Claims and Billing
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.
Note: The following NCDHHS guidance (excerpted from the Good Faith Provider Contracting Policy PDF) will take effect January 1, 2022:
With the exception of out of network emergency services, post-stabilization services and services provided during transitions in coverage, ACNC is prohibited from reimbursing an out of network provider more than ninety percent (90%) of the Medicaid Fee-for-Service rate if: 1. ACNC has made a good faith effort to contract with a provider but the provider has refused that contract. F. ACNC Provider Network Management will notify the Provider Data Management department to create a provider record in the claims payment system for the Provider with whom good faith contracting efforts have failed, per Section I.B., and attach a ninety percent (90%) payment agreement to the Provider's record.
Learn more about joining the AmeriHealth Caritas North Carolina network.
What would you like to do?
As of July 1, 2022, AmeriHealth Caritas North Carolina is accepting ANSI 5010 ASC X12 275 attachments (solicited and 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.
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
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.
- Medical payment cycles run every Monday, Wednesday and Friday.
- Pharmacy payment cycles run every four days.
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.
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.
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
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
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.
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 – Friday from 8 a.m. – 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.
- ECHO Health EFT/ERA Enrollment Form PDF
- ECHO Health EFT/ERA Supplemental Guide Enrollment Instructions PDF
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.
Supplemental Billing Information
CAQH CORE and NACHA Provider Case Studies in EFT/ERA Implementation PDF
Council for Affordable Quality Healthcare.