Claims, Billing, and Payment

AmeriHealth Caritas Next contracts with Change Healthcare — one of the largest electronic data interchange (EDI) clearinghouses in the country — to offer state-of-the-art EDI and other electronic billing services. Use of EDI can boost claims submission efficiency and timeliness of reimbursement to enhance your revenue cycle.

If you need EDI Technical Assistance, call provider services at 1-833-301-3377.

Filing claims is fast and easy for AmeriHealth Caritas Next providers. Here you can find the tools and resources you need to help manage your submission of claims and receipt of payments.

All claims submitted by providers must be billed on the CMS-1500 or UB-04, or the electronic equivalent (via EDI) of these standard forms

Timely claims filing

In-network claims

• Original submission must be submitted no more than 180 days from date of service.
• Rejected claims must be resubmitted no more than 180 days from date of service.
• Denied claims must be resubmitted within 365 days from date of service.

Out-of-network providers

All claims must be submitted within 180 days from date of service.

Change Healthcare uses a tool called ConnectCenter to improve claims management functionality. Providers who have a limited ability to submit claims through their hospital or project management system may now benefit from key features of the ConnectCenter tool. There is no cost to providers to use ConnectCenter.

Key features are:

• Claims users do not need to choose between data entry of claims and upload of 837 files. All users may do both.
• Secondary and tertiary claims can be submitted.
• Institutional claims are supported.
• Claims created online are fully validated in real-time so that providers can correct them immediately.
• Whether providers upload their claims or create them online, the claim reports are integrated with the claim correction screen for ease in follow-up.
• Dashboard and work list views enables providers to streamline their billing to-do list.
• Remittance advice is automatically linked to provider's submitted claim, providing a comprehensive view of the status of their claim.

To register for ConnectCenter, visit ConnectCenter Sign Up. If prompted, use vendor code 214629. If you need assistance, Change Healthcare customer support is available through online chat or by phone at 1-800-527-8133, option 2.

Electronic claims will need to be submitted to Change Healthcare using a 4-digit ConnectCenter payer identifier (CPID). The CPIDs for AmeriHealth Caritas Next are:

Institutional claims: 7043

Professional claims: 9426

To learn how to navigate ConnectCenter visit the resources below.

User guides

• Enrollment Central (PDF)
• Claims — Create a Claim (video)
• Claims — Getting Started (PDF)
• Claims — Status (PDF)
• Claims — Uploading a Claim (PDF)
• Eligibility — Getting Started (PDF)
• Keying Institutional Claims (PDF)
• Keying Professional Claims (PDF)
• Provider Management — Getting Started (PDF)
• Provider Sign-up and User Management (PDF)
• Remits — Getting Started (PDF)

Submit claims through EDI for faster, more efficient claims processing and payment. See the "Submit claims electronically" section of this page for more details.

AmeriHealth Caritas Next's (Delaware) EDI payer ID number 47073.

Send paper claims to:

AmeriHealth Caritas Next
Attn: Claims Processing Department
P.O. Box 7425
London, KY 40742-7425

To check your claim status, sign in to NaviNet and select Claims Status Summary under Administrative Reports or if you need assistance, call Provider Services at 1-833-301-3377.

Medical and pharmacy payment cycles run every Monday.

Providers may file a claims dispute electronically through NaviNet. See the instructions below:

How to file a claims dispute

1. Log in to NaviNet.
2. Find “Health Plans” in the top navigation bar.
3. Select AmeriHealth Caritas Next from the drop down.
4. Navigate to the Workflows for this plan in the upper left-hand navigation menu.
5. Click on the Forms and Dashboards link.
6. Navigate to Appeals and Claims Disputes section.
7. You will be given two choices: Appeals on Behalf of a Member or Claims Disputes.
8. Select Claims Disputes.
9. Complete the appropriate form.
10. Click submit.

You can also dispute a claims decision by downloading the Claims Dispute Form from the forms section of our website and submit your request along with any supporting documentation, in writing to:

AmeriHealth Caritas Next
Provider Claim Disputes
P.O. Box 7429
London, KY 40742-7429

Refer to your AmeriHealth Caritas Next Provider Manual (PDF) for timely claims dispute filing guidelines.

Electronic claim payment options

Change Healthcare is partners with ECHO Health, Inc. (ECHO Health), a leading innovator in electronic payment solutions, to offer more electronic payment options to our healthcare providers so that they can select the payment method that best suits their accounts receivable workflow.

