Claims, Billing, and Payment
Claims submission alert:
Please note that there are two different AmeriHealth Caritas plans operating in North Carolina. To enable prompt payment, please be careful to charge your claims to the correct health plan by using the correct payer ID when you submit your claims. Please consult the table below for the appropriate plan payer ID. Improper claim submission could result in denied claims and payment delays.
Plan name
Plan Type
Plan Payer ID
AmeriHealth Caritas North Carolina
Medicaid
81671
AmeriHealth Caritas Next
Individual and family health plans offered both on and off the Health Insurance Marketplace
83148
Filing claims is fast and easy for AmeriHealth Caritas Next providers. Here you can find the tools and resources you need to help manage your submission of claims and receipt of payments.
All claims submitted by providers must be billed on the CMS-1500 or UB-04, or the electronic equivalent (via electronic data interchange [EDI]) of these standard forms.
Timely claims filing
In-network claims
- Original submission must be submitted no more than 180 days from date of service.
- Rejected claims must be resubmitted no more than 180 days from date of service.
- Denied claims must be resubmitted within 365 days from date of service.
Out-of-network providers
- All claims must be submitted within 180 days from date of service.
Submit a 275 claim attachment transaction
AmeriHealth Caritas Next is accepting ANSI 5010 ASC X12 275 unsolicited claim attachment transactions. The 275 attachments are accepted via Optum/Change Healthcare and Availity. Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 claim attachment transaction submissions via Plan Payer ID: 83148.
Availity
There are two ways 275 claim attachments can be submitted:
- Batch — You may either connect to Availity directly or submit via your EDI clearing house.
- Portal — Individual providers may also register at: www.availity.com/documents/learning/LP_AP_GetStarted_Atypical/index.html#/.
After logging in, providers registered with Availity may access the Attachments — Training Demo for detailed instructions on the submission process via: Training Link [apps.availity.com] or refer to the Availity Claims Attachment Quick Reference guide located under Claims Resources at the bottom of this page.
Optum/Change Healthcare
There are two ways 275 claim attachments can be submitted:
- Batch — You may either connect to Optum/Change Healthcare directly or submit via your EDI clearing house.
- API (via JSON) — You may submit an attachment for a single claim.
General guidelines
- A maximum of 10 claim attachments are allowed per submission. Each attachment cannot exceed 10 megabytes (MB) and total file size cannot exceed 100 MB.
- The acceptable supported formats are pdf, tif, tiff, jpeg, jpg, png, docx, rtf, doc, and txt.
- The 275 claim attachments must be submitted prior to the 837. After successfully submitting a 275 claim attachment, an Attachment Control Number will generate. The Attachment Control Number must be submitted in the 837 transactions as follows:
- CMS 1500
- Field Number 19
- Loop 2300
- PWK segment
- UB-04
- Field Number 80
- Loop 2300
- PWK01 segment
- CMS 1500
In addition to the Attachment Control Number, the following 275 claim attachment report codes must be reported in field 19 of the CMS 1500 or field number 80 of the UB-04.
| Attachment type | Claim assignment attachment report code |
|---|---|
| Itemized Bill | 03 |
| Medical Records for HAC review | M1 |
| Single Case Agreement (SCA)/LOA | 04 |
| Advanced Beneficiary Notice (ABN) | 05 |
| Consent Form | CK |
| Manufacturer Suggested Retail Price /Invoice | 06 |
| Electric Breast Pump Request Form | 07 |
| CME Checklist consent forms (Child Medical Eval) | 08 |
| EOBs — for 275 attachments should only be used for non-covered or exhausted benefit letter | EB |
| Certification of the Decision to Terminate Pregnancy | CT |
| Ambulance Trip Notes/Run Sheet | AM |