Claims, Billing, and Payment
Claims submission alert:
Please note that there are two different AmeriHealth Caritas plans operating in North Carolina. To enable prompt payment, please be careful to charge your claims to the correct health plan by using the correct payer ID when you submit your claims. Please consult the table below for the appropriate plan payer ID. Improper claim submission could result in denied claims and payment delays.
|AmeriHealth Caritas North Carolina
|AmeriHealth Caritas Next
|Individual and family health plans offered both on and off the Health Insurance Marketplace
|Plan payer ID
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 electronic data interchange [EDI]) of these standard forms.
Timely claims filing
- Original submission must be submitted no more than 180 days from date of service.
- Rejected claims must be resubmitted no more than 180 days from date of service.
- Denied claims must be resubmitted within 365 days from date of service.
- All claims must be submitted within 180 days from date of service.
Submit a 275 claim attachment transaction
AmeriHealth Caritas Next is accepting ANSI 5010 ASC X12 275 unsolicited attachments via 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: 83148.
There are three ways that 275 attachments can be submitted.
- 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.
The acceptable supported formats are pdf, tif, tiff, jpeg, jpg, png, docx, rtf, xml, doc, and txt. View the Change Health Care 275 claims attachment transaction video for detailed instructions on this new process.
In addition, the following 275 claims attachment report codes have been added effective 8/1/23. When submitting an attachment, use the applicable code in field number 19 of the CMS-1500 or field number 80 of the UB-04, as documented in the Claims Filing Instructions (PDF).
|Claim assignment attachment report code
|Medical Records for HAC review
|Single Case Agreement (SCA)/LOA
|Advanced Beneficiary Notice (ABN)
|Manufacturer-suggested Retail Price/Invoice
|Electric Breast Pump Request Form
|CME Checklist Consent Forms (Child Medical Eval.)
|EOBs – for 275 attachments, should only be used for noncovered or exhausted benefit letter
|Certification of the Decision to Terminate Pregnancy
|Ambulance Trip Notes/Run Sheet
What would you like to do?
AmeriHealth Caritas Next contracts with Change Healthcare — one of the largest 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.
If you need EDI Technical Assistance, call provider services at 1-855-266-0219.
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 enable 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. If prompted, 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 payer 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.
- Enrollment Central (PDF)
- Claims — Create a Claim (video)
- Claims – Getting Started (PDF)
- Claims – Status (PDF)
- Claims – Uploading a Claim (PDF)
- Eligibility – Getting Started (PDF)
- Keying Institutional Claims (PDF)
- Keying Professional Claim (PDF)
- Provider Management - Getting Started (PDF)
- Provider Sign-up and User Management (PDF)
- Remits - Getting Started (PDF)
Submit claims through EDI for faster, more efficient claims processing and payment. See the "Submit claims electronically" section of this page for more details.
AmeriHealth Caritas Next's (North Carolina) EDI payer ID number: 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, or if you need assistance, call Provider Services at 1-855-266-0219.
Medical and pharmacy payment cycles run every Monday.
Providers may file a claims dispute electronically through NaviNet. See the instructions below:
How to file a claims dispute
Log in to NaviNet.
Find Health Plans in the top navigation bar.
Select AmeriHealth Caritas Next from the drop down.
Navigate to the Workflows for this plan in the upper left-hand navigation menu.
Click on the Forms and Dashboards link.
Navigate to Appeals and Claims Disputes section.
You will be given two choices: Appeals on Behalf of a Member or Claims Disputes.
Select Claims Disputes.
Complete the appropriate form.
You can also appeal a claims decision by downloading the Claims Dispute form (PDF) from the forms section of our website and submitting your request, along with any supporting documentation, in writing to:
AmeriHealth Caritas Next
Provider Claim Disputes
P.O. Box 7429
London, KY 40742-7429
Refer to your AmeriHealth Caritas Next Provider Manual (PDF) for timely claims dispute filing guidelines.
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 payment options offered are virtual credit card (VCC), electronic funds transfer (EFT), and MedPay (MPX).
Virtual credit card (VCC)
ECHO Health offers VCCs as an optional payment method. VCCs are randomly generated, temporary credit card numbers that are either faxed or mailed to providers for claims reimbursement. Major advantages to VCCs are that providers do not have to enroll or fill out multiple forms to receive VCCs, and that 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, 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.
Electronic funds transfers (EFTs)
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, 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).
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 835 files) 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. 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 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 payer ID 83148 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 can 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 EFTs or ERAs, please reference our FAQs (PDF) or call ECHO Health Support team at 1-888-492-5579.