Family Planning Billing Information
For dates of service up to and including July 31, 2013, AmeriHealth First will continue to be responsible for the payment of all family planning claims.
AmeriHealth First will also retain responsibility for the ongoing support and resolution of claims payment issues for family planning claims for dates of service prior to August 1, 2013. Questions? Call the AmeriHealth First Family Planning Department at 1-800-541-4560.
- Beginning with dates of service August 1, 2013 and forward, AmeriHealth Caritas Pennsylvania will be responsible for the payment of family planning claims and resolution of claims payment issues.
- Timely filing for initial claim submission for AmeriHealth Caritas Pennsylvania family planning claims is 180 days from the date of service.
- Family planning claims may be billed electronically via 837 forms or via paper on a CMS 1500 or UB-04 form. Contact your EDI software vendor or Emdeon to submit claims electronically. AmeriHealth Caritas Pennsylvania's payer ID is 22248.
- To facilitate reporting, submit electronic claims with the family planning indicator in professional claims at Loop 2400/SV1 12 set to "Y". Bill the FP modifier on paper claims, but continue to report the pricing modifier in the first position.
Paper claims should be submitted to:
AmeriHealth Caritas Pennsylvania
Claims Processing Department
P.O. Box 7118
London KY 40742
-Electronic claims sent to AmeriHealth First with a date of service August 1, 2013 or after will be denied. Paper claims sent to IBC with a date of service August 1, 2013 or after will be re-routed to AmeriHealth Caritas Pennsylvania.
-All claims sent to AmeriHealth Caritas Pennsylvania with dates of service prior to August 1, 2013 will not be re-routed to IBC; they will be denied by AmeriHealth Caritas Pennsylvania.
- DPW's Sterilization Consent Form (PDF) (MA31) must accompany all claims for reimbursement for sterilization services. The form must be completed correctly in accordance with the instructions. The claim and consent forms will be retained by AmeriHealth Caritas Pennsylvania.
- The Pennsylvania Department of Public Welfare's Physician's Certification for an Abortion (PDF) (MA3) and the Pennsylvania Department of Public Welfare's Recipient Statement Form (MA368 [PDF]) or MA369 [PDF]) must accompany all claims for reimbursement for termination of pregnancy services. The Physician's Certification for an Abortion and Recipient Statement Form must be submitted in accordance with the instructions on the certification/form. The claim form, Physician's Certification for an Abortion, and Recipient Statement Form will be retained by AmeriHealth Caritas Pennsylvania.