Hurricane Helene Disaster Recovery for Providers

Are you an AmeriHealth Caritas Next provider who has been affected by Hurricane Helene?

AmeriHealth Caritas Next stands with our provider network during this period of hurricane emergency. AmeriHealth Caritas Next has implemented the following adjustments beginning September 25, 2024, for all North Carolina providers:

Provider flexibilities

  • You will still be able to access important information through our provider portal, including:
    • Member eligibility and benefits information, including Member in pending status
    • Panel roster reports
    • Care gap reports to identify needed services
    • Member clinical summaries
    • Social determinants of health information
    • Admission and discharge reports
    • Medical and pharmacy claims data
    • Electronic submission of prior authorization requests
  • Temporary pause of prior authorization requirements. While this pause on prior authorizations is in place, providers can render services prior to obtaining authorization and services will not be denied for failure to obtain prior authorization.
  • Extended grievances and appeals deadlines for 30 days from the date they would have expired.
  • Temporary flexibilities for members to see out of network providers if an in-network provider is not available. No prior authorization is required.
  • Members may refill their regular medications earlier than usual to ensure a sufficient supply.

Use of out-of-network providers, facilities, and pharmacies is authorized when access to in-network providers and pharmacies is unavailable or when traveling to in-network providers, facilities, and pharmacies is difficult, unsafe, or not practical.

AmeriHealth Caritas Next encourages all providers to enroll in electronic funds transfer (EFT), using this ECHO Health EFT/ERA Enrollment link to complete your registration. It will be helpful to use information from your first check stub to register. See the Claims and Billing webpage for more information. If you have questions or are experiencing any problems, please contact a Provider Network Account Executive (PDF) for support.

Pharmacy providers

AmeriHealth Caritas Next has lifted refill too soon edits on medications in response to the Hurricane emergency. AmeriHealth Caritas Next members are able to refill their medications to replace lost or damaged medications and can transfer prescriptions to a different pharmacy if their regular pharmacy is unavailable or lacks supplies. If members need help finding an open pharmacy, please use the following link https://www.ncbop.org/emergencyoperatingpharmacieshelene.html on the North Carolina Board of Pharmacy website.

If you are a pharmacy in one of the counties affected by Hurricane Helene and are open and available to provide services to patients, we ask that you please notify the North Carolina Board of Pharmacy by either sending an email to the North Carolina Board of Pharmacy with your pharmacy details such as permit number, name, physical address, phone number, and days and hours of operation, or complete the North Carolina Board of Pharmacy’s form (PDF) and email it to emergency@ncbop.org.

Providers should contact PerformRxSM Pharmacy Provider Services, for assistance with prescription flexibility processing during the state of emergency at 1-844-280-9131. Hours of operation: 8 a.m. to 6 p.m. After hours, Saturdays, Sundays, and holidays, please call the 24/7 Pharmacy Member Services number at 1-844-211-0968.

Verifying member eligibility

Ask to see the member’s plan ID card.

For automated real time eligibility, call AmeriHealth Caritas Next Provider Services. Hours of operation: Monday through Friday 8 a.m. to 6 p.m. at 1-855-266-0219 and follow the prompts for member eligibility.

OR

Access NaviNet, our provider portal, a free, web-based application for electronic transactions and information through a secure multi-payer portal.

AmeriHealth Caritas Next emergency policy changes are temporary and will expire November 29, 2024. This page will be updated with new information as it becomes available.

If you have additional questions or need assistance, please contact your AmeriHealth Caritas Next Provider Services. Hours of operation: Monday through Friday 8 a.m. to 6 p.m. at 1-855-266-0219.

For Providers