AmeriHealth Caritas Ohio Providers
The February 1, 2023, launch of the Next Generation of Ohio Medicaid program includes the implementation of the Next Generation managed care plans, Electronic Data Interchange (EDI), and the Fiscal Intermediary (FI). Read more about the NextGen implementation here (PDF).
Beginning February 1, 2023, the Ohio Department of Medicaid Provider Network Management System Direct Data Entry portal will allow providers to submit eligibility inquiries through the Provider Network Management (PNM) system. For more information and guidance, visit https://managedcare.medicaid.ohio.gov/managed-care/centralized-credentialing.
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.
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.