AmeriHealth Caritas Ohio Providers
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: Providers who were unable to successfully submit claims during the outage may now submit them through Change Healthcare once connectivity is restored. We have extended the claims timely filing deadline for claims that would have been rejected due to untimely filing during the service interruption. For more details, see the Claims Timely Filing Deadline Extension provider notice.
- Electronic remittance advice (ERA/835) files: Providers can view and download an electronic remittance pdf via the NaviNet provider portal. Providers may also access the ERA/835 file through ECHO Health. For additional information, please see the recent 835 Access provider notice. NOTE: Due to the Change Healthcare security incident, remittance advices generated after February 21, 2024 may not include all of the information previously provided. As Change Healthcare continues to restore services, this information will become available.
- 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 processing of your payments or obtaining your 835 files any sooner. If you have other questions, you may contact Provider Services at 1-833-644-6001.
We thank you for your partnership and patience. We will continue to provide updates as we work to resolve the downstream impacts of Change Healthcare’s service interruption.
Latest updates
Electronic claims submission
Providers with Electronic Data Interchange (EDI) capabilities may submit claims, eligibility inquiries, claim status inquiries, and associated attachments using Electronic Data Interchange (EDI) by being a trading partner (TP) authorized by ODM or by contracting with an ODM-authorized TP. For more information, visit https://medicaid.ohio.gov/resources-for-providers/billing/trading-partners/trading-partners.
Direct claim entry
Direct Data Entry (DDE) providers should submit claims via the AmeriHealth Caritas NaviNet Provider Portal. Visit our claims and billing page for more information.
Medicaid Annual Eligibility Redetermination Reviews
Important information for providers regarding Annual Eligibility Redetermination Reviews.
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Ohio Department of Medicaid (ODM) billing guidelines
- Ohio Department of Medicaid billing information
- ODM HIPAA Transaction Standard Companion Guide: 837 Institutional Fee-For-Service Claims (PDF)
- ODM HIPAA Transaction Standard Companion Guide: 837 Professional Health Care Claim (PDF)
- ODM HIPAA Transaction Standard Companion Guide: 837 Dental Fee-For-Service Claims (PDF)
AmeriHealth Caritas Ohio’s Payer ID
- For all claims EXCEPT transportation: 35374
All claims sent to AmeriHealth Caritas Ohio, through the central PNM portal, should include the AmeriHealth Caritas Ohio Payer ID in 1000B Receiver Loop and 2010BB Payer Name Loop.
AmeriHealth Caritas Ohio Provider Services is available Monday through Friday, 7 a.m. to 8 p.m., except for the following holidays: New Year’s Day, Martin Luther King Jr. Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Thanksgiving Day, the day after Thanksgiving, and Christmas Day. Phone: 1-833-644-6001. Emergency closures will be listed on our Alerts and Newsletters page.