Claims, Billing, and Payment
Claims submission alert:
Please note that there are two separate plans offered by AmeriHealth Caritas North Carolina, Inc.:
- For AmeriHealth Caritas Next QHP claims, please use EDI payer ID number 83148.
- For AmeriHealth Caritas North Carolina Medicaid claims, please use EDI payer ID number 81671.
Please see the complete notice (PDF) for more information. Improper claim submissions could result in payment delays.
Filing claims is fast and easy for AmeriHealth Caritas Next providers. Here you can find the tools and resources you need to help manage your submission of claims and receipt of payments.
All claims submitted by providers must be billed on the CMS-1500 or UB-04, or the electronic equivalent (via EDI) of these standard forms.
What would you like to do?
AmeriHealth Caritas Next 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 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
To register for ConnectCenter, visit ConnectCenter Sign Up. Use vendor code: 214629. If you need assistance, Change Healthcare customer support is available through online chat or by phone at 1-800-527-8133, option 2.
Electronic claims will need to be submitted to Change Healthcare using a 4-digit ConnectCenter Payor identifier (CPID). The CPIDs for AmeriHealth Caritas Next are:
Institutional claims: 6038
Professional claims: 9192
To learn how to navigate ConnectCenter visit the resources below.
- Provider Management PDF
- Getting Started with Claims PDF
- Creating a Professional Claim PDF
- Creating an Institutional Claim PDF
- Uploading Claims PDF
- Getting Started with Remits PDF
- Getting Started with Claim Status PDF
- Getting Started with Eligibility PDF
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 Next's EDI payer ID number is 83148
Send paper claims to:
AmeriHealth Caritas Next
Attn: Claims Processing Department
P.O. Box 7412
London, KY 40742-7412
To check your claim status, sign in to NaviNet and select Claims Status Summary under Administrative Reports. Call Provider Services at 1-855-266-0129.
Medical and Pharmacy payment cycles run every Monday.
You can appeal a claims decision by downloading the Provider Claim dispute form from the forms section of our website and submit your request, along with any supporting documentation, in writing to:
AmeriHealth Caritas Next
Attn: Provider Grievances and Appeals
P.O. Box 7379
London, KY 40742-7381
Electronic Claim Payment Options
Change Healthcare is partners with ECHO Health, Inc. (ECHO Health), a leading innovator in electronic payment solutions, to offer more electronic payment options to our healthcare providers so that they can select the payment method that best suits their accounts receivable workflow.
Electronic Funds Transfers (EFT)
Electronic funds transfers allow you to receive your payments directly in the bank account you designate rather than receiving them by VCC or paper check. When you enroll in EFT, you will automatically receive electronic remittance advices (ERAs) for those payments. All generated ERAs and a detailed explanation of payment for each transaction will also be accessible to download from the ECHO provider portal (www.providerpayments.com). If you are new to EFT, you will need to enroll with ECHO Health for EFT from AmeriHealth Caritas Next.
Please note: Payment will appear on your bank statement from PNC Bank and ECHO as “PNC – ECHO”.
- To sign-up to receive EFT from AmeriHealth Caritas Next visit https://enrollments.ECHOhealthinc.com/efteradirect/enroll. There is no fee for this service.
- To sign-up to receive EFT from all of your payers processing payments on the Settlement Advocate platform, visit https://enrollments.ECHOhealthinc.com. A fee for this service may be required.
If you have questions regarding how to enroll in EFT, please reference the AmeriHealth Caritas Next EFT Enrollment Guide (PDF).
Virtual Credit Card (VCC)
ECHO Health offers Virtual Credit Cards as an optional payment method. Virtual Credit Cards are randomly generated, temporary credit card numbers that are either faxed or mailed to providers for claims reimbursement. Major advantages to VCC are that providers do not have to enroll or fill out multiple forms in order to receive VCC, and personal information, like practice bank account information, will never be requested. Providers will also be able to access their payment the day the VCC is received. In the future, AmeriHealth Caritas Next providers who are not currently registered to receive payments electronically will receive VCC payments as their default payment method, instead of paper checks. Your office will receive either faxed or mailed VCC payments, each containing a VCC with a number unique to that payment transaction with an instruction page for processing and a detailed Explanation of Payment /Remittance Advice (EOP/RA). Normal transaction fees apply based on your merchant acquirer relationship. If you do not wish to receive your claim payments through VCC, you can opt out by contacting ECHO Health directly at 1-888-492-5579.
Offered in partnership with Deluxe Corporation, this payment option includes the digital presentment of three payment modalities – 1) eCheck 2) VCC 3) EFT/ACH. Specifically targeted to providers who have never enrolled for ACH (EFT) and have opted-out of VCC.
Please note: If you have enrolled for MPX with another payer, you will continue to receive your payments through your MPX portal.
To receive paper checks and paper EOPs, you must opt out of the Virtual Card Services by contacting ECHO Health at 1-888-492-5579, after your initial virtual card payment is received.
AmeriHealth Caritas Next 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 Next 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 Opens a new window. 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) Opens a new window for instructions.
Contact your practice management/hospital information system for instructions on how to receive ERAs from AmeriHealth Caritas Next under Payer ID 83148 and the ECHO Payer ID 58379. If your practice management/hospital information system is already set up and can accept ERAs from AmeriHealth Caritas Next, then it is important to check that the system includes both AmeriHealth Caritas Next 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 Next Payer ID 83148 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 FAQs (PDF) or call ECHO Health Support team at 1-888-492-5579.