Providers

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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: We have resumed payments for claims submitted prior to the incident. Since Change Healthcare is still unable to accept claims submissions, providers who submitted claims during the outage may be able to resubmit them either through additional solutions identified below through Availity and PCH Global, or once Change Healthcare’s connectivity is restored, through Change Healthcare. We appreciate the inconvenience this is causing.
  • Electronic claims submission: We have established a connection with Availity to receive electronic claims. If you or your clearinghouse do not currently use Availity to submit claims, you may register at: https://www.availity.com/Essentials-Portal-Registration. You will find registration options for Healthcare and Atypical Provider, so please choose the one that aligns with your business. For registration process assistance and other resources, access the training site link on the Availity registration page. 
  • Manual claims submission: We have established a direct claims entry process through PCH Global. To submit claims directly, 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:
    • Payer name: AmeriHealth
    • PO Box: PO 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: Electronic remittances are available at this time. However, some individual remittance advices may not be available due to Change Healthcare’s security incident.
  • 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 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]

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.