Providers
AmeriHealth Caritas Florida’s contract with the Florida Statewide Medicaid Managed Care program ended on January 31, 2025.
AmeriHealth Caritas Florida is working together with the Agency for Health Care Administration (AHCA) to provide a smooth transition for our providers.
AHCA has information on the SMMC program available online at: https://ahca.myflorida.com/medicaid/statewide-medicaid-managed-care. This website provides information about the SMMC program; the plans that are available by region; and information on provider training, upcoming webinars, and plan provider relations contacts.
Please submit ALL claims as soon as possible. More information and Transition FAQs
Latest updates
Attention Providers
AmeriHealth Caritas Florida has restored connectivity with Optum/Change Healthcare. The restoration of connectivity with Optum/Change Healthcare affords our providers options for claims submissions.
Electronic claims
AmeriHealth Caritas Florida providers will have the option of submitting electronic claims via:
- Optum/Change Healthcare – Providers with a software vendor or who use another clearinghouse to submit claims to Optum/Change Healthcare must consult their vendor/clearinghouse to confirm the process for claim submission. Please note: The 275 Claim Attachment transaction is currently available via Optum/Change Healthcare.
- Availity - Providers or clearinghouses not currently using Availity to submit claims, must register at: https://www.availity.com/intelligent-gateway/. Please note: The 275 Claim Attachment transaction is currently available via Availity.
Manual/direct entry claims
Providers may submit manual/direct entry claims via:
- Optum/Change Healthcare ConnectCenter™ - This option is currently only available for providers who had an established account prior to the security incident. Access to the portal and usernames will remain the same but a password reset, and multi-factor authentication are required.
- PCH Global – Providers not currently using PCH Global must enroll for claims submission at: https://pchhealth.global.
For questions, contact your dedicated Provider Network Account Executive or Provider Services at 1-800-617-5727.
Medicaid Annual Eligibility Redetermination Reviews
Important information for providers regarding Annual Eligibility Redetermination Reviews.
View additional updates on our Newsletters and Updates page.
AmeriHealth 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.
- Search the provider/pharmacy directory and formulary
- View provider-specific resources like credentialing and clinical practice guidelines
- Get the latest plan communications such as letters, forms, and guides
- View available training and education resources
- Important information about submitting claims and billing information
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.