Starting January 1, 2014, we will begin transitioning our AmeriHealth Pennsylvania membership to the new operating platform. As a result, we will be enforcing industry standards for claims processed on the new platform. If you have been submitting claims based on industry standards, as has been communicated to you in the past, you will have no issues with the topics noted below. However, if you have not, please be advised that you will see an increase in rejections and/or claim denials for claims processed on the new platform.These standards include, but are not limited to, the following: NAIC code. The payer NAIC code must be the same as the claim and envelope layers? Receiver and Payer codes. In addition, please refer to the payer ID grids at www.amerihealth.com/edi to ensure that you submit claims with the appropriate NAIC code, as identified in the Payer Information column and in accordance with the member?s coverage. This will direct your claims to the correct operating platform for processing. Interim billing claims. Interim billing claims are not accepted from acute care facilities for inpatient claims. Acute care facilities are required to submit claims after the member is discharged. Occurrence code M0. Occurrence code M0 (zero) must be reported with Condition Code C3. Missing procedure description. A description is required for all non-specific codes (i.e., not otherwise classified [NOC]; unspecified; other; miscellaneous; prescription drug, generic; or prescription drug, brand name). Invalid revenue codes. The ?001? revenue code is meant to indicate the total charge, and it should no longer be submitted at the service line level. The total charge should only be in the total charge field at the claim level. Room and board. A room and board revenue code is required for all inpatient bill types. NPI/Taxonomy code. The provider?s National Provider Identifier (NPI) must be billed with the corresponding taxonomy code. Operating physician requirement. If a claim has a surgical revenue code with a surgical procedure code, the operating physician is required. Referring provider. The referring provider is required on all claims when place of service is 81 (i.e., independent clinical lab) is used. For more information about our transition to the new platform for AmeriHealth Pennsylvania members, please visit the Upcoming System and Process Changes section of the AmeriHealth Provider News Center. 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.