Claims and Billing

Submit claims through electronic data interchange (EDI) for faster, more efficient claims processing and payment. AmeriHealth Caritas Delaware EDI payer ID number is 77799

Electronic claims may be submitted via:

Availity

• Providers or clearinghouses not currently using Availity to submit claims, must register at: https://www.availity.com/intelligent-gateway/ Opens a new window.
• Providers who are currently registered with Availity for another payer, or using another clearinghouse, must request to have electronic claims for AmeriHealth Caritas Delaware routed to Availity.
• For registration process assistance, submit the Provider Inquiry form at the bottom of the Availity webpage or contact Availity Client Services at 1-800-AVAILITY (282-4548). Assistance is available Monday through Friday from 8 a.m. to 8 p.m. ET.

Optum/Change Healthcare

• AmeriHealth Caritas Delaware has re-established connectivity with Optum/Change Healthcare.
• Providers who have a software vendor or use another clearinghouse to submit claims to Optum/Change Healthcare will need to consult with their vendor/clearinghouse to see if there have been changes in their process for claims submission.
• For questions contact Optum/Change Healthcare’s call center at: 1-800-527-8133, Monday through Friday from 8 a.m. to 8 p.m. CT.

Providers may submit manual/direct entry claims (at no cost) via:

Optum/Change Healthcare ConnectCenter™

This option is currently only available for providers who were registered with ConnectCenter prior to the security incident. It is not necessary to complete a new registration, and usernames will remain the same. Providers will be notified when the option for new registrations is reinstated.

To reconnect:

• Access the portal via the Claims submission link in the NaviNet provider portal or via one of the direct links below:
  • Connect Center connectcenter.changehealthcare.com Opens a new window
  • physician.connectcenter.changehealthcare.com Opens a new window.
• Follow the instructions on the login page to reset your password and to set up the required multi-factor authentication.
• For more information on available functionality, please review the release notes in the Product News section after signing into the ConnectCenter portal.
• Optum/Change Healthcare also provides helpful user guides to assist providers with navigating the ConnectCenter portal. To access the user guide, visit the Claim Resource section at the bottom of this page.

PCH Global

To enroll for claims submission through PCH Global please go to: https://pchhealth.global.

• Click the Sign-Up link in the upper right-hand corner.
  • Complete the registration process and log into your account. You will be asked how you heard about PCH Global; select Payer, then AmeriHealth. Access your profile by clicking on Manage User and then My Profile. You will need to complete all the profile information. When you go to the Subscription Details screen, select the More option on the right-hand side to see how to enter the promo code Exela-EDI.
  • When you are ready to submit claims, use the following information to search for our payer information:
• Payer name: AmeriHealth Caritas Delaware
• P.O. Box: 801100

For a detailed walk-through of the registration process, refer to the PCH Global Registration manual (PDF) Opens a new window, found on the PCH Global website in the Resource Menu.

Send paper claims to:

AmeriHealth Caritas Delaware
Attn: Claims Processing Department
P.O. Box 80100
London, KY 40742-0100

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 two ways that 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: www.availity.com/documents/learning/LP_AP_GetStarted_Atypical/index.html#/ [linkprotect.cudasvc.com] Opens a new window.

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] Opens a new window or refer to the Availity Claims Attachment Quick Reference guide Opens a new window.

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. Opens a new window

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.

To inquire about claim status, sign in to NaviNet Opens a new window and select Claims Status Summary under Administrative Reports. Provider Claim Services can also check the status of up to 5 claims via phone at 1-800-845-6592.

Requests for reconsideration 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

A Provider Complaint is a request from a health care provider to change a decision made by AmeriHealth Caritas Delaware related to claim payment, policy procedure or administrative functions, or denial for services already provided. A provider complaint is not a pre-service appeal of a denied or reduced authorization for services or an administrative complaint

Provider disputes may be submitted via:

Provider Compliant Form Opens a new window

A Hospital Appeal is a request for AmeriHealth Caritas Delaware to review a decision about a member’s care or adjustment of a payment in accordance with the terms specified in the Hospital agreement; AmeriHealth Caritas Delaware Provider Manual; and/or written policies and procedures. Appeals may be submitted via:

AmeriHealth Caritas Delaware Appeals Information

If a Plan provider identifies improper payment or overpayment of claims from AmeriHealth Caritas Delaware the improperly paid or overpaid funds must be returned to the Plan within 60 days from the date of discovery of the overpayment. Please include the member’s name and ID, date of service and claim ID.

Providers are required to return the improper or overpaid funds by:

AmeriHealth Caritas Delaware refund information. Opens a new window

AmeriHealth Caritas Delaware offers ERAs through ECHO Health, Inc. ECHO is a leading provider of electronic solutions for payments to healthcare providers. ECHO consolidates individual provider and vendor payments into a single compliant format, remits electronic payments and provides an explanation of payment (EOP) details to providers.

To receive ERAs providers will need to include both the Plan payer ID and the ECHO payer ID 58379. Contact your practice management/hospital information system for instructions on how to receive ERAs from AmeriHealth Caritas Delaware under Payer ID 77799 and the ECHO Payer ID 58379.

All ECHO Health-generated ERAs and EOPs for each transaction will be accessible to download from the ECHO provider portal Opens a new window. If you are a first-time user and need to create a new account, please reference ECHO Health's Provider Payment Portal Quick Reference Guide (PDF) Opens a new window for instructions.

If your practice management/hospital information system is already set up and can accept ERAs from AmeriHealth Caritas Delaware it is important to check that their system includes both the Plan and ECHO Health Payer IDs.

If you are not receiving any payer ERAs, contact your current practice management/hospital information system vendor to ask if your software can process ERAs. Your software vendor is then responsible for contacting Optum/Change Healthcare to enroll for ERAs under 77799 and ECHO Health Payer ID 58379.

If your software does not support ERAs or you continue to reconcile manually, but would like to start receiving ERAs only, please contact the ECHO Health Enrollment team at 1-888-834-3511.