Getting Started

Claims submission

• The AmeriHealth Caritas North Carolina EDI Payer ID number is 81671.
• AmeriHealth Caritas North Carolina does not require your practice or facility to enroll with Change Healthcare to submit EDI claims. Electronic claim submissions to AmeriHealth Caritas North Carolina will follow the same process as other electronic commercial submissions.
• Your Provider ID for submitting claims or receiving electronic funds transfer (EFT) payments is your NPI number.
• Learn more about electronic claims submissions.

Payment

• EFT allows providers to receive payments directly in the bank account of their choice. When enrolled in EFT, providers will automatically receive electronic remittance advices for those payments. To enroll, contact ECHO Healthcare at 1-888-834-3511, Monday to Friday, between 8 a.m. to 6 p.m. ET, or visit https://enrollments.echohealthinc.com/efteradirect/enroll.

Claims payment schedule

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

• AmeriHealth Caritas North Carolina Medication Look-Up Tool.
  Use the Medication Look-Up Tool to search for covered medicines.
• Preferred Drug List (PDL).
• Prescribers are encouraged to write prescriptions for "preferred" products but may prescribe medications that are not on the PDL.
• If a prescriber deems that the patient's clinical status requires therapy with a nonpreferred drug, the prescriber will be responsible for initiating a prior authorization request.

• Provider Manual (PDF)
  This assists your practice in serving our members. You can view or print the provider manual or request a hard copy of the provider manual by calling Provider Recruitment at 1-844-399-0474.
• Quick-Reference Guide (PDF)
  An all-in-one resource containing important contact information.
• Prior Authorization Quick-Reference Guide (PDF)
  A quick-reference guide for services that require prior authorization or notifications. This is not a complete list. If you do not see the service you are seeking, call Utilization Management at 1-833-900-2262.

NaviNet allows easy access to member eligibility verification, claims submission and status, claims investigation, prior authorization submission and access to member panel rosters for primary care providers included under your contract. NaviNet is an easy-to-use, no-cost, web-based solution that links participating providers to AmeriHealth Caritas North Carolina and offers tools for patient health management. NaviNet helps speed up the provider-health plan connection and can often replace paper transactions.

• If you are already a NaviNet user for your other health plans, AmeriHealth Caritas North Carolina will be automatically added to your account.
• If you are not a NaviNet user, you will be able to register for NaviNet. Visit NaviNet's website to sign up. You will need your Federal Tax ID number. Make sure to complete all information requested.

If you need more information or assistance, call NaviNet at 1-888-482-8057 or AmeriHealth Caritas North Carolina Provider Services at 1-888-738-0004.

• Prior Authorization Reference Guide (PDF)
  Refer to this guide for quick information about services requiring prior authorization and how to submit your request.

• Find out more about provider training Schedule of upcoming provider orientation sessions.