AmeriHealth Caritas Ohio Providers
Working with you, we will help you deliver excellent care and improved health outcomes to the AmeriHealth Caritas Ohio’s Ohio Department of Medicaid (ODM) Medicaid Managed Care enrollees: our members.
If you have questions, you can call AmeriHealth Caritas Ohio Provider Services at 1-833-644-6001.
- Provider Manual (PDF)
A guide to assist your practice in serving our members. You can view/print the Provider manual or request a hard copy of the provider manual by calling Provider Services at 1-833-644-6001.
- Network News
A no-cost e-mail service that allows you to go paperless and receive information from us faster. Subscribe to this service.
- Efficient Claims Submission and Payment
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. For more information on TPs, please visit the ODM TP webpage. 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 launch date in the fourth quarter of 2022.
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.
NaviNet allows easy access to Member eligibility verification, claims submission and status, claims investigation, prior authorization submission, and access to member panel rosters for PCPs included under your contract.
- If you are already a NaviNet user for your other health plans, AmeriHealth Caritas Ohio will be automatically added to your account. On December 1, 2022, you will be able to access the AmeriHealth Caritas Ohio information, and any specific data for your practice.
- If you are not a NaviNet user, visit https://navinet.navimedix.com to sign up. You will need your Federal Tax ID number. Make sure to complete all information requested. On December 1, you will be able to access the AmeriHealth Caritas Ohio information and any specific data for your practice.
- If you need more information or assistance, call NaviNet at 1-888-482-8057 or AmeriHealth Caritas Ohio Provider Services at 1-833-644-6001.