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SOR changes for migrated AmeriHealth Pennsylvania members

January 9, 2014

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As previously communicated, we are in the process oftransitioning AmeriHealth Pennsylvania members to anew claims processing platform. During this transition,we will be working with you in a dual claims-processingenvironment until all of our AmeriHealth Pennsylvaniamembership is migrated to the new platform.

One area of change during the transition is to the Statement of Remittance (SOR):

  • For non-migrated members. Providers will continue toreceive the same SOR that they currently receive todayfor AmeriHealth New Jersey and Delaware membersand for AmeriHealth Pennsylvania members who havenot yet been migrated to the new platform.
  • For migrated AmeriHealth Pennsylvania members.For AmeriHealth Pennsylvania members who have beenmigrated to the new platform, providers will no longerreceive the current SOR. Professional providers willreceive what will be called the Provider Explanation ofBenefits (EOB), and facility providers will receive whatwill be called the Provider Remittance. The ProviderEOB and Provider Remittance will have a new look andformat. On the new format for facility claims, serviceswill be combined and displayed on one line.

Detailed guides for the new Provider EOB and ProviderRemittance will be available soon in the ClaimsSubmission and Payments section of the UpcomingSystem and Process Changes site. Terms in the newdocuments will be explained to assist you in interpretingyour payments.

For more information, please visit our Upcoming System and Process Changes site. On this site, you will find a communication archive and Frequently Asked Questions(FAQ) document. If you still have questions afterreviewing the FAQ, email us.

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