AmeriHealth is pleased to announce that the transition of our Pennsylvania membership and claims processing to a new operating platform has been completed. As you know, AmeriHealth began this transition in January 2014. The new platform offers greater capabilities, increased flexibility in benefit design, and enhanced functionalities to improve the overall customer experience.

This important transition included the following milestones:

• Transition of X12 transactions. All trading partners send and receive transactions to/from the Highmark Gateway as of November 1, 2013.
• Commercial member claims. All AmeriHealth Pennsylvania commercial members have now been migrated to the new platform. The transition of commercial member claims happened over time, generally based on when the customer/member?s contract renewed.

Important changes as a result of the transition

Below are some of the important changes that occurred as a result of our transition to the new platform. These changes affect the way you do business with AmeriHealth.

• Member ID cards/numbers. As members were migrated to the new platform, they were issued a new member ID card with a new ID number. The subscriber and all members covered under the subscriber?s policy share the same ID number.
• Provider payment. Now that all members are migrated, you will receive a different format of the Statement of Remittance (SOR) ? called the Provider Explanation of Benefits (professional) and Provider Remittance (facility). On the new format for facility claims, services will be combined and displayed on one line. Note: You will continue to receive an SOR for dates of service that occurred prior to the member?s migration to the new platform. In addition, 835 transactions generated on the new platform contain additional and updated information. Please refer to our Trading Partner Business Center for more specific information.
• Claims processing. Additional data elements are required to ensure proper claims processing on the new platform. For example, taxonomy codes are required on all claims submissions. Information regarding the specific data elements required can be found in the AmeriHealth HIPAA Transaction Standard Companion Guide (Pennsylvania only), which is available on our EDI website.
• Provider Automated System. Now that all Pennsylvania members have been migrated to the new platform, the Provider Automated System is no longer available for any functionality (e.g., eligibility, claims status, authorizations). Providers must use the NaviNet^® web portal to retrieve this information.
• NaviNet. Many changes have been implemented on AmeriHealth NaviNet Plan Central, including adding, removing, and enhancing transactions. For more specific information, please refer to the NaviNet Transaction Changes section of our System and Process Changes site. This section of our site contains user guides and webinars for the new or enhanced transactions.

Check member ID cards at every visit

Because all members were issued a new member ID card upon migration, it is imperative that provider offices do the following:

1. Obtain a copy of the member?s current ID card at every visit to ensure that you submit the most up-to-date information to AmeriHealth.
2. Verify eligibility and benefits using NaviNet prior to rendering service.

For more information

For more information, visit our System and Process changes site. This site contains a communication archive as well as a frequently asked questions (FAQ) document. If you still have questions after reviewing the FAQ, email us.

NaviNet is a registered trademark of NaviNet, Inc.