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Electronic Billing Services (EDI, ERA, EFT)

AmeriHealth Caritas Pennsylvania and AmeriHealth Caritas Northeast contract with Change Healthcare — one of the largest electronic data interchange (EDI) clearinghouses in the country — to offer state-of-the-art EDI and other electronic billing services. Use of EDI can boost claims submission efficiency and timeliness of reimbursement to enhance your revenue cycle.

Submitting claims electronically (EDI)

AmeriHealth Caritas Pennsylvania or AmeriHealth Caritas Northeast claims can be submitted electronically through Change Healthcare, or via another clearinghouse. Contact your EDI clearinghouse or Change Healthcare at 1-877-363-3666 to inform them that you wish to initiate electronic claim submissions to AmeriHealth Caritas Pennsylvania or AmeriHealth Caritas Northeast, or visit Change Healthcare's website for information on enrolling.

AmeriHealth Caritas Pennsylvania and AmeriHealth Caritas Northeast do not require you to enroll with Change Healthcare to submit electronic claims.  If you already use another EDI vendor to submit claims electronically, inform your vendor of the payer ID for AmeriHealth Caritas Pennsylvania (22248) or for AmeriHealth Caritas Northeast (77001).


Direct submission

Practices can submit claims directly to Change Healthcare through WebConnect. WebConnect provides two methods for submitting claims — key them in manually or import batches of claims. There is no cost to manually key claims in using WebConnect, but claims must be entered one at a time, which may not be feasible for practices with high claim volume.

Practices that choose to import batches of claims via WebConnect should be aware there is a one-time setup fee of $300 for this service. Providers should call 1-877-363-3666 and follow the appropriate prompts, or go to https://office.emdeon.com/vendorfiles/amerihealth.html to enroll for direct submission with Change Healthcare. Change Healthcare will also provide information on their various electronic solutions, the requirements for connectivity, and setup instructions.


Electronic remittance advice (ERA) or 835 transmissions

Many systems utilize the 835 file to generate ERA reports and auto-post payments.

If you have a practice management or hospital information system vendor, it is responsible for facilitating transmissions with Change Healthcare. If applicable, please check with your software vendor to confirm that you have the ability to process ERA or 835 files.

If your vendor has this ability, your vendor can provide instructions on how to receive ERAs from AmeriHealth Caritas Pennsylvania or AmeriHealth Caritas Northeast.

If your vendor does not have the ability to process ERA transmissions, please call Change Healthcare's customer service at 1-877-363-3666 and follow the appropriate prompts to speak to a Change Healthcare customer service representative about alternative ERA options.


Electronic funds transfer (EFT)

EFT simplifies reimbursement by replacing paper checks with direct deposits. Studies show providers save an estimated $1.53 per payment received by EFT compared to paper check payments1.

As part of its suite of services, Change Healthcare offers EFT to for AmeriHealth Caritas Pennsylvania and AmeriHealth Caritas Northeast. While you do not have to enroll with Change Healthcare for electronic claims submission or ERA, you must enroll with Change Healthcare to receive EFT for AmeriHealth Caritas Pennsylvania or AmeriHealth Caritas Northeast.

Enroll in EFT with Change Healthcare to help minimize risk, reduce administrative overhead, and get access to payments more quickly.

1www.caqh.org/sites/default/files/core/events/2015/q1/FINAL_NACHA_2_26_15_NationalWebinarPresentation.pdf (PDF)