Claims, Billing, and Payment

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 electronic data interchange [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.

Submit a 275 claim attachment transaction

AmeriHealth Caritas Next is accepting ANSI 5010 ASC X12 275 claim attachment transactions (unsolicited) via Availity. Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 claim attachment transaction submissions via payer ID: 45408

A maximum of 10 attachments are allowed per submission. Each attachment cannot exceed 10 megabytes (MB) and total file size cannot exceed 100 MB.

There are two ways 275 claim attachments can be submitted:

The acceptable supported formats are pdf, tif, tiff, jpeg, jpg, png, docx, rtf, doc, and txt.

After logging in, providers registered with Availity may access the Attachments - Training Demo for detailed instructions on the submission process via: Training Link [apps.availity.com].

The following 275 claim attachment transaction report codes must be used when submitting an attachment. Enter the applicable code in field number 19 of the CMS 1500 or field number 80 of the UB04, as documented in the Claim Filing Instructions (PDF).

Attachment type Claim assignment attachment report code
Itemized Bill 03
Medical Records for HAC review M1
Single Case Agreement (SCA)/LOA 04
Advanced Beneficiary Notice (ABN) 05
Consent Form CK
Manufacturer-suggested Retail Price/Invoice 06
Electric Breast Pump Request Form 07
CME Checklist Consent Forms (Child Medical Eval.) 08
EOBs – for 275 attachments, should only be used for noncovered or exhausted benefit letter EB
Certification of the Decision to Terminate Pregnancy CT
Ambulance Trip Notes/Run Sheet AM
<div class="small alert alert-info show my-4 pt-3 pb-2 px-1 sitewideAlert" role="alert" aria-live="polite">
<div class="container">
<h2 class="h6 text-dark">Claims submission alert:</h2>
<p class="text-dark">Please note that AmeriHealth Caritas&nbsp;operates three different health plans in Florida. To enable prompt payment, please be careful to charge your claims to the correct health plan by using the correct payer ID when you submit your claims. Please consult the table below for the appropriate plan payer ID. <strong>Improper claim submission could result in denied claims and payment delays.</strong></p>
<table class="ctaBoxTable table table-striped table-light">
<tbody>
<tr>
<th scope="col">Plan name</th>
<th scope="col">AmeriHealth Caritas Florida</th>
<th scope="col">AmeriHealth Caritas Next</th>
<th scope="col">AmeriHealth Caritas VIP Care</th>
</tr>
<tr>
<th scope="row">Plan type</th>
<td>Medicaid<br /> Medicaid Services offered under the Florida Statewide Medicaid Managed Care Program (SMMC)</td>
<td>Individual and family health plans both on and off the&nbsp;Health Insurance Marketplace</td>
<td>Medicare Advantage Dual Eligible Special Needs Plan (D-SNP)</td>
</tr>
<tr>
<th scope="row">Plan payer ID</th>
<td>77003</td>
<td>45408</td>
<td>88232</td>
</tr>
</tbody>
</table>
</div>
</div>
<p>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.</p>
<p>All claims submitted by providers <strong>must</strong> be billed on the CMS-1500 or UB-04, or the electronic equivalent (via electronic data interchange [EDI]) of these standard forms.</p>
<h2>Timely claims filing</h2>
<h3>In-network claims</h3>
<ul>
<li>Original submission must be submitted no more than 180 days from date of service.</li>
<li>Rejected claims must be resubmitted no more than 180 days from date of service.</li>
<li>Denied claims must be resubmitted within 365 days from date of service.</li>
</ul>
<h3>Out-of-network providers</h3>
<ul>
<li>All claims must be submitted within 180 days from date of service.</li>
</ul>
<h3>Submit a 275 claim attachment transaction</h3>
<p>AmeriHealth Caritas Next Florida is accepting ANSI 5010 ASC X12 275 claim attachment transactions (unsolicited) via Availity. Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 claim attachment transaction submissions via payer ID: 45408</p>
<p>A maximum of 10 attachments are allowed per submission. Each attachment cannot exceed 10 megabytes (MB) and total file size cannot exceed 100MB.</p>
<p>There are two ways 275 claim attachments can be submitted:</p>
<ul>
<li>Batch — You may either connect to Availity directly or submit via your EDI clearing house.</li>
<li>Portal — Individual providers may also register at https://www.availity.com/Essentials-Portal-Registration to submit attachments.</li>
</ul>
<p>The acceptable supported formats are pdf, tif, tiff, jpeg, jpg, png, docx, rtf, doc, and txt.</p>
<p>After logging in, providers registered with Availity may access the Attachments - Training Demo for detailed instructions on the submission process via: Training Link [apps.availity.com].</p>
<p>The following 275 claim attachment transaction report codes must be used when submitting an attachment. Enter the applicable code in field number 19 of the CMS 1500 or field number 80 of the UB04, as documented in the Claim Filing Instructions</p>
<table class="table table-striped small" id="reimbursementPolicyTable">
<thead>
<tr>
<th>Attachment type</th>
<th>Claim assignment attachment report code</th>
</tr>
</thead>
<tbody>
<tr>
<td>Itemized Bill</td>
<td>03</td>
</tr>
<tr>
<td>Medical Records for HAC review</td>
<td>M1</td>
</tr>
<tr>
<td>Single Case Agreement (SCA)/LOA</td>
<td>04</td>
</tr>
<tr>
<td>Advanced Beneficiary Notice (ABN)</td>
<td>05</td>
</tr>
<tr>
<td>Consent Form</td>
<td>CK</td>
</tr>
<tr>
<td>Manufacturer-suggested Retail Price/Invoice</td>
<td>06</td>
</tr>
<tr>
<td>Electric Breast Pump Request Form</td>
<td>07</td>
</tr>
<tr>
<td>CME Checklist Consent Forms (Child Medical Eval.)</td>
<td>08</td>
</tr>
<tr>
<td>EOBs &ndash; for 275 attachments, should only be used for noncovered or exhausted benefit letter</td>
<td>EB</td>
</tr>
<tr>
<td>Certification of the Decision to Terminate Pregnancy</td>
<td>CT</td>
</tr>
<tr>
<td>Ambulance Trip Notes/Run Sheet</td>
<td>AM</td>
</tr>
</tbody>
</table>

What would you like to do?

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 1-833-983-3577.

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: 7044

Professional claims: 9427

To learn how to navigate ConnectCenter visit the resources below.

User guides

Submit claims through electronic data interchange (EDI) for faster, more efficient claims processing and payment. See the "Submitting claims electronically" section of this page for more details.

AmeriHealth Caritas Next's Florida EDI payer ID number 45408.

Send paper claims to:

AmeriHealth Caritas Next
Attn: Claims Processing Department
P.O. Box 7344
London, KY 40742-7344

To check your claim status, sign in to NaviNet and select Claims Status Summary under Administrative Reports, or call Provider Services at 1-833-983-3577.

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 the 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 (PDF) 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 health care 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 VCC are that providers do not have to enroll or fill out multiple forms to receive VCC, 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 with 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.”

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 835 files) 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 45408 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 45408 and the ECHO 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 45408 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 the AmeriHealth Caritas Next payer ID 45408 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 EFTs or ERAs, please reference our FAQs (PDF) or call ECHO Health Support team at 1-888-492-5579.

For Providers