Skip to Main content

Getting started

NOTE: Some phone numbers may not be operational until February 1, 2020. Providers should call Provider Recruitment at 1-844-399-0474 or email ProviderRecruitmentNC@amerihealthcaritas.com if they need additional information or assistance.

Manuals and Guides

  • Provider manual (PDF) and provider manual revision log (PDF)
    A guide to assist your practice in serving our members. You can view/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 not a complete list. If you do not see the service you are seeking, call Utilization Management at 1-833-900-2262
  • NCDHHS Provider Playbook: Medicaid Managed Care
    Access the latest information, tools and other resources from NCDHHS to help you and your patients smoothly transition to Medicaid Managed Care

Drug Formulary

Prior Authorizations

  • Prior Authorizations process.*
    *NOTE: The Prior Authorization process and related forms will not be available until October 1, 2019.

Provider Training Schedules

Network News

  • A no-cost e-mail service that allows you to go paperless and receive information from us faster.  Subscribe to this service.

NaviNet

Beginning February 1, 2020, NaviNet will allow easy access to member eligibility verification, claims submission and status, claims investigation, prior authorization submission and access to member panel rosters for PCPs 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 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. On January 20, you will be able to access the AmeriHealth Caritas North Carolina information. Specific member data for your practice will be available February 1.
  • If you are not a NaviNet user, you will be able to regiser for NaviNet beginning January 13. Visit https://navinet.navimedix.com 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.

Efficient Claims Submission and Payment:

AmeriHealth Caritas North Carolina works with Change Healthcare to speed your claim payments. As long as you have the capability to send electronic data interchange (EDI) claims to Change Healthcare through direct submission or via another clearinghouse/vendor, you may submit claims electronically.

    • 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.
    • Reminder: Your Provider ID for submitting claims or receiving electronic funds transfer (EFT) payments is your NPI number.
    • Sign up with Change Healthcare to receive EFT at 1-877-363-3666 or visit https://www.changehealthcare.com.
    • For assistance, contact Change Healthcare provider support at 1-877-363-3666 or visit https://www.changehealthcare.com.

*This number is not yet operational. We look forward to answering your calls in the near future. In the interim, please contact Provider Recruitment at 1-844-399-0474.