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:

Important update

Electronic remittance advice (ERA/835) files:

Payment recovery details are now available on the remittance advice or 835 you receive with your payments for claims processed on and after May 6, 2024.

For claims processed February 21, 2024, through May 5, 2024, ACNC has generated a comprehensive claims recovery report available in the NaviNet provider portal. The claims recovery report provides payment recovery details by your member account number, claim number, provider tax ID, payee/group ID and NPI.

To access the claims recovery report:

1. Log in to the NaviNet provider portal.
2. Select applicable health plan.
3. Go to Report Inquiry under Workflows for this Plan.
4. Click on Administrative Reports > Claim Recovery Report.

Claim Submission Options:

1. 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. 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.

2. Submitting claims through Change Healthcare: Although ACNC has not reconnected directly to Change Healthcare, providers may submit claims to ACNC through Change Healthcare.
   
   • Providers may use Relay Health or iEDI (the two clearing houses being offered today by Change Healthcare/Optum) for submitting claims to ACNC. Claims submitted through these clearinghouses will be routed to us via Availity until we reestablish direct connectivity to Change Healthcare.
   • • To use Relay Health or iEDI, you will have to establish new connectivity with these clearinghouses.
     • For new connectivity requirements, you will need to reach out to your Change Healthcare account representative.
   • If you do not know who your account representative is, you can submit an inquiry via the Change Healthcare General Inquiry

3. 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:

   • Payer name: AmeriHealth - AmeriHealth Medical Management - North Carolina
   • P.O. Box: 7380

For a detailed walk through of the registration process, refer to the PCH Global Registration manual (PDF), found on the PCH Global website in the Resource Menu.

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 the processing of your payments any sooner. If you have other questions, you may contact Provider Services at 1-888-738-0004.

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

Extra Benefits for Our Members

AmeriHealth Caritas North Carolina has added electric nonmedical breast pumps for expectant or new parents. Visit Extra Benefits for more information on the value-added services available for members.