Claims and Billing
Filing claims is fast and easy for AmeriHealth Caritas Ohio providers. Here you will find the tools and resources you need to help manage your submission of claims and receipt of payments.
What would you like to do?
How to Submit Claims
Providers may submit claims, prior authorizations, and associated attachments through the centralized Ohio Provider Network Management (PNM) system.
Providers may submit claims, prior authorization requests, eligibility inquiries, claims status inquiries and associated attachments using Electronic Data Interchange (EDI) by being a trading partner (TP) authorized by ODM or by contracting with an ODM-authorized TP. All AmeriHealth Caritas Ohio provider claims may be submitted to the Plan via the central PNM portal for electronic claims submission. Claims for billable services provided to AmeriHealth Caritas Ohio members must be submitted by the provider who performed the services.
Links to the ODM PNM system and step-by-step guidance on new centralized claims submission procedures will be available closer to the fourth quarter of 2022 launch date.
Ohio Department of Medicaid (ODM) billing guidelines
- Ohio Department of Medicaid billing information
- ODM HIPAA Transaction Standard Companion Guide: 837 Institutional Fee-For-Service Claims (PDF)
- ODM HIPAA Transaction Standard Companion Guide: 837 Professional Health Care Claim (PDF)
- ODM HIPAA Transaction Standard Companion Guide: 837 Dental Fee-For-Service Claims (PDF)
AmeriHealth Caritas Ohio's Payer ID
- For all claims EXCEPT transportation: 35374
- For transportation claims only: 42435
All claims sent to AmeriHealth Caritas Ohio, through the central PNM portal, should include the AmeriHealth Caritas Ohio Payer ID in 1000B Receiver Loop and 2010BB Payer Name Loop.
Check claim status
- Go to NaviNet, our secure provider portal.
- Call our provider center at 1-833-644-6001.
- Visit ODM's PNM portal.
Dispute a claim
More information will be available in the fourth quarter 2022.