Claims and Billing

ACNC is accepting ANSI 5010 ASC X12 275 unsolicited claim attachment transactions. Claim attachments are accepted via Availity and Optum/Change Healthcare. Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 attachment submissions via payer ID: 81671.

1. Availity Intelligent Gateway

There are two ways the 275 attachments can be submitted:

• Batch — You may either connect to the Availity Intelligent Gateway directly or submit via your EDI clearing house.
  
  
• Portal — Individual providers can register at Availity Opens a new window to submit attachments.

After logging in, providers registered with Availity may access the Attachments - Training Demo for detailed instructions on the submission process via this Training Link Opens a new window.

2. Optum/Change Healthcare

There are two ways 275 unsolicited 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

View the Change Healthcare 275 claim attachment transaction video Opens a new window for detailed instructions on this process.

General guidelines 

• A maximum of 10 attachments are allowed per submission. Each attachment cannot exceed 10 megabytes (MB) and total file size cannot exceed 100MB.
• 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 followed:
  • CMS 1500
    • Field Number 19
    • Loop 2300
    • PWK segment
  • UB-04
    • Field Number 80
    • Loop 2300
    • PWK01 segment

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 (see grid below).

ACNC is accepting ANSI 5010 ASC X12 275 solicited claim attachment transactions. The 275 solicited attachments are accepted via Availity, NaviNet or postal mail.

Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 solicited claim attachment transaction submissions via payer ID 81671.

Providers may submit the documentation via:

Availity

• There are two ways 275 solicited claim attachments can be submitted
  • Batch — You may either connect to Availity directly or submit via your EDI clearing hous
  • Portal — Individual providers may also register at Availity Get Started 

After logging in, providers registered with Availity may access the Attachments - Training Demo for detailed instructions on the submission process via: Training Link Opens a new window or refer to the Availity Claims Attachment Quick Reference guide located under Claims Resources at the bottom of this page.

NaviNet

• Login to NaviNet.
• Under Workflows menu, select Practice Documents.
• Search (using any filter options) and open the document in viewer.
• Click the ‘Respond’ (  ) icon at the upper right corner of the viewer.
• Click ‘Add Document’ and complete the upload process.
  • Acceptable supported formats are pdf, tiff, jpeg, jpg, png, docx, rtf,  doc, csv, xls, xlsx and txt.

Postal Mail

There are two ways to submit:

1. PCH Global (No cost to providers)

To enroll for claims submission through PCH Global, please go to https://pchhealth.global Opens a new window 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
  • P.O. Box: 7380

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

2. Optum/Change Healthcare ConnectCenter™

The direct entry claims portal, ConnectCenter, is available for reconnection, at no cost, for providers who were registered with ConnectCenter prior to the security incident. 

It is not necessary to complete a new registration, and usernames will remain the same.

To reconnect:

• Access the login page via the Claims submission link in the NaviNet provider portal or via one of the direct links below:
  • Connect Center connectcenter.changehealthcare.com Opens a new window
  • physician.connectcenter.changehealthcare.com Opens a new window.
    
    
• Follow the instructions on the login page to reset your password and to set up the required multi-factor authentication.

For more information on available functionality, please review the release notes in the Product News section after signing into the ConnectCenter portal.

Send paper claims to:

AmeriHealth Caritas North Carolina
Attn: Claims Processing Department
P.O. Box 7380
London, KY 40742-7380

A remittance advice (or ERA/835) for each transaction is included with your payments.

ACNC offers ERAs (also referred to as an 835 file) through ECHO Health.

All ECHO HEALTH generated ERAs and a detailed explanation of payment for each transaction are accessible to download through our NaviNet Provider portal Opens a new window or from the ECHO provider portal Opens a new window. If you are a first-time user and need to create a new account, please reference ECHO Health's Provider Payment Portal Quick Reference Guide (PDF) Opens a new window for instructions.

Contact your practice management/hospital information system for instructions on how to receive ERAs from AmeriHealth Caritas North Carolina under Payer ID 81671 and the ECHO Payer ID 58379. If your practice management/hospital information system is already set up and can accept ERAs from AmeriHealth Caritas North Carolina, then it is important to check that the system includes both AmeriHealth Caritas North Carolina and ECHO Health Payer ID 58379 for ERAs.

If you are not receiving any payer ERAs, please contact your current practice management/hospital information system vendor to inquire if your software has the ability to process ERAs. Your software vendor is then responsible for contacting Change Healthcare to enroll for ERAs under AmeriHealth Caritas North Carolina Payer ID 81671 and ECHO Health Payer ID 58379.

If your software does not support ERAs or you continue to reconcile manually, and you would like to start receiving ERAs only, please contact the ECHO Health Enrollment team at 1-888-834-3511.

Payment Recovery Details

Recovery details are currently provided on the remittance advice or 835 you receive with your payments for claims processed on and after May 6, 2024. 

For claims processed February 21, 2024, through May 5, 2024, ACNC has generated a comprehensive claims recovery report available in the NaviNet provider portal. The claims recovery report provides payment recovery details by your member’s account number, claim number, provider tax ID, payee/group ID and NPI.

To access the claims recovery report:

1. Log in to the NaviNet provider portal.
2. Select applicable health plan.
3. Go to Report Inquiry under Workflows for this Plan.
4. Click on Administrative Reports > Claim Recovery Report

• ACNC utilizes the NCDHHS fee schedules Opens a new window.
• Medical payment cycles run every Monday, Wednesday and Friday.
• Pharmacy payment cycles run every four days.

AmeriHealth Caritas North Carolina has contracted with Change Healthcare and ECHO^® Health Inc., to administer electronic funds transfer (EFT) payments. There are no fees for single-payer agreements to receive a direct payment from AmeriHealth Caritas North Carolina via EFT or to receive an electronic remittance advice (ERA).

How to enroll

If you already receive payments from ECHO Health, you may be able to enroll for EFT with AmeriHealth Caritas North Carolina using your existing account. Please make sure you have an ECHO Health draft number and corresponding payment amount so your enrollment request can be validated. A draft number is listed as the EPC draft number on ECHO Health's explanation of payments. If you need assistance locating an ECHO payment in order to register, you can contact ECHO at 1-800-946-4041, Monday through Friday, from 8 a.m. to 6 p.m. ET.

Please use the ECHO Health EFT/ERA Enrollment link below to complete your registration. It will be helpful to use information from your first check stub to register..

• ECHO Health EFT/ERA Enrollment Opens a new window

ECHO claims payment schedule

• Medical payment cycles run every Monday, Wednesday and Friday.
• Pharmacy payment cycles run every four days.

To inquire about claim status, sign in to NaviNet Opens a new window and select Claims Status Summary under Administrative Reports. Provider Services can help check the status of up to 5 claims via phone at 1-888-738-0004.

You can appeal a claims decision online by signing in to NaviNet and selecting the Provider Grievances and Appeals option in the right-hand navigation. Or, if you prefer, you may download the Appeals Submittal form from our forms section of our website and submit your request, along with any supporting documentation, in writing to:

AmeriHealth Caritas North Carolina
Attn: Provider Grievances and Appeals
P.O. Box 7379
London, KY 40742-7381

Submitting claims electronically

AmeriHealth Caritas North Carolina contracts 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.