Providers

Latest updates

Attention 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 either through Availity or PCH Global, or, 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 (PDF) provider notice.
  • Electronic claims submission through Availity: If you or your clearinghouse do not currently use Availity to submit claims, you must  register with Availity at: https://www.availity.com/Essentials-Portal-Registration. Please choose the registration option that aligns with your business: Healthcare or Atypical Provider.
    • For registration process assistance and other resources, access the training site link on the Availity registration page.
    • If you are currently registered with Availity for another payor, or if you use another clearinghouse, you must request that they route your electronic claims for AmeriHealth Caritas Florida to Availity. 
    • For additional information and resources see the recent Additional information for Availity provider notice (PDF).
  • Manual claims submission through PCH Global: To enroll for claims submission through PCH Global, please go to https://pchhealth.global and click the Sign-Up link in the upper right-hand corner to register.  
    Complete the registration process and log into your account. You will be asked how you heard about PCH Global; select Payer, then AmeriHealth. Access your profile by clicking on Manage User and then My Profile. You will need to complete all the profile information. When you go to the Subscription Details screen, select the More option on the right-hand side to see how to enter the promo code Exela-EDI.
    When you are ready to submit claims, use the following information to search for our payer information:
    a. Payer name: AmeriHealth
    b. P.O. Box: 7367
    For a detailed walk through of the registration process, refer to the PCH Global Registration manual, found on the PCH Global website in the Resource Menu.
  • 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 (PDF) 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 1-800-617-5727.

We thank you for your partnership and will continue to provide updates as we work to resolve the downstream impacts of Change Healthcare’s service interruption.

Additional Funding available for Non-Waiver Home and Community-Based Services (HCBS) Providers

Please refer to the following link for more information: https://ahca.myflorida.com/medicaid/medicaid-policy-quality-and-operations/medicaid-policy-and-quality/medicaid-policy/federal-authorities/florida-one-time-retention-payment-for-non-hcbs-waiver-payments-frequently-asked-questions [ahca.myflorida.com]

Medicaid Annual Eligibility Redetermination Reviews

Important information for providers regarding Annual Eligibility Redetermination Reviews.

Effective November 4, 2022, AmeriHealth Caritas Florida is replacing the existing payer-provider platform with NaviNet. Beginning October 3, 2022, you may register for NaviNet. Learn more (PDF).

View additional updates on our Newsletters and Updates page.

NCQA Commendable AccreditationAmeriHealth Caritas Florida has earned the Commendable Health Plan Accreditation status from the National Committee for Quality Assurance (NCQA) for 2019–2020. The NCQA awards this status to organizations with service and clinical quality that meet their comprehensive requirements for consumer protection and quality improvement.

AmeriHealth Caritas Florida recognizes that our provider partnerships are a major factor in our ability to deliver quality Medicaid services and neighborhood-based care throughout Florida. Every day, AmeriHealth Caritas Florida's mission to provide quality, affordable service to the underserved in our communities is reflected in the care, expertise, and support that our providers offer.

Direct secure messaging

Direct secure messaging (DSM) enables managed care organizations and providers to securely send patient health information electronically to many types of organizations. AmeriHealth Caritas Florida encourages network providers to use the Florida Health Information Exchange (HIE) to send orders, records, results, and other health information.

We want to thank our providers for helping to make AmeriHealth Caritas Florida a better health care plan. Your feedback, questions, and concerns are always welcome. Call Provider Services at 1-800-617-5727 to speak to a representative.

Providers