AmeriHealth Caritas Delaware Providers

Attention Providers

Change Healthcare System Interruption

We thank you for your partnership and patience, as we continue to work to resolve the downstream impacts of Change Healthcare’s service interruption.

Below is a summary of the current status of our systems and processes:

Eligibility verification, claim status inquiry, prior authorization submission/processing and authorization inquiry: These functionalities continue to operate normally and are available via the NaviNet provider portal. If you do not have access to NaviNet, please visit: https://register.navinet.net/ to sign up.

Claims Submission Options:

Electronic claims:

  • Availity: Providers may submit claims to AmeriHealth Caritas Delaware is through Availity. Providers or clearinghouses not currently using Availity to submit claims, must register at: https://www.availity.com/intelligent-gateway/.
    • Providers who are currently registered with Availity for another payer, or using another clearinghouse, must request to have their electronic claims for AmeriHealth Caritas Delaware routed to Availity.
    • For registration process assistance, submit the Provider Inquiry form at the bottom of the Availity webpage or contact Availity Client Services at 1-800-AVAILITY (282-4548).  Assistance is available Monday through Friday from 8 AM to 8 PM ET.
    • 275 Claim Attachment Transactions: AmeriHealth Caritas Delaware is accepting ANSI 5010 ASC X12 275 claim attachment transactions (unsolicited) via Availity. Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 claim attachment transaction submissions via payer ID: 77799
  • A maximum of 10 attachments are allowed per submission. Each attachment cannot exceed 10 megabytes (MB) and total file size cannot exceed 100MB. The acceptable supported formats are pdf, tif, tiff, jpeg, jpg, png, docx, rtf, doc, and txt.
  • There are two ways 275 claim attachment transactions can be submitted:
  • After logging in, providers registered with Availity may access the Attachments - Training Demo for detailed instructions on the submission process via: Training Link [apps.availity.com].
  • Specific 275 claim attachment transaction report codes must be used when submitting an attachment. Visit the https://www.amerihealthcaritasde.com/provider/claims-billing/index.aspx for the list of applicable codes.
  • Optum/Change Healthcare: Even though AmeriHealth Caritas Delaware has not reconnected directly, providers may also submit claims through Optum/Change Healthcare.
    • Providers will have to establish new connectivity with Optum.
    • For new connectivity requirements, reach out to your Optum/Change Healthcare account representative.
    • If you do not know who your account representative is, you can submit an inquiry via the Change Healthcare General Inquiry form.

Manual/direct entry claims:

  • PCH Global: Providers may submit manual or direct entry claims at no cost, through PCH Global. To enroll for claims submission through PCH Global, please go to https://pchhealth.global and click the Sign-Up link in the upper right-hand corner. 
    • 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:

a.  Payer name: AmeriHealth Caritas Delaware

b.  P.O. 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.

  • Optum/Change Healthcare ConnectCenter™: The direct entry claims portal, ConnectCenter, is available for reconnection, at no cost, for providers who were registered with ConnectCenter prior to the security incident. 
    • It is not necessary to complete a new registration, and usernames will remain the same.

To reconnect:

For more information on available functionality, please review the release notes in the Product News section after signing into the ConnectCenter portal.

Electronic remittance advice (ERA/835) files: Payment recovery details are currently provided on the remittance advice or 835 you receive with your payments for claims processed on and after May 6, 2024. 

For claims processed February 21, 2024, through May 5, 2024, AmeriHealth Caritas Delaware has generated a comprehensive claims recovery report available in the NaviNet provider portal. The claims recovery report provides payment recovery details by your member’s account number, claim number, provider tax ID, payee/group ID and NPI.

To access the claims recovery report:

  1. Log in to the NaviNet provider portal.
  2. Select applicable health plan.
  3. Go to Report Inquiry under Workflows for this Plan.

Click on Administrative Reports > Claim Recovery Report.

For current claims payments, providers can view and download an electronic remittance PDF via the NaviNet provider portal. Providers may also access the ERA/835 file through the ECHO Health provider payment portal at: www.providerpayments.com. Providers who are not currently registered with ECHO for access to the portal will have to create a new account.

For questions, contact your dedicated Provider Network Account Executive or Provider Services at: 1-800-999-3371; Option 0, then Option 4

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.

Submit a 275 claim attachment transaction

AmeriHealth Caritas Delaware is accepting ANSI 5010 ASC X12 275 unsolicited attachments via Change Healthcare. Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 attachment submissions via payer ID: 77799

There are three ways that 275 attachments can be submitted.

  • Batch — You may either connect to Change Healthcare directly or submit via your EDI clearinghouse.
  • API via JSON — You may submit an attachment for a single claim.
  • Portal — Individual providers can register at Change Healthcare to submit attachments.

The acceptable supported formats are PDF, tif, tiff, jpeg, jpg, png, docx, rtf, xml, doc, and txt.  View the Change Health Care 275 claims attachment transaction video for detailed instructions on this new process.

In addition, the following 275 claims attachment report codes have been added effective 8/1/23.  When submitting an attachment, use the applicable code in field number 19 of the CMS 1500 or field number 80 of the UB04, as documented in the Claims Filing Instructions (PDF).

Attachment type Claim assignment attachment report code
Itemized bill

03
Medical records for HAC review

M1
Single Case Agreement (SCA)/LOA 04
Advance Beneficiary Notice (ABN) 05
Consent Form CK
Manufacturer suggested retail price/innovation 06
Electric Breast Pump Request Form 07
CME Checklist consent forms (Child Medical Eval) 08
EOBs – for 275 attachments should only be used for non-covered or exhausted benefit letter EB
Certification of the Decision to Terminate Pregnancy CT
Ambulance trip notes/run sheet AM

How can we help you?

Providers