Electronic Billing Services (EDI, ERA, EFT)
AmeriHealth Caritas Pennsylvania and AmeriHealth Caritas Northeast (the “Plan”) contract with Change Healthcare – one of the largest electronic data interchange (EDI) clearinghouses in the country – to offer state-of-the-art EDI and other electronic billing services. Use of EDI can boost claims submission efficiency and timeliness of reimbursement to enhance your revenue cycle.
Electronic Claims Submission (EDI)
Claims can be submitted electronically through Change Healthcare, or via another clearinghouse. Contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic claim submissions to the Plan.
The Plan does not require you to enroll with Change Healthcare to submit electronic claims. If you already use another EDI vendor to submit claims electronically, inform your vendor of the EDI payer ID for AmeriHealth Caritas Pennsylvania 22248 and AmeriHealth Caritas Northeast 77001.
Submission via Change Healthcare
Providers can submit claims directly to Change Healthcare through WebConnect. WebConnect provides two methods for submitting claims: key them in manually or import batches of claims. There is no cost to manually key claims in using WebConnect, but claims must be entered one at a time, which may not be feasible for practices with high claim volume. Practices that choose to import batches of claims via WebConnect should be aware there is a one-time set up fee of $300 for this service. Providers should call 1-877-667-1512 and follow the appropriate prompts, or go to Change Healthcare WebConnect to enroll for direct submission with Change Healthcare. Change Healthcare will also provide information on their various electronic solutions, the requirements for connectivity, and setup instructions.
Electronic Claim Payment Options
Change Healthcare is now partnering with ECHO Health, Inc. (ECHO Health), a leading innovator in electronic payment solutions, to offer more electronic payment options to our health care providers so that they can select the payment method that best suits their accounts receivable workflow.
Virtual Credit Card (VCC)
ECHO Health offers Virtual Credit Cards as an optional payment method. Virtual Credit Cards are randomly generated, temporary credit card numbers that are either faxed or mailed to providers for claims reimbursement. Major advantages to VCC are that providers do not have to enroll or fill out multiple forms in order to receive VCC, and personal information, like practice bank account information, will never be requested. Providers will also be able to access their payment the day the VCC is received. In the future, providers who are not currently registered to receive payments electronically will receive VCC payments as their default payment method, instead of paper checks. Your office will receive either faxed or mailed VCC payments, each containing a VCC with a number unique to that payment transaction with an instruction page for processing and a detailed Explanation of Payment /Remittance Advice (EOP/RA). Normal transaction fees apply based on your merchant acquirer relationship. If you do not wish to receive your claim payments through VCC, you can opt out by contacting ECHO Health directly at 1-888-492-5579.
Electronic Funds Transfers (EFT)
Electronic funds transfers allow you to receive your payments directly in the bank account you designate rather than receiving them by VCC or paper check. When you enroll in EFT, you will automatically receive electronic remittance advices (ERAs) for those payments. All generated ERAs and a detailed explanation of payment for each transaction will also be accessible to download from the ECHO provider portal (www.providerpayments.com). If you are new to EFT, you will need to enroll with ECHO Health for EFT from AmeriHealth Caritas Pennsylvania and AmeriHealth Caritas Northeast.
Please note: Payment will appear on your bank statement from PNC Bank and ECHO as “PNC – ECHO”.
To sign up to receive EFT, visit https://enrollments.ECHOhealthinc.com/efteradirect/enroll. There is no fee for this service.
To sign up to receive EFT from all of your payers processing payments on the Settlement Advocate platform, visit https://enrollments.ECHOhealthinc.com. A fee for this service may be required.
If you have questions regarding how to enroll in EFT, please reference the EFT Enrollment Guide.
Electronic Remittance Advice (ERA)
The Plan now also offers ERAs (also referred to as an 835 file) through Change Healthcare/ECHO Health. To receive ERAs from Change Healthcare and ECHO, you will need to include both the Change Healthcare and AmeriHealth Caritas Pennsylvania payer ID 22248 and AmeriHealth Caritas Northeast payer ID 77001 and the ECHO payer ID 58379.
Contact your practice management/hospital information system for instructions on how to receive ERAs from AmeriHealth Caritas Pennsylvania under payer ID 22248 and AmeriHealth Caritas Northeast under payer ID 77001 and the ECHO Payer ID 58379.
If your practice management/hospital information system is already set up and can accept ERAs from the Plan, then it is important to check that the system includes both AmeriHealth Caritas Pennsylvania payer ID 22248 and AmeriHealth Caritas Northeast payer ID 77001 and ECHO Health Payer ID 58379 for ERAs.
If you are not receiving any payer ERAs, please contact your current practice management/hospital information system vendor to inquire if your software has the ability to process ERAs. Your software vendor is then responsible for contacting Change Healthcare to enroll for ERAs under AmeriHealth Caritas Pennsylvania payer ID 22248 and AmeriHealth Caritas Northeast payer ID 77001 and ECHO Health Payer ID 58379.
If your software does not support ERAs or you continue to reconcile manually, and you would like to start receiving ERAs only, please contact the ECHO Health Enrollment team at 1-888-834-3511.
If you have additional questions regarding VCC, EFT, or ERAs, please reference our FAQ or call Echo Health Support team at 1-888-492-5579.