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
- Message Us: Secure Correspondence: Log in to the Provider Portal [medicaid.dhss.delaware.gov]
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 attachments via Change Healthcare. Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 attachment submissions via payer ID: 77799
There are three ways that 275 attachments can be submitted.
- Batch — You may either connect to Change Healthcare directly or submit via your EDI clearinghouse.
- API via JSON — You may submit an attachment for a single claim.
- Portal — Individual providers can register at Change Healthcare to submit attachments.
The acceptable supported formats are PDF, tif, tiff, jpeg, jpg, png, docx, rtf, xml, doc, and txt. View the Change Health Care 275 claims attachment transaction video for detailed instructions on this new process.
In addition, the following 275 claims attachment report codes have been added effective 8/1/23. When submitting an attachment, use the applicable code in field number 19 of the CMS 1500 or field number 80 of the UB04, as documented in the Claims Filing Instructions (PDF).
| 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?
- Provider Reference Guide (PDF).
Keep this sheet of contact information close by for when you need to give us a call. - Contact your Account Executive.
The best partnerships are formed by staying in touch. If you have questions about us, contact your Account Executive or email delawareprovidernetwork@amerihealthcaritas.com. - Frequently asked questions.
Do you have a question about working with AmeriHealth Caritas Delaware? Start here. - Let Us Know.
Get help with urgent member needs using resources such as the Rapid Response and Outreach Team (RROT). - Find a form.
We compiled all of our forms in one spot to help save you time. - Prior authorizations.
Receive prior authorization before administering some health services to members. - Download your provider manual (PDF).
This manual will help you and your office staff provide services to our members. - Get credentialed.
Let's work together to enrich the lives of our members through the delivery of quality health care. - Find a doctor, drug, or pharmacy.
Use our directory to find other providers in our network. - Learn more about our claims and billing process.
See how to get your payment quickly, electronically, or by paper. - Training and education
Our training and education materials are an important part of delivering superior health care to our members.