We are thankful for our health partners
As we enter the season of gratitude, AmeriHealth Caritas Ohio wants to extend a heartfelt “thank you” for your ongoing commitment to delivering quality care to our members. 

Questions about reimbursement or payment policies? 

Click the appropriate link below for detailed information.

 

275 claim attachment transaction is now available via Availity

AmeriHealth Caritas Ohio 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 for payer ID: 84243.

 

A maximum of ten 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:

• Batch - You may either connect to Availity directly or submit via your EDI clearing house.
• Portal - Individual providers may also register at: https://www.availity.com/Essentials-Portal-Registration to submit attachments.

 

Submitting disputes with attachments via NaviNet

As of 8/29/24 providers can submit a dispute with attachments to AmeriHealth Caritas Ohio via NaviNet. To access, go to the Plan Central Home page, Forms and Dashboards and select Provider Disputes.

 

How to investigate a claim

1. Log into NaviNet. 
2. On the Health Plans menu, under My Plans, click AmeriHealth Caritas Ohio.
3. Under Workflows for This Plan, click Claim Status Inquiry, and then find your claim.
4. On the Claim Details screen, above the status bar, click Claim Investigation. The Investigation Claim # pop-up window appears.
5. Choose an investigation type, and then type your comments for the investigation reviewers. Claim investigations are per claim, not per line item. To reference a specific claim line, provide the line number in the Comments box.
6. In the remaining boxes, type your contact information for this investigation so that customer service can contact you, if necessary.
7. Click Submit.

 

Contact Utilization Management for a prior authorization prior to providing care to our members: 1-833-735-7700. Additionally, if interested in joining our network please reach out to our Contracting department via email at: providerrecruitmentoh@amerihealthcaritasoh.com. This email address can also be used by vision providers looking for in-network vendors who can provide for eye glass frames and lenses.

 

Submit prior authorization requests (PA) electronically through NaviNet
AmeriHealth Caritas Ohio offers our providers access to our Medical Authorizations portal for electronic authorization inquiries and submission. The portal is accessed through NaviNet and located on the Workflows menu.

 

In addition to submitting and inquiring on existing authorizations, you will also be able to:

• Verify if No Authorization is Required
• Receive Auto Approvals, in some circumstances
• Submit Amended Authorization
• Attach supplemental documentation
• Sign up for in-app status change notifications directly from the health plan
• Access a multi-payer Authorization log
• Submit inpatient concurrent reviews online if you have Health Information
• Exchange (HIE) capabilities (fax is no longer required)
• Review inpatient admission notifications and provide supporting clinical documentation

Can you spot the phish? 
More than 3.4 billion phishing emails are sent out each day worldwide. But one factor can make life much harder for scammers: You. As the first line of defense, it is important that you are able to recognize and report a suspected phishing email.

What is phishing?
Phishing scams are emails that look real, but they are designed to steal important information. A phishing email with malicious software can allow cybercriminals to take control of your computer and put protected health information (PHI) and personally identifiable information (PII), as well as your organization’s confidential and proprietary information, at risk.
 
Beware of ransomware
In addition to stealing information, phishing scams can lead to ransomware attacks. Ransomware is a form of malware designed to encrypt files on a device, rendering them unusable until a ransom is paid. It may be a phishing email if it:

• Promises something of value (e.g., “Win a free gift card!”).
• Asks for money or donations.
• Comes from a sender or company you don’t recognize.
• Links to a site that is different than the company the sender claims to be from.
• Asks you for personal information, such as your username and password/passphrase.
• Includes misspelled words in the site’s URL address or subject line.
• Has a sense of urgency for you to act now.

What you should do if you receive a suspicious email:

• Do not click any links in the email.
• Do not provide your username and password; you should never share your username or password, even if you recognize the source. Phishing scams frequently mimic well-known companies, such as banks or retailers like Target or Amazon.
• Do not reply/respond to the email or forward it to anyone else within your organization.
• Familiarize yourself with your organization’s process for reporting suspicious emails. If you suspect an email is a phishing attempt, report it immediately.
• Your organization's information security department may have additional information and guidance on how to protect yourself from phishing scams.