Claims and Billing

ACNC is accepting ANSI 5010 ASC X12 275 claim attachments (unsolicited) via the Availity Intelligent Gateway. 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: 81671.

A maximum of 10 attachments are allowed per submission. Each attachment cannot exceed 10 megabytes (MB) and total file size cannot exceed 100MB. There are two ways the 275 attachments can be submitted.

• Batch — You may either connect to the Availity Intelligent Gateway directly or submit via your EDI clearing house.
  
  
• Portal — Individual providers can register at Availity to submit attachments.

After logging in, providers registered with Availity may access the Attachments - Training Demo for detailed instructions on the submission process via this Training Link.

When submitting an attachment, use the applicable code from the list below in field number 19 (additional claim information of CMS 1500) or field number 80 (remarks field) of UB04.

There are two ways to submit:

1. PCH Global (No cost to providers)

To enroll for claims submission through PCH Global, please go to https://pchhealth.global and click the Sign-Up link in the upper right-hand corner to register.

• 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 - AmeriHealth Medical Management - North Carolina
• P.O. Box: 7380

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

2. Optum/Change Healthcare ConnectCenter™

The direct entry claims portal, ConnectCenter, is available for reconnection, at no cost, 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.

To reconnect:

• Access the login page via the Claims submission link in the NaviNet provider portal or via one of the direct links below:
• Connect Center connectcenter.changehealthcare.com
• physician.connectcenter.changehealthcare.com.
  
  
• 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.

There are two ways to submit:

1. Availity Intelligent Gateway

If you or your clearinghouse do not currently use Availity to submit claims, you must register with Availity at Availity Lifeline Self-Serve Resources.

• Providers who are currently registered with Availity for another payer, or using another clearinghouse, must request to have their electronic claims for ACNC 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.

2. Optum/Change Healthcare

Although ACNC has not reconnected directly to Change Healthcare, providers may submit claims to ACNC through Change Healthcare.

• Providers will have to establish new connectivity with Optum.
• For new connectivity requirements, reach out to your Optum/Change Healthcare account representative.
• If you do not know who your account representative is, you can submit an inquiry via the Change Healthcare General Inquiry form.

Send paper claims to:

AmeriHealth Caritas North Carolina
Attn: Claims Processing Department
P.O. Box 7380
London, KY 40742-7380

A remittance advice (or ERA/835) for each transaction is included with your payments.

ACNC offers ERAs (also referred to as an 835 file) through ECHO Health.

All ECHO HEALTH generated ERAs and a detailed explanation of payment for each transaction are accessible to download through our NaviNet Provider portal or from the ECHO provider portal. 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) for instructions.

Contact your practice management/hospital information system for instructions on how to receive ERAs from AmeriHealth Caritas North Carolina under Payer ID 81671 and the ECHO Payer ID 58379. If your practice management/hospital information system is already set up and can accept ERAs from AmeriHealth Caritas North Carolina, then it is important to check that the system includes both AmeriHealth Caritas North Carolina and ECHO Health Payer ID 58379 for ERAs.

If you are not receiving any payer ERAs, please contact your current practice management/hospital information system vendor to inquire if your software has the ability to process ERAs. Your software vendor is then responsible for contacting Change Healthcare to enroll for ERAs under AmeriHealth Caritas North Carolina Payer ID 81671 and ECHO Health Payer ID 58379.

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

Payment Recovery Details

Recovery details are currently provided on the remittance advice or 835 you receive with your payments for claims processed on and after May 6, 2024. 

For claims processed February 21, 2024, through May 5, 2024, ACNC has generated a comprehensive claims recovery report available in the NaviNet provider portal. The claims recovery report provides payment recovery details by your member’s account number, claim number, provider tax ID, payee/group ID and NPI.

To access the claims recovery report:

1. Log in to the NaviNet provider portal.
2. Select applicable health plan.
3. Go to Report Inquiry under Workflows for this Plan.
4. Click on Administrative Reports > Claim Recovery Report

• ACNC utilizes the NCDHHS fee schedules.
• Medical payment cycles run every Monday, Wednesday and Friday.
• Pharmacy payment cycles run every four days.

AmeriHealth Caritas North Carolina has contracted with Change Healthcare and ECHO^® Health Inc., to administer electronic funds transfer (EFT) payments. There are no fees for single-payer agreements to receive a direct payment from AmeriHealth Caritas North Carolina via EFT or to receive an electronic remittance advice (ERA).

How to enroll

If you already receive payments from ECHO Health, you may be able to enroll for EFT with AmeriHealth Caritas North Carolina using your existing account. Please make sure you have an ECHO Health draft number and corresponding payment amount so your enrollment request can be validated. A draft number is listed as the EPC draft number on ECHO Health's explanation of payments. If you need assistance locating an ECHO payment in order to register, you can contact ECHO at 1-800-946-4041, Monday through Friday, from 8 a.m. to 6 p.m. ET.

Please use the ECHO Health EFT/ERA Enrollment link below to complete your registration. It will be helpful to use information from your first check stub to register..

• ECHO Health EFT/ERA Enrollment

ECHO claims payment schedule

• Medical payment cycles run every Monday, Wednesday and Friday.
• Pharmacy payment cycles run every four days.

To inquire about claim status, sign in to NaviNet and select Claims Status Summary under Administrative Reports. Provider Services can help check the status of up to 5 claims via phone at 1-888-738-0004.

You can appeal a claims decision online by signing in to NaviNet and selecting the Provider Grievances and Appeals option in the right-hand navigation. Or, if you prefer, you may download the Appeals Submittal form from our forms section of our website and submit your request, along with any supporting documentation, in writing to:

AmeriHealth Caritas North Carolina
Attn: Provider Grievances and Appeals
P.O. Box 7379
London, KY 40742-7381

Submitting claims electronically

AmeriHealth Caritas North Carolina contracts with Change Healthcare — one of the largest electronic data interchange (EDI) clearinghouses in the country — to offer state-of-the-art EDI and other electronic billing services. Use of EDI can boost claims submission efficiency and timeliness of reimbursement to enhance your revenue cycle.