Electronic payment options offered are virtual credit card (VCC), electronic funds transfer (EFT), and MedPay (MPX).

Virtual credit card (VCC)

ECHO Health offers VCCs as an optional payment method. VCCs are randomly generated, temporary credit card numbers that are either faxed or mailed to providers for claims reimbursement. Major advantages to VCCs are that providers do not have to enroll or fill out multiple forms to receive VCCs, and that personal information, like practice bank account information, will never be requested. Providers will also be able to access their payment the day the VCC is received.

In the future, AmeriHealth Caritas Next providers who are not currently registered to receive payments electronically will receive VCC payments as their default payment method, instead of paper checks. Your office will receive either faxed or mailed VCC payments, each containing a VCC with a number unique to that payment transaction, an instruction page for processing and a detailed Explanation of Payment /Remittance Advice (EOP/RA). Normal transaction fees apply based on your merchant acquirer relationship. If you do not wish to receive your claim payments through VCC, you can opt out by contacting ECHO Health directly at 1-888-492-5579.

Electronic funds transfers (EFTs)

EFTs allow you to receive your payments directly in the bank account you designate rather than receiving them by VCC or paper check. When you enroll in EFT, you will automatically receive electronic remittance advices (ERAs) for those payments. All generated ERAs and a detailed explanation of payment for each transaction will also be accessible to download from the ECHO provider portal (www.providerpayments.com). If you are new to EFT, you will need to enroll with ECHO Health for EFT from AmeriHealth Caritas Next.

Please note: Payment will appear on your bank statement from PNC Bank and ECHO as “PNC – ECHO”.

• To sign-up to receive EFT from AmeriHealth Caritas Next visit https://enrollments.ECHOhealthinc.com/efteradirect/enroll. There is no fee for this service.
• To sign-up to receive EFT from all your payers, visit https://enrollments.ECHOhealthinc.com. A fee for this service may be required.

If you have questions regarding how to enroll in EFT, please reference the AmeriHealth Caritas Next EFT Enrollment Guide (PDF) .

MedPay (MPX)

Offered in partnership with Deluxe Corporation, this payment option includes the digital presentment of three payment modalities – 1) eCheck 2) VCC 3) EFT/ACH. Specifically targeted to providers who have never enrolled for ACH (EFT) and have opted-out of VCC.

Please note: If you have enrolled for MPX with another payer, you will continue to receive your payments through your MPX portal.

Paper

To receive paper checks and paper EOPs, you must opt out of the Virtual Card Services by contacting ECHO Health at 1-888-492-5579, after your initial virtual card payment is received.

AmeriHealth Caritas Next offers ERAs (also referred to as an 835 file) through Change Healthcare/ECHO Health. To receive ERAs from Change Healthcare and ECHO, you will need to include both the Change Healthcare AmeriHealth Caritas Next payer ID and the ECHO payer ID 58379.

All Change Healthcare/ECHO Health-generated ERAs and a detailed explanation of payment for each transaction will be accessible to download from the ECHO provider portal. If you are a first-time user and need to create a new account, please reference ECHO Health's Provider Payment Portal Quick Reference Guide (PDF) for instructions.

Contact your practice management/hospital information system for instructions on how to receive ERAs from AmeriHealth Caritas Next under payer ID 47073 and the ECHO Health payer ID 58379. If your practice management/hospital information system is already set up and can accept ERAs from AmeriHealth Caritas Next, then it is important to check that the system includes both AmeriHealth Caritas Next payer ID 47073 and ECHO Health payer ID 58379 for ERAs.

If you are not receiving any payer ERAs, please contact your current practice management/hospital information system vendor to inquire if your software can process ERAs. Your software vendor is then responsible for contacting Change Healthcare to enroll for ERAs under AmeriHealth Caritas Next payer ID 47073 and ECHO Health payer ID 58379.

If your software does not support ERAs or you continue to reconcile manually, and you would like to start receiving ERAs only, please contact the ECHO Health Enrollment team at 1-888-834-3511.

For enrollment support, please contact ECHO Health Inc. at 1-888-834-3511.

If you have additional questions regarding EFT, or ERAs, please reference our FAQs (PDF) or call ECHO Health Support team at 1-888-492-5579.

• Access the Claims and Billing Manual (PDF).
  Use this guide to help avoid common claim errors and delays in the processing of your claims.