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Rewards and extra benefits
AmeriHealth Caritas Ohio (ACOH) offers extra benefits and wellness programs to support your patients (our members). We help them get the care they deserve and stay healthy while offering these extra benefits, in addition to the covered services required by Ohio Department of Medicaid.
- Health Risk Assessment (HRA) - $15 in CARE Card rewards
- Mission GED - ACOH will provide the member with testing vouchers so they can take tests for an HSE diploma at no cost
- WW (formerly Weight Watchers) membership - all members ages 18-64 can get an online membership at no cost for 6 months
- CARE Card - members can do things to stay healthy and earn rewards on a reloadable gift card
- Living Beyond Pain - members ages 21 – 59 diagnosed with diabetes can get one additional eye exam every 12 months
- Dental Care - members 21 and older can get one additional cleaning and exam per calendar year
- Transportation benefit - all members can get unlimited nonemergency trips for provider visits more than 30 miles from their home. Qualifying members can get up to 60 non-emergency one-way trips per year within 30 miles of their home.
- Rec Center memberships - membership at participating parks and recreation centers for qualified members younger than age 19
- Bright Start - members get access to our pregnancy care program
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Click here to view rewards and extra benefits available to your patients from ACOH. |
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Ohio Department of Medicaid is not approving any trading partner to submit EDI claims directly to the MCEs
Ohio Department of Medicaid (ODM) has determined that the direct submission of claims by trading partners (TP) to Managed Care Entities (MCE) is not needed and would create an inconsistent provider experience across MCEs. Click here to read the entire ODM memo.
Providers and/or trading partners experiencing EDI claim issues should contact ODMs Integrated Helpdesk (IHD) at 800-686-1516. Additional resources related to claims submission can be found on ODMs website here:
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To our Vaccine for Kids (VFC) providers
AmeriHealth Caritas Ohio PCPs are required to enroll with the Ohio Department of Health (ODH) Immunization Program to receive vaccines for members under age 19 years through the Vaccines for Children Program.
Vaccinations covered by the VFC program will not be reimbursed by AmeriHealth Caritas Ohio; however, the Plan reimburses providers for appropriate vaccine administration to members aged 18 years and younger. Providers are expected to plan for a sufficient supply of vaccines and are required to report the use of VFC vaccines immunizations by:
- Use of the “SL” modifier to indicate the provider is participating in the program
- The SL modifier must be listed on the administration and all associated immunization & toxoid lines of the claim. By applying the SL modifier, this will indicate no reimbursement of the associated toxoid/ immunizations
- Toxoid/Immunization CPT codes must be submitted with a charge amount greater than zero
- Providers will receive reimbursement for the administration of the vaccine only
As of 03/01/2023, providers participating in the VFC program may receive denials if claims have been submitted without the SL modifier and/or the billed amount.
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REMINDER - do not send paper claims
AmeriHealth Caritas Ohio does not accept paper claims. If you have submitted a paper claim, you will receive a phone call or email advising you that your claim has not been processed. You will be directed on next steps at that time.
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Register for Provider Network Management module refresher training
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ODM in partnership with Maximus, the Provider Network Management (PNM) module vendor, is continuing the provider awareness and training efforts. Registration is now open for the April 19 - 26 PNM module refresher training. The training schedule is posted and available on the Next Generation website. Below you will find how to register and a list of training topics.
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Learning management system registration
Absorb, the learning management system (LMS), is where you can access virtual and self-paced training sessions. If you do not have an account in the LMS, it’s important that you create one to access all training sessions, answer forms, and view a variety of PNM module resources. Access the job aid and follow the steps to create your account and register for training.
Training agenda
Training module topics include:
- Account Administration and Dashboard
- New Enrollment
- Affiliations
- Updates & Revalidations
For more information
To learn more about the PNM module and Centralized Credentialing, visit the PNM and Centralized Credentialing page on the Next Generation website. If you are experiencing any technical issues accessing the PNM module or have specific questions, please contact the ODM Integrated Helpdesk (IHD) at 800-686-1516 or IHD@medicaid.ohio.gov. The IHD is open 8 a.m.-4:30 p.m. Monday-Friday, Eastern time.
