AmeriHealth Caritas Delaware Providers

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, or once Change Healthcare’s connectivity is restored, through Change Healthcare. We appreciate the inconvenience this is causing.
      • IMPORTANT UPDATE: AmeriHealth Caritas Delaware  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-RegistrationOpens a new window. 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.
    • 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 Caritas Delaware
      • PO Box: 801100
    • 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 remittance are available at this time. However, some individual remittance advices may not be available due to Change Healthcare’s service disruption related to the security incident.
      • IMPORTANT UPDATE: AmeriHealth Caritas Delaware 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 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 or obtaining your 835 files any sooner. If you have other questions, you may contact Provider Services at 1-800-999-3371.

    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.

    Thank you for choosing AmeriHealth Caritas Delaware

    We are AmeriHealth Caritas Delaware, a mission-driven Medicaid managed care organization. Through dedicated providers like you, we serve Delaware Medicaid members in the Diamond State Health Plan (DSHP), Delaware Healthy Children Program, DSHP-Plus, and DSHP-Plus LTSS programs.

    With your partnership, we aim to deliver excellent care and improved health outcomes to our members.

    If you have questions, you can call AmeriHealth Caritas Delaware Provider Services at 1-855-707-5818.

    **ATTENTION PROVIDERS, IMPORTANT REMINDER**

    Have you registered your NPI, Taxonomy and Location with DMAP? If not, you will not be eligible for Medicaid payments after September 30, 2024

    In compliance with 42 CFR § 438.602 [ecfr.gov] and 42 CFR Part 455 [ecfr.gov], subparts B and E and the 21st Century Cures Act [congress.gov], Delaware Medicaid is required to screen and enroll all current and prospective Managed Care Organization-Only Providers (MCOPs).

    For additional Information, please contact DMMA:

    Provider Services at 1-800-999-3371; Option 0, then Option 4

    Email*delawarepret@gainwelltechnologies.com - *Reminder: Do not send any correspondence that has protected health information (PHI) to this mailbox.

    How can we help you?