AmeriHealth Caritas Ohio Providers

Change Healthcare System Interruption

We thank you for your partnership and patience, as we continue to work to resolve the downstream impacts of Change Healthcare’s service interruption.

Below is a summary of the current status of our systems and processes:

Eligibility verification, claim status inquiry, prior authorization submission/processing and authorization inquiry: These functionalities continue to operate normally and are available via the NaviNet provider portal. If you do not have access to NaviNet, please visit: https://register.navinet.net/ to sign up.

1. Electronic remittance advice (ERA/835) files: Payment recovery details are currently provided on the remittance advice or 835 you receive with your payments for claims processed on and after May 6, 2024.
   
   For claims processed February 21, 2024, through May 5, 2024, AmeriHealth Caritas Ohio has generated a comprehensive claims recovery report available in the NaviNet provider portal. For more details for accessing this report see the Remittance advice payment recovery details now available provider notice. For current claims payments, providers can view and download an electronic remittance PDF via the NaviNet provider portal. Providers may also access the ERA/835 file through the ECHO Health provider payment portal at: www.providerpayments.com. Providers who are not currently registered with ECHO for access to the portal will have to create a new account.
   
   
2. 275 Claim Attachment Transactions: AmeriHealth Caritas Ohio 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: 84243.

• A maximum of 10 attachments are allowed per submission. Each attachment cannot exceed 10 megabytes (MB) and total file size cannot exceed 100MB. The acceptable supported formats are pdf, tif, tiff, jpeg, jpg, png, docx, rtf, doc, and txt. 
• There are two ways 275 attachments can be submitted:
• Batch — You may either connect to Availity directly or submit via your EDI clearing house.
• Portal — Individual providers may also register at: https://www.availity.com/Essentials-Portal-Registration to submit attachments.
• 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].
• Specific 275 claim attachment transaction report codes must be used when submitting an attachment. Visit https://www.amerihealthcaritasoh.com/provider/claims-billing/index.aspx for the list of applicable codes.

For questions, contact your dedicated Provider Network Account Executive or Provider Services at: 1-833-644-6001.

Latest updates

Electronic claims submission

Providers with Electronic Data Interchange (EDI) capabilities may submit claims, eligibility inquiries, claim 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. For more information, visit https://medicaid.ohio.gov/resources-for-providers/billing/trading-partners/trading-partners.

Direct claim entry

Direct Data Entry (DDE) providers should submit claims via the AmeriHealth Caritas NaviNet Provider Portal. Visit our claims and billing page for more information.

Medicaid Annual Eligibility Redetermination Reviews

Important information for providers regarding Annual Eligibility Redetermination Reviews.

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