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.

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Submit a claim

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

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

Provider Claim Dispute Process

Provider claim disputes are any provider inquiries, complaints, or requests for reconsiderations ranging from general questions about a claim to a provider disagreeing with a claim denial. Provider claim disputes do not include provider disagreements with the health plan’s decision to deny, limit, reduce, suspend, or terminate a covered services for lack of medical necessity that are subject to external medical review as described in Section VI of the Provider Manual (PDF).

Providers may file a written claim dispute no later than 12 months from the date of service or 60 calendar days after the payment, denial, or partial denial of a timely claim submission, whichever is later.

Provider claim disputes, along with supporting documentation, may be submitted by mail, by fax, or online. If submitting by mail or fax, please include a completed Provider Claim Dispute Form (PDF).

Mail:

AmeriHealth Caritas Ohio
Attn: Provider Claim Disputes
P.O. Box 7126
London, KY 40742

Fax:

1-833-216-2272
Attn: Claim Disputes

Online:

Requests for reconsideration (disputes) may be submitted through the NaviNet® Electronic Claim Inquiry feature. For detailed information on electronic claim inquiry submission, please see the NaviNet Claims Investigation User Guide (PDF).