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Options for claims submission and medical attachment with Change Healthcare
AmeriHealth Caritas Ohio is accepting Medical Attachments (unsolicited) via our preferred vendor Change Healthcare. Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic Medical Attachment (275) submissions via payer ID: 84243. (Please note data fees may apply)
There are three ways the Medical Attachments can be submitted to the Change Healthcare clearinghouse. The acceptable supported formats are PDF, TIF, TIFF, JPEG, JPG, PNG, DOCX, RTF, XML, DOC, TXT, GIF and BMP.
- Batch — You may either connect to Change Healthcare directly or submit via your EDI clearing house.
- API via JSON — You may submit an attachment for a single claim.
- Portal — Individual providers can register at Change Healthcare to submit Medical Attachments.
AmeriHealth Caritas Ohio providers with a limited ability to submit claims through their hospital or project management system may benefit from a tool that Change Healthcare offers called ConnectCenter. There is no cost to providers to use ConnectCenter. To register for ConnectCenter, click here. If you need assistance with ConnectCenter, Change Healthcare customer support is available through online chat or by phone at 1-800-527-8133, option 2.
Key features are:
- Claims users do not need to choose between data entry of claims and upload of 837 files. All users may do both.
- Secondary and tertiary claims can be submitted
- Institutional claims are supported
- Claims created online are fully validated in real-time so that providers can correct them immediately
- Whether providers upload their claims or create them online, the claim reports are integrated with the claim correction screen for ease in follow-up
- Dashboard and work list views enables providers to streamline their billing to-do list
- Remittance Advice is automatically linked to provider's submitted claim, providing a comprehensive view of the status of their claim
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PNM affiliation steps not completed may impact provider billing
Through a series of PNM queries, ODM has identified several affiliation issues that impact billing organizations claims. It is imperative that providers fully execute all steps when affiliating a rendering provider to their group/organization/hospital to avoid claims payment issues. ODM has identified that providers tend to leave affiliations in one of two incomplete statuses (Affiliation Status):
- Pending Approval
- Confirmed
For more information, visit the PNM learning tab. You will find step-by-step instructions in three Quick Reference Guides (QRGs) for affiliation assistance.
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Claims Payment Systemic Error (CPSE) Report
Click here to view the Claims Payment Systemic Errors (CPSE) report.
This report is updated and posted on the ‘Alerts and Newsletter’ page monthly. AmeriHealth Caritas Ohio encourages you to review this log frequently and before contacting our Provider Services team. If after reviewing you still have additional questions, please feel free to reach out to Provider Services at 1-833-644-6001 and, as always, you can reach out to your local account executive.
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Peer-to-Peer Telephone Line
To discuss a medical determination with a physician in the AmeriHealth Caritas Ohio Medical Management department, providers may call the Peer-to-Peer telephone line by following the prompts at 1-833-735-7700. Providers must call within two business days of notification of the determination or within two business days of the member’s discharge from an inpatient facility.
The purpose of the Peer-to-Peer process is to address medical determinations regarding health care services. This process is not intended to address denied claims or other issues. For information on filing an informal provider complaint, please refer to the "Provider and Network Information" section of the Provider Manual. For information on disputing a claim, please refer to the "Claims Submission Protocols and Standards" section of the Provider Manual.
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Join us at a virtual new provider orientation session |
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AmeriHealth Caritas Ohio has added additional provider orientation sessions. Please see the dates below and join your personal account executives online via Zoom from 10 a.m. - 11 a.m.
May 16 - Click here to register
June 20 - Click here to register
July 18 - Click here to register
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If you have attended an orientation session and have not completed the attestation, please click here to do so. |
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Tell us a little bit about where you’re from and where you went to school.
