AmeriHealth Caritas Delaware Providers

Attention Providers

Restoration of Optum/Change Healthcare Connectivity

Summary: AmeriHealth Caritas Delaware has restored connectivity with Optum/Change Healthcare. The restoration of connectivity with Optum/Change Healthcare affords our providers options for claims submissions.

Electronic claims

AmeriHealth Caritas Delaware providers will have the option of submitting electronic claims via:

  • Optum/Change Healthcare – Providers with a software vendor or who use another clearinghouse to submit claims to Optum/Change Healthcare must consult their vendor/clearinghouse to confirm the process for claim submission. Please note: The 275 Claim Attachment transaction is currently available via Optum/Change Healthcare.
  • Availity - Providers or clearinghouses not currently using Availity to submit claims, must register at: https://www.availity.com/intelligent-gateway/. Please note: The 275 Claim Attachment transaction is currently available via Availity.

Manual/direct entry claims

Providers may submit manual/direct entry claims via:

  • Optum/Change Healthcare ConnectCenter™ - This option is currently only available for providers who had an established account prior to the security incident. Access to the portal and usernames will remain the same but a password reset, and multi-factor authentication are required.
  • PCH Global – Providers not currently using PCH Global must enroll for claims submission at: https://pchhealth.global.

Questions:

If you have questions about this communication, please contact your Provider Account Executive or the Provider Services department at 1-855-707-5818

Thank you for choosing AmeriHealth Caritas Delaware

We are AmeriHealth Caritas Delaware, a mission-driven Medicaid managed care organization. Through dedicated providers like you, we serve Delaware Medicaid members in the Diamond State Health Plan (DSHP), Delaware Healthy Children Program, DSHP-Plus, and DSHP-Plus LTSS programs.

With your partnership, we aim to deliver excellent care and improved health outcomes to our members.

If you have questions, you can call AmeriHealth Caritas Delaware Provider Services at 1-855-707-5818.

**ATTENTION PROVIDERS, IMPORTANT REMINDER**

Have you registered your NPI, Taxonomy and Location with DMAP? If not, you will not be eligible for Medicaid payments after September 30, 2024.

In compliance with 42 CFR § 438.602 [ecfr.gov] and 42 CFR Part 455 [ecfr.gov], subparts B and E and the 21st Century Cures Act [congress.gov], Delaware Medicaid is required to screen and enroll all current and prospective Managed Care Organization-Only Providers (MCOPs).

For additional Information, please contact DMMA:

Provider Services at 1-800-999-3371; Option 0, then Option 4

Email*: delawarepret@gainwelltechnologies.com - *Reminder: Do not send any correspondence that has protected health information (PHI) to this mailbox.

Submit a 275 claim attachment transaction

AmeriHealth Caritas Delaware is accepting ANSI 5010 ASC X12 275 unsolicited claim attachment transactions. The 275 attachments are accepted via Optum/Change Healthcare and 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: 77799

Availity

There are three ways that 275 attachments can be submitted.

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] or refer to the Availity Claims Attachment Quick Reference guide located under Claims Resources at the bottom of this page.

Optum/Change Healthcare

There are two ways 275 claim attachments can be submitted:

  • Batch — You may either connect to Optum/Change Healthcare directly or submit via your EDI clearing house.
  • API (via JSON) — You may submit an attachment for a single claim.

View the Optum Change Healthcare 275 claim attachment transaction video for detailed instructions on this process.

General guidelines

  • A maximum of 10 claim 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.
  • The 275 claim attachments must be submitted prior to the 837. After successfully submitting a 275 claim attachment, an Attachment Control Number will generate. The Attachment Control Number must be submitted in the 837 transactions as follows:
    • CMS 1500
      • Field Number 19
      • Loop 2300
      • PWK segment
    • UB-04
      • Field Number 80
      • Loop 2300
      • PWK01 segment

In addition to the Attachment Control Number, the following 275 claim attachment report codes must be reported in field 19 of the CMS 1500 or field number 80 of the UB-04.

Attachment type Claim assignment attachment report code
Itemized bill

03
Medical records for HAC review

M1
Single Case Agreement (SCA)/LOA 04
Advance Beneficiary Notice (ABN) 05
Consent Form CK
Manufacturer suggested retail price/innovation 06
Electric Breast Pump Request Form 07
CME Checklist consent forms (Child Medical Eval) 08
EOBs – for 275 attachments should only be used for non-covered or exhausted benefit letter EB
Certification of the Decision to Terminate Pregnancy CT
Ambulance trip notes/run sheet AM

How can we help you?

Providers