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AmeriHealth is making system and process changes that will affect the way
we do business with you. These changes
will help us to drive down costs, expand and enhance capabilities, and ensure a
positive customer experience.
Please be aware of the following changes effective November 1,
2013, which will impact your provider practices or
facilities.
- Claims Submission/Reporting Requirements. Effective
November 1, 2013, additional data elements will be required to ensure proper
claims processing. For example, taxonomy codes will be required on all claims
submissions.
Information regarding the specific data elements required can be found in the
AmeriHealth HIPAA Transaction
Standard Companion Guide, which is available on our website at www.amerihealth.com/providers/claims_and_billing/
x12_gateway.html.
- Change to Mom/Baby Claims Submission Process. Effective
November 1, 2013, mom and baby inpatient hospital
claims must be submitted as separate claims ? one for the mom and one for the
baby ? and you will receive two
separate Statements of Remittance (SOR).
For mom/well-baby claims, payment details will show on the mom?s SOR, as
shown in the examples below. There will
be no payment information on the well-baby?s SOR. Sick-baby dates of service
will pay at the contracted rate, and the
payment details will be on the baby?s SOR.*
Current State (prior to November 1, 2013):
Claim ID
DRG
Rev code
Billed charges
Payment
Comments
11111
765
120
15,000
5,000
Mom delivery line; line will pay
11111
765
170
4,000
0
Well-baby line; line will not pay
Total
19,000
5,000
Future state (on or after November 1, 2013):
Claim ID
DRG
Rev code
Billed charges
Payment
Comments
11111
765
120
15,000
5,000
Mom delivery line; line will pay
Claim ID
DRG
Rev code
Billed charges
Payment
Comments
22222
795
170
4,000
0
Baby claim; line will not pay if mom is inpatient
For more information about our Upcoming System and Process Changes, please
visit our dedicated site at
www.amerihealth.com/pnc/upcomingchanges. On this site, you will find a
communication archive and Frequently Asked Questions (FAQ) document. If you
still have questions after reviewing the FAQ, email us at providercommunications@amerihealth.com.
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