Providers

Change Healthcare System Interruption

Change Healthcare, our electronic data interchange (EDI) clearinghouse for claims and payment cycle management, continues to address their network interruption related to a security incident. Below are updates for our systems and processes:

  1. Claims payments: We have resumed payments for claims submitted prior to the incident. Since Change Healthcare is still unable to accept claims submissions, providers who submitted claims during the outage may be able to resubmit them either through additional solutions identified below through Availity and PCH Global, or once Change Healthcare’s connectivity is restored, through Change Healthcare. We appreciate the inconvenience this is causing.

  2. Electronic claims submission: We have established a connection with Availity to receive electronic claims. If you or your clearinghouse do not currently use Availity to submit claims, you may register at: https://www.availity.com/Essentials-Portal-Registration. You will find registration options for Healthcare and Atypical Provider, so please choose the one that aligns with your business. For registration process assistance and other resources, access the training site link on the Availity registration page.

  3. Manual claims submission: We have established a direct claims entry process through PCH Global. To submit claims directly, please go to https://pchhealth.global and click the Sign-Up link in the upper right-hand corner to register.  Complete the registration process and log into your account. You will be asked how you heard about PCH Global; select Payer, then AmeriHealth. Access your profile by clicking on Manage User and then My Profile. You will need to complete all the profile information. When you go to the Subscription Details screen, select the More option on the right-hand side to see how to enter the promo code Exela-EDI

    When you are ready to submit claims, use the following information to search for our payer information:

  • Payer name: AmeriHealth - AmeriHealth Medical Management - North Carolina
  • PO Box: 7380

For a detailed walk through of the registration process, refer to the PCH Global Registration manual (PDF), found on the PCH Global website in the Resource Menu.

  1. Electronic remittance advice: Electronic remittances are available at this time. However, some individual remittance advices may not be available due to Change Healthcare’s security incident.

  2. Prior authorization submission and processing: The prior authorization systems continue to operate normally.

  3. Eligibility verification, claim status inquiry, and authorization inquiry: These capabilities continue to be available via NaviNet. If you do not have access to NaviNet provider portal, please visit https://register.navinet.net/ to sign up.

Please note, in the interim, our Provider Services Department will not be able to assist with the processing of your payments any sooner. If you have other questions, you may contact Provider Services at 1-888-738-0004.

We thank you for your partnership and will continue to provide updates as we work to resolve the downstream impacts of Change Healthcare’s service interruption.

Quality Corner

Glycemic Status Assessment for Patients

AmeriHealth Caritas North Carolina (ACNC) offers a $10 incentive for members every 6 months for maintaining HbA1c results of less than 9.0%. For providers interested in partnering with ACNC on HbA1c events, please contact ACNC quality management by email at acncqualitymanagement@amerihealthcaritas.com.

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Provider Resources

Extra Benefits for Our Members

AmeriHealth Caritas North Carolina has added electric nonmedical breast pumps for expectant or new parents. Visit Extra Benefits for more information on the value-added services available for members.

Helpful resources

If you have questions, you can call AmeriHealth Caritas North Carolina Provider Services at 1-888-738-0004.

  • Contact your Account Executive.
    The best relationships are formed by staying in touch. If you have questions about us, contact your dedicated Account Executive.
  • Questions and answers.
    Do you have a question about working with AmeriHealth Caritas North Carolina? Start here.
  • Let us know (PDF)
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  • Get credentialed.
    North Carolina's Department of Health and Human Services (NCDHSS) has a centralized, one-stop provider enrollment application and credentialing process to reduce the provider's administrative burden of becoming an in-network provider. For more information regarding enrollment providers can call the NCTracks call center at 1-800-688-6696, fax 1-855-710-1965 or email NCTracksProvider@nctracks.com
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