Action to come: AmeriHealth to transition to new EDI Gateway vendor

Home

Administrative

Billing & Reimbursement

TitleWeb
Action to come: AmeriHealth to transition to new EDI Gateway vendor

April 3, 2023

Our three-year, phased platform transition

As health care continues to change at an unprecedented rate, AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey are preparing to move its core business to a new claims processing platform over the next three years. AmeriHealth Administrators will continue to use its existing platform for claims processing, with enhanced capabilities to come.

This transition to a next generation platform will help us operate more efficiently and deliver new and innovative products and services.

We are committed to supporting a smooth transition with comprehensive communications and tools before, during, and after the transition. Learn more.

Throughout the remainder of 2023, AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey, and AmeriHealth Administrators will transition Electronic Data Interchange (EDI) transactions from the Highmark EDI Gateway to Smart Data Solutions (SDS) Stream Clearinghouse.

This affects providers and trading partners who submit EDI transactions on behalf of providers. Providers are encouraged to connect with their trading partners to ensure awareness.

Features of SDS's Stream Clearinghouse:

An integrated data exchange between AmeriHealth companies and trading partners.
The tools and access necessary for trading partners to submit, receive, and request information from different systems.
A commitment to delivering the high level of service to which you are accustomed.

The goal is to make this transition as seamless as possible for all users.

Migrating EDI X12 transactions

As a result of this transition, trading partners that currently submit transactions via the Highmark EDI Gateway will send/receive transactions to/from SDS. We will work with you on the following changes:

Agreements. You will be assigned a new trading partner ID and, where applicable, enter into a new agreement with SDS.
Connectivity changes. We will help you to establish a network connection with SDS, establish logon credentials, and understand and implement the new naming convention for file submission and receipt.
Content changes. If you submit claims for the receiver ID 54763, you currently receive a U277. You will receive only 277CA acknowledgement transactions later this year.

Next steps will be shared in May. In the meantime, if you have any questions, please email us at amerihealthgateway@amerihealth.com.