Claims and Billing
Change Healthcare System Interruption
Change Healthcare, our electronic data interchange (EDI) clearinghouse for claims and payment cycle management, continues to address their network interruption related to a security incident. Below are updates for our systems and processes:
- Claims payments: We have resumed payments for claims submitted prior to the incident. Since Change Healthcare is still unable to accept claims submissions, providers who submitted claims during the outage may be able to resubmit them either through additional solutions identified below through Availity and PCH Global, or once Change Healthcare’s connectivity is restored, through Change Healthcare. We appreciate the inconvenience this is causing.
- Electronic claims submission: We have established a connection with Availity to receive electronic claims. If you or your clearinghouse do not currently use Availity to submit claims, you may register at: https://www.availity.com/Essentials-Portal-Registration. You will find registration options for Healthcare and Atypical Provider, so please choose the one that aligns with your business. For registration process assistance and other resources, access the training site link on the Availity registration page.
- Manual claims submission: We have established a direct claims entry process through PCH Global. To submit claims directly, 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
- PO 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.
- Electronic remittance advice: Electronic remittances are available at this time. However, some individual remittance advices may not be available due to Change Healthcare’s security incident.
- Prior authorization submission and processing: The prior authorization systems continue to operate normally.
- Eligibility verification, claim status inquiry, and authorization inquiry: These capabilities continue to be available via NaviNet. If you do not have access to NaviNet provider portal, please visit https://register.navinet.net/ to sign up.
Please note, in the interim, our Provider Services Department will not be able to assist with the processing of your payments any sooner. If you have other questions, you may contact Provider Services at 1-888-738-0004.
We thank you for your partnership and will continue to provide updates as we work to resolve the downstream impacts of Change Healthcare’s service interruption.
Filing claims is fast and easy for AmeriHealth Caritas North Carolina providers. Here you can find the tools and resources you need to help manage your submission of claims and receipt of payments. You may also refer to our Provider Claims and Billing Manual (PDF) for helpful information.
What would you like to do?
As of July 1, 2022, AmeriHealth Caritas North Carolina is accepting ANSI 5010 ASC X12 275 attachments (unsolicited) via our preferred vendor 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: 81671.
There are three ways the 275 attachments can be submitted. The acceptable supported formats are PDF, TIF, TIFF, JPEG, JPG, PNG, DOCX, RTF, XML, DOC, and TXT.
- Batch — You may either connect to Change Healthcare directly or submit via your EDI clearing house.
- API via JSON — You may submit an attachment for a single claim.
- Portal — Individual providers can register at Change Healthcare to submit attachments.
For more information on Claims submission via Change Healthcare, see the tab below.
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.
To check your claim status, sign in to NaviNet and select Claims Status Summary under Administrative Reports. Call Provider Services at 1-888-738-0004 or contact your dedicated Account Executive for assistance.
Submit claims through electronic data interchange (EDI) for faster, more efficient claims processing and payment. See the "Submitting claims electronically" section of this page for more details.
AmeriHealth Caritas North Carolina's EDI payer ID number is 81671.
Send paper claims to:
AmeriHealth Caritas North Carolina
Attn: Claims Processing Department
P.O. Box 7380
London, KY 40742-7380
- Medical payment cycles run every Monday, Wednesday and Friday.
- Pharmacy payment cycles run every four days.
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.
Change Healthcare uses a tool called ConnectCenter to improve claims management functionality. Providers who have a limited ability to submit claims through their hospital or project management system may now benefit from key features of the ConnectCenter tool. There is no cost to providers to use ConnectCenter.
Key features are:
- Claims users do not need to choose between data entry of claims and upload of 837 files. All users may do both.
- Secondary and tertiary claims can be submitted.
- Institutional claims are supported.
- Claims created online are fully validated in real-time so that providers can correct them immediately.
- Whether providers upload their claims or create them online, the claim reports are integrated with the claim correction screen for ease in follow-up.
- Dashboard and work list views enable providers to streamline their billing to-do list.
- Remittance Advice is automatically linked to provider's submitted claim, providing a comprehensive view of the status of their claim.
- Electronic medical attachments can be submitted using the Medical Attachment Portal. Get more information or support with this new feature on Change Healthcare’s website.
To register for ConnectCenter, visit ConnectCenter Sign Up. If you need assistance, Change Healthcare customer support is available through online chat or by phone at 1-800-527-8133, option 2.
To learn how to navigate ConnectCenter visit the resources below.
Video Tutorials
User Guides
- Claims – Getting Started PDF
- Claims – Status PDF
- Claims – Uploading a Claim PDF
- Eligibility Getting Started PDF
- Enrollment Central PDF
- Keying Institutional Claims PDF
- Keying Professional Claim PDF
- Provider Management - Getting Started PDF
- Provider Sign-up and User Management PDF
- Remits - Getting Started PDF
AmeriHealth Caritas North Carolina claims can be submitted electronically through Change Healthcare, or via another clearinghouse. Contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic claim submissions to AmeriHealth Caritas North Carolina. You can also visit Change Healthcare's website for information on enrolling.
AmeriHealth Caritas North Carolina does not require you to enroll with Change Healthcare to submit electronic claims. If you already use another EDI vendor to submit claims electronically, inform your vendor of the AmeriHealth Caritas North Carolina EDI payer ID: 81671
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.
If you have never received an EFT payment through ECHO Health for any payer, please use the fillable form linked below to complete your registration. It will be helpful to use the ERA/EFT Supplemental Guide to walk you through the steps on the form.
When you complete the form, you may submit it using any of the following options:
- Secure email: EDI@ECHOHealthInc.com
- Fax: 1-440-835-5656
- Mail: 810 Sharon Drive, Westlake OH 44145
ECHO Claims payment schedule
- Medical payment cycles run every Monday, Wednesday and Friday.
- Pharmacy payment cycles run every four days.
AmeriHealth Caritas North Carolina offers ERAs (also referred to as an 835 file) through Change Healthcare/ECHO Health. To receive ERAs from Change Healthcare and ECHO, you will need to include both the Change Healthcare AmeriHealth Caritas North Carolina payer ID and the ECHO payer ID 58379.
All Change Healthcare/ECHO HEALTH generated ERAs and a detailed explanation of payment for each transaction will be accessible to download 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.
For enrollment support, please contact ECHO Health Inc. at 1-888-834-3511.
If you have additional questions regarding EFT, or ERAs, please reference our FAQ or call ECHO Health Support team at 1-888-492-5579.
Change Healthcare uses a tool called ConnectCenter to improve claims management functionality. Providers who have a limited ability to submit claims through their hospital or project management system may now benefit from key features of the ConnectCenter tool. There is no cost to providers to use ConnectCenter.
Key features are:
- Claims users do not need to choose between data entry of claims and upload of 837 files. All users may do both.
- Secondary and tertiary claims can be submitted
- Institutional claims are supported
- Claims created online are fully validated in real-time so that providers can correct them immediately
- Whether providers upload their claims or create them online, the claim reports are integrated with the claim correction screen for ease in follow-up
- Dashboard and work list views enables providers to streamline their billing to-do list
- Remittance Advice is automatically linked to provider's submitted claim, providing a comprehensive view of the status of their claim
- Electronic medical attachments can be submitted using the Medical Attachment Portal. Get more information or support with this new feature on Change Healthcare’s website.
To register for ConnectCenter, visit ConnectCenter Sign Up. If you need assistance, Change Healthcare customer support is available through online chat or by phone at 1-800-527-8133, option 2.
To learn how to navigate ConnectCenter visit the resources below.
Video Tutorials
User Guides