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February is Black History Month |
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NaviNet
NaviNet is an easy-to-use, no-cost, web-based platform that links providers to AmeriHealth Caritas Ohio. Through NaviNet, you can access:
- Member eligibility verification
- Claims investigation
- Care gap reports to identify needed services
- Member Clinical Summaries
- Medical claims data
- Member panel rosters for PCPs included under your contract
The following resources will help you use or get started with NaviNet:
Sign up for NaviNet
Log in to NaviNet |
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Care coordination portal down
The AmeriHealth Caritas Ohio care coordination portal will be offline for a short time. Once the updates and maintenance has concluded, we will be sure to reach back out with an update. In the meantime if you need assistance, please call Member Services 24/7: 1-833-764-7700.
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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
Effective 03/01/2023, claims received without the SL modifier and/or the billed amount will be denied for providers participating in the VFC program.
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It’s the time of year for Split Claims
Expenses incurred in different calendar years cannot be processed as a single claim. A separate claim is required for the expenses incurred in each calendar year.
There are a number of prescribed situations where a claim is received for certain services that require the splitting of the single claim into one or more additional claims. The splitting of such a claim is necessary for various reasons such as proper recording of deductibles, separating expenses payable on a cost basis from those paid on a charge basis, or for accounting and statistical purposes.
EXCEPTION FOR DURABLE MEDICAL EQUIPMENT REGIONAL CARRIERS (DMERCs):
Expendable items (disposable items such as blood glucose test strips and PEN nutrients) that will be used in a time frame that spans two calendar years and are required to be billed with appropriately spanned “from” and “to” dates of service may be processed on a single claim line. For these types of items, DMERCs must base pricing and deductible calculations on the “from” date, since that is the date when the item was furnished.
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Change Healthcare Portal - Payer ID and submitting attachments or other documentation
- AmeriHealth’s
Payer ID is 35374
- Change Healthcare
will also accept claims with Payer ID 84243
Ohio Department of Medicaid has notified participating MCOs that due to a system upgrade still in process, a work around is required to process attachments required for services related to abortion, sterilization, hysterectomy, medical supplies, or other identified services not listed.
How will this impact your claim submission?
EDI Providers
- Submit the 837-claim information utilizing your designated clearinghouse.
- Do not attach the consent/itemized bill information at this time.
- Copy the claim number information from EDI submission
- Go to our Change Healthcare Portal to log in/register to submit the required attachments for claims processing. There are multiple ways in which attachments can be sent to the plan:
- There are three ways the 275 attachments can be submitted. The acceptable supported formats are PDF, TIF, TIFF, JPEG, JPG, PNG, DOCX, RTF, XML, DOC, and TXT.
- 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 HealthcareOpens a new window to submit attachments.
- Please reference the instruction guide for details on options for submitting attachments.
Direct Data Entry Providers
Log in to Change Healthcare using the tool called ConnectCenter to improve claims management functionality. Providers who have a limited ability to submit claims through their hospital or project management system may now benefit from key features of the ConnectCenter tool. There is no cost to providers to use ConnectCenter.
- Go to our Change Healthcare Portal to log in/register to submit claim information and associated attachments.
- To register for ConnectCenter, visit ConnectCenter Sign-Up. If you need assistance, Change Healthcare customer support is available through online chat or by phone at 1-800-527-8133, option 2.
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“View” our new vision benefit!
It is with great excitement that AmeriHealth Caritas Ohio, announces a new enhanced benefit for plan members. Effective February 1, 2023, routine vision services will be covered for all members. Detailed information about this new benefit is provided below.
- Members aged 21 and under and age 65 and older, one comprehensive eye exam per year. One pair of glasses (frames and lenses) a year
- Members aged 21 to 64, one comprehensive eye exam every 2 years. One pair of glasses (frames and lenses) every 2 years
Extra eye care for diabetics
- One comprehensive eye exam every year. One new pair of glasses (frame and lenses) every 2 years. Adjustments to lenses, as needed, every year
For additional details, please visit our website.
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New provider orientation
AmeriHealth Caritas Ohio is hosting a series of virtual provider orientations. Please see the dates below and join your personal account executives online. Each session is held via Zoom from 10 a.m. - 11 a.m.
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Feb. 21 - Click here to register
Mar. 7 - Click here to register
Mar. 21 - Click here to register
April 4 - Click here to register
April 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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Grievances
Access to service is a right and AmeriHealth Caritas Ohio (ACOH) takes reported grievances seriously. Given the severity of the grievance and the impact it may have, resolution (including member notifications) must meet a timeframe of two business days following receipt of any access to service grievance.
ACOH believes in taking a hands-on approach to resolving grievances and understands that each grievance must be treated differently. We strive to make sure the member understands that we care about fulfilling their needs and will stay in constant contact to gather additional information, answer questions, inform them of each step taken, and walk side-by-side with them until their grievance is resolved.
If we receive a grievance against you, grievance associates will reach out to you, the provider, seeking resolution for the issue. Due to time sensitivity, we will work with you as quickly and efficiently as possible to get the grievance resolved. We look forward to working hand-in-hand with you and creating a better health outcome for our members.
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Checkwrite
For the convenience of our providers, AmeriHealth Caritas Ohio has established three Checkwrite days per week - Mondays, Wednesdays, and Fridays. We are committed to providing timely claims adjudication for you. All claims for services rendered by in-network providers must be submitted to AmeriHealth Caritas Ohio within 365 days from the actual date of service (or the date of discharge for inpatient admissions).
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Provider manual
We are pleased to have you participating in our network. Our provider manual is designed to provide important information on processes, programs and the delivery of care to AmeriHealth Caritas Ohio members. Click here to access the manual. |
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Tell us a little bit about where you’re from and where you went to school.
I grew up in a military family and settled outside Toledo by junior high. I went to St. Joseph Central Catholic High School in Fremont. I obtained my BA in Social Work from Saint Mary’s College in Notre Dame, IN and my Masters of Science in Social Administration (MSSA) in Social Work from Case Western Reserve University. I completed over 2,000 hours of post graduate school training to become a Licensed Independent Social Worker, and later obtained my supervision designation.
Everyone at AmeriHealