As a reminder, claims received by AmeriHealth on or after June 10, 2018, are subject to a new claim editing process during prepayment review. The new process ensures compliance with current industry standards and supports the automated application of correct national coding principles.* 

Since implementation of this new claim editing process, there has been an increase in provider reporting errors resulting in an E8038 rejection code:

Invalid Diagnosis Code Used As Principal Diagnosis Code. Please Correct And Resubmit. Electronically Enabled Providers Should Resubmit Electronically.

If you see claims denied with this, or a similar, rejection code, it may be helpful to review the following previously published articles related to the new claim editing process:

• Enhanced claim edits to support correct coding principles
• ICD-10 in Action: Coding guidelines and conventions ? Excludes1 and Excludes2 notes
• ICD-10 in Action: Common reporting errors
• Reminder: Claim investigation and corrected claim submission procedures

For more information

To learn more about the claim editing process, please review our Claim edit enhancements: Frequently asked questions (FAQ), which can also be found in the Frequently Asked Questions archive on AmeriHealth NaviNet^® Plan Central. Note: The FAQ will be updated as more information becomes available.

If you still have questions after reviewing the FAQ, please send an email to ahclaimeditquestions@amerihealth.com.

*Self-funded groups have the option to opt out of the enhanced claim edits; therefore, your outcomes may vary by plan.

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