ClaimsSubmissionPayment

During the transition to a new operating platform for AmeriHealth Pennsylvania members, we will be working with you in a dual claims-processing environment until all of our AmeriHealth Pennsylvania membership is migrated to the new platform. In other words, as AmeriHealth Pennsylvania members are migrated, their claims will be processed on the new platform; however, we will continue to process claims on the current platform for AmeriHealth New Jersey and Delaware members and for AmeriHealth Pennsylvania members who have not yet been migrated.

As a result, providers will see changes related to claims submission and payment, including, but not limited to, the following:

updated member ID numbers
taxonomy code requirement
new format for Provider Explanation of Benefits (EOB) and Provider Remittance (formerly known as Statement of Remittance)

Please refer to the following guides, which provide an explanation of the fields used in the new Provider EOB and Provider Remittance:

How to read your professional Provider EOB

How to read your facility Provider Remittance

Below is an archive of communications regarding changes to claims submission and payment. We encourage you to visit this page frequently for updated information.

Communications

Date	Title	Audience
09/01/15	Interpreting your PCP payments via EFT	Participating providers
07/31/15	Guidelines for billing with taxonomy codes and use of NPI on claims	Participating providers
07/31/15	Upcoming changes to claims processing requirements and enforcing these changes for AmeriHealth New Jersey members	Participating providers
07/02/15	Billing requirement for anesthesia claims	Participating providers
07/02/15	Reminder: Upcoming changes to the medical and claim payment policy for AmeriHealth New Jersey members	Participating providers
06/01/15	Reminder: Transitioning outstanding Accounts Receivable balances to new platform	Participating providers
06/01/15	SOR changes for migrated AmeriHealth New Jersey members	Participating providers
06/01/15	Upcoming changes to the enforcement of medical and claim payment policy for AmeriHealth New Jersey members	Participating providers
05/01/15	Enforcing claims processing requirements	Participating providers
03/02/15	Important billing information for modifiers 25 and 59	Participating providers
03/02/15	POA indicator and properly filling out claims	Participating providers
02/20/15	Bulletin 01-2015: Reminder: Present on admission indicator billing requirements	Participating acute care hospitals
12/1/14	Transitioning outstanding Accounts Receivable balances to new platform	Participating providers
10/1/14	New Medicare Advantage HMO and PPO policy notifications now available	Participating providers
8/28/14	Medicare Advantage HMO policies and clinical relationship logic to undergo changes	Participating providers
8/1/14	Reminder: Upcoming changes to Medicare Advantage HMO policies and clinical relationship logic	Participating providers
7/1/14	Check member ID cards at every visit	Participating providers
5/30/14	Guidelines for billing with taxonomy codes	Participating providers
5/30/14	Interpreting your PCP payments via EFT	Participating providers
5/30/14	Electronic claim resubmission requirements	Participating providers
1/9/14	Use a valid NPI for all claims	Participating providers
1/9/14	Changes to 835 transactions for migrated AmeriHealth Pennsylvania members	Participating providers
1/9/14	SOR changes for migrated AmeriHealth Pennsylvania members	Participating providers
1/9/14	Re-issue of member ID cards for migrated members	Participating providers
12/2/13	Enforcement of industry standards related to platform transition	Participating providers
12/2/13	Medically Unlikely Edits now applied to professional and facility claims for AmeriHealth Pennsylvania members	Participating providers
12/2/13	New payment option for migrated AmeriHealth Pennsylvania members with spending accounts	Participating providers
12/2/13	Provider Automated System not available for migrated AmeriHealth Pennsylvania members	Participating providers
11/22/13	Medically Unlikely Edits (Bulletin 25-2013)	Participating hospitals and ambulatory surgical centers
11/22/13	Use Correct NAIC Codes (Bulletin 24-2013)	Participating hospitals and ambulatory surgical centers
11/19/13	Enforcing Industry Standards (Bulletin 23-2013)	Participating hospitals and ambulatory surgical centers
11/15/13	Interim Billing Claims (Bulletin 22-2013)	Participating acute care hospitals
11/13/13	Operating Physician Requirement for Facility Claims (Bulletin 21-2013)	Participating hospitals and ambulatory surgical centers
11/12/13	Re-Issue of member ID cards (Bulletin 20-2013)	Participating hospitals and ambulatory surgical centers