AmeriHealth Caritas Ohio Providers
Restoration of Optum/Change Healthcare Connectivity
Summary: AmeriHealth Caritas Ohio 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 Ohio 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.
Questions:
If you have questions about this communication, please contact your Provider Account Executive or the Provider Services department at 1-833-644-6001.
Latest updates
Electronic claims submission
Providers with Electronic Data Interchange (EDI) capabilities may submit claims, eligibility inquiries, claim status inquiries, and associated attachments using Electronic Data Interchange (EDI) by being a trading partner (TP) authorized by ODM or by contracting with an ODM-authorized TP. For more information, visit https://medicaid.ohio.gov/resources-for-providers/billing/trading-partners/trading-partners.
Direct claim entry
Direct Data Entry (DDE) providers should submit claims via the AmeriHealth Caritas NaviNet Provider Portal. Visit our claims and billing page for more information.
Medicaid Annual Eligibility Redetermination Reviews
Important information for providers regarding Annual Eligibility Redetermination Reviews.
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Ohio Department of Medicaid (ODM) billing guidelines
- Ohio Department of Medicaid billing information
- ODM HIPAA Transaction Standard Companion Guide: 837 Institutional Fee-For-Service Claims (PDF)
- ODM HIPAA Transaction Standard Companion Guide: 837 Professional Health Care Claim (PDF)
- ODM HIPAA Transaction Standard Companion Guide: 837 Dental Fee-For-Service Claims (PDF)
AmeriHealth Caritas Ohio’s Payer ID
- For all claims EXCEPT transportation: 35374
All claims sent to AmeriHealth Caritas Ohio, through the central PNM portal, should include the AmeriHealth Caritas Ohio Payer ID in 1000B Receiver Loop and 2010BB Payer Name Loop.
AmeriHealth Caritas Ohio Provider Services is available Monday through Friday, 7 a.m. to 8 p.m., except for the following holidays: New Year’s Day, Martin Luther King Jr. Day, Memorial Day, Juneteenth, Independence Day, Labor Day, Thanksgiving Day, the day after Thanksgiving, and Christmas Day. Phone: 1-833-644-6001. Emergency closures will be listed on our Alerts and Newsletters page.