Latest updates
Attention 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 and PCH Global, or once Change Healthcare’s connectivity is restored, through Change Healthcare. We appreciate the inconvenience this is causing.
- IMPORTANT UPDATE: AmeriHealth Caritas Florida acknowledges many providers were unable to submit claims as a result of the service disruption. Therefore, we are extending the claims timely filing deadline for claims that would have been rejected due to untimely filing. For more details, see the recent Claims Timely Filing Deadline Extension provider notice.
- 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 training site link on the Availity registration page.
- IMPORTANT UPDATE: In order to submit electronic claims to AmeriHealth Caritas Florida, you must register with Availity. For additional information and resources see the recent Additional information for Availity provider notice (PDF).
- Manual claims submission: We have established a direct claims entry process through PCH Global. To submit claims directly, 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
- PO Box: PO BOX 7367
- For a detailed walk through of the registration process, refer to the PCH Global Registration manual, found on the PCH Global website in the Resource Menu.
- Electronic remittance advice: Electronic remittances are available at this time. However, some individual remittance advices may not be available due to Change Healthcare’s security incident.
- IMPORTANT UPDATE: AmeriHealth Caritas Florida has established an alternative option for our providers to access the electronic remittance advice (ERA/835) file through ECHO Health. For additional information, please see the recent 835 Access (PDF)provider notice.
- 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 at1-800-617-5727.
We thank you for your partnership and will continue to provide updates as we work to resolve the downstream impacts of Change Healthcare’s service interruption.
Additional Funding available for Non-Waiver Home and Community-Based Services (HCBS) Providers
Please refer to the following link for more information: https://ahca.myflorida.com/medicaid/medicaid-policy-quality-and-operations/medicaid-policy-and-quality/medicaid-policy/federal-authorities/florida-one-time-retention-payment-for-non-hcbs-waiver-payments-frequently-asked-questions [ahca.myflorida.com]
Medicaid Annual Eligibility Redetermination Reviews
Important information for providers regarding Annual Eligibility Redetermination Reviews.
Effective November 4, 2022, AmeriHealth Caritas Florida is replacing the existing payer-provider platform with NaviNet. Beginning October 3, 2022, you may register for NaviNet. Learn more (PDF).
- Effective March 1, 2022, AmeriHealth Caritas Florida will require a provider taxonomy code on all claims. (PDF)Please update your billing systems as soon as possible to prevent claim rejections.
- Coronavirus Disease (COVID-19) Information for Providers. Stay up to date about COVID-19, visit theCenters for Disease Control and Prevention's website
- PHE COVID-19 Information (March 2020-April 2023)
View additional updates on our Newsletters and Updates page.
AmeriHealth Caritas Florida has earned the Commendable Health Plan Accreditation status from the National Committee for Quality Assurance (NCQA) for 2019–2020. The NCQA awards this status to organizations with service and clinical quality that meet their comprehensive requirements for consumer protection and quality improvement.
AmeriHealth Caritas Florida recognizes that our provider partnerships are a major factor in our ability to deliver quality Medicaid services and neighborhood-based care throughout Florida. Every day, AmeriHealth Caritas Florida's mission to provide quality, affordable service to the underserved in our communities is reflected in the care, expertise, and support that our providers offer.
- Search the provider/pharmacy directory and formulary
- View provider-specific resources like credentialing and clinical practice guidelines
- Get the latest plan communications such as letters, forms, and guides
- View available training and education resources
- Important information about submitting claims and billing information
Direct secure messaging
Direct secure messaging (DSM) enables managed care organizations and providers to securely send patient health information electronically to many types of organizations. AmeriHealth Caritas Florida encourages network providers to use the Florida Health Information Exchange (HIE)to send orders, records, results, and other health information.
We want to thank our providers for helping to make AmeriHealth Caritas Florida a better health care plan. Your feedback, questions, and concerns are always welcome. Call Provider Services at 1-800-617-5727 to speak to a representative.