I was born in Landstuhl, Germany to military parents. We lived overseas until I was about 9 years old before settling down in Clarksville, Tennessee. I earned credits from The Community College of the Air Force at Shepherds Air force Base, TX while studying for my military career in Health Services Management.
Everyone at AmeriHealth Caritas Ohio (ACOH) has a story about why they joined the team. What’s yours?
I was working for another plan for 10 years, and honestly wasn’t looking to leave. But comfort can be the enemy of growth. When I heard about AmeriHealth Caritas Ohio, and how they wanted to do things better and differently I knew I wanted to part of the team. I was the 5th Account Executive on the team, making me part of the “Starting Five!”
What drew you to this profession
After I left the Air Force, I tried my hand in a few careers - from sales to phlebotomy to bartending. None of those roles gave me the fulfillment of helping those in need. I took a leap of faith and took an entry level position at a company whose mission was to make a difference in the lives of underserved people by improving their healthcare. From there it's all history. |
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What do you like to do in your free time?
My husband and I have a blended family which includes 15 children from the ages of 2-24! Depending on the time of year free time is spent supporting cheer, track, volleyball, swim and/or football. When I’m not being an all-around Sports Mom, I enjoy playing games (Connect four, Monopoly, Sorry) watching crime documentaries and cooking.
If you could have dinner with anyone in the world, dead or alive, who would it be? Why?
Hands down it would be my maternal grandmother. She was my first best friend and passed when I was 22. I would love to cook dinner for her and show her I’m keeping her legacy alive and my house is now “Big Mamas House!”
What are two apps on your phone you CANNOT live without?
This is a tough one! If I had to choose, it would be TikTok (while it’s still available) and my camera.
Any interesting facts about yourself that you’d like to share?
My parents share the same birthday - year and all! It gets even more interesting… my father-in-law shares the same month and day as them!
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Mazia Wilder with her husband and their family |
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April is National Minority Health Month
National Minority Health Month is a time to build awareness of the disproportionate burden of premature deaths and illnesses in racial and ethnic minority and American Indian/Alaska Native communities. It is also a time to encourage action through health education and early detection and to control disease complications.
Did you know?
- It is estimated that only 14 percent of the U.S. population has proficient health literacy.
- Nearly 20 percent of people in the U.S. speak a language other than English at home.
- It is estimated that over 60 percent of racial and ethnic minority patients over the age of 18 believe it is at least somewhat important to visit a health care provider who shares or understands their culture.
- In 2021, OMH awarded $250 million to local governments to promote evidence-based health literacy strategies that are culturally appropriate.
Learn more about Minority Health Month and how to get involved.
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CPC webinars from ODM
- Tuesday, June 6 - CPC Quarterly Webinar: Improve foster care supports for youth and tips on how to communicate effectively with local schools
- Tuesday, September 12 - CPC Quarterly Webinar: Enrollment in CPC and PNM
Register here.
Improving Outcomes for People with Disabilities 2023 virtual roundtable
Ohio Association of Health Plans and Ohio Center for Autism and Low Incidence (OCALI) are hosting a series of virtual roundtables. This series provides attendees the opportunity to hear from and engage with national experts and local leaders and deepen their understanding of people with disabilities as a focus of population health. The one-hour roundtables include lived experience, didactic presentation, and opportunity for interaction. Each session is designed to both challenge your thinking and change your practice, providing you with tools and resources you can use immediately. Click here to register.
Webinar: Heart Health and the Science of Sleep
The Ohio Cardiovascular & Diabetes Health Collaborative is offering a Heart Health and the Science of Sleep webinar with CME credit offered. Objectives:
- Identify the cardiovascular implications of sleep conditions
- Screen patients at risk for sleep conditions
- Counsel patients on how to optimize sleep health
Sign up here. |
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Need help? Visit the provider section of the AmeriHealth Caritas Ohio website for more information, news and resources. Or contact your dedicated AmeriHealth Caritas Ohio account executive. We’re here to help! |
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