriHealth Caritas plans operating in Florida. Please be careful to submit your claims to the appropriate plan using the correct payer ID. Improper claim submissions could result in payment delays.