As of January 1, 2014, we have begun transitioning AmeriHealth Pennsylvania members to a new operating platform. During this transition, we are working with you in a dual claims-processing environment until all of our AmeriHealth Pennsylvania membership is migrated to the new platform.

New 835 transactions

One specific area where you will see changes is for 835 transactions. In addition to receiving current 835 transactions from AmeriHealth, providers will also receive 835 transactions from Highmark, Inc. (Highmark) for AmeriHealth Pennsylvania members who have been migrated to the new platform.

The current AmeriHealth-generated 835 transaction will remain unchanged; however, the new Highmark-generated 835 transaction will contain additional and updated information, as detailed in the following:

• Your AmeriHealth corporate ID number will not appear on the Highmark-generated 835 transaction. Only your National Provider Identifier (NPI) and Tax Identification Number (TIN) will appear.
• The Electronic Funds Transfer (EFT) Entry Date will be used rather than the check date.
• Payments made from member health care accounts (i.e., HRAs, HSAs) will be included on the Highmark-generated 835 transactions using the ?COB Reporting Model.? The COB Reporting Model means that payments toward member liability made directly by member health care accounts will appear as a secondary claim payment with the following information:
  ?? Payer Name = AmeriHealth Health Care Account
  ?? Claim Status Code = 2 ? Processed as secondary
  ?? Claim Adjustment Group and Reason Code = OA23

For more information about 835 transactions, please refer to the AmeriHealth HIPAA Transaction Standard Companion Guide (for Pennsylvania business) at www.highmark.com/edi-amerihealth.

Providers should work with their clearinghouse or trading partner to ensure a smooth transition and to avoid claims processing issues.