Welcome, 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, 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 https://www.availity.com/documents/learning/LP_AP_GetStarted/index.html#/ link on the Availity registration page.
- Electronic remittance advice: Electronic remittance 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 1-800-521-6007.
Thank you for your participation in our network and for your continued commitment to the care of our Members/Participants. We will continue to provide updates as we work to resolve the downstream impacts of Change Healthcare’s service interruption.
Public health emergency ending: What you need to know
As you know, the Pennsylvania Department of Human Services (DHS) was able to keep Medical Assistance (MA) coverage open for most people during the COVID-19 Public Health Emergency (PHE) even if they were no longer eligible for MA. DHS is now in the process of making sure that everyone who is receiving MA is still eligible by reviewing each person’s information.
Latest Updates
- Change Healthcare System Interruption - March 8, 2024 Update (PDF)
- Change Healthcare System Interruption - March 6, 2024 Update (PDF)
- Change Healthcare System Interruption - March 4, 2024 Update (PDF)
- Change Healthcare System Interruption (PDF)
- Formulary changes (PDF)
- HEDIS Advance Notice (PDF)
- Avastin billing by ophthalmologists (PDF)
- Skilled nursing facility continued stay coverage, review, and billing reminders (PDF)
Coronavirus (COVID-19)
Let Us Know
Learn about our program developed to assist your practice in engaging and managing the health care needs of chronically ill AmeriHealth Caritas Pennsylvania members.
Quick Contact Information
- Provider Services: 1-800-521-6007
- Credentialing: 1-866-546-7972