If your office receives an overpayment from AmeriHealth and you need to
submit an adjustment to correct the overpayment, you can do so in one of the
following ways.
The NaviNet® web portal
Participating providers with access to NaviNet should initiate an adjustment
to correct an overpayment by selecting the Claim Inquiry and
Maintenance transaction and then Claim Status Inquiry. From there
you can enter one of the two appropriate search criteria options:
- Billing Provider/Member ID/Date of Birth
- Billing Provider/Member Last Name/First Name/Date of Birth
Once the search is complete, you can find a link to Claim
Investigation through the Claims Search Results and Claim Details screens.
Through the Claim Investigation link you can submit the credit and/or
retraction request, which will appear on a future Statement of Remittance
(SOR), Provider Explanation of Benefits (Provider EOB), or Provider
Remittance.
Overpayment/Refund Form
Offices that are nonparticipating with AmeriHealth or not yet
NaviNet-enabled can submit their adjustment request using the
Overpayment/Refund Form, which is located on the Provider Forms web page for AmeriHealth Pennsylvania or the
Provider Forms web page for
AmeriHealth New Jersey. Once the form has been completed, please mail it, along
with a copy of the SOR, Provider EOB, or Provider Remittance, to:
- AmeriHealth/AmeriHealth New Jersey Claims Overpayment
- 1901 Market Street
- Treasury Services, 39th Floor
- Philadelphia, PA 19103-1480
Note: The submission address for the Overpayment/Refund
Form recently changed. Please ensure you are using the most recent version
of the form.
If you have any questions regarding submitting an overpayment request,
please contact Customer Service.
*AmeriHealth New Jersey is in the process of migrating
its membership to a new operating platform. Once a member has been migrated to
the new platform, professional providers will receive a Provider EOB instead of
an SOR, and facility providers will receive a Provider Remittance.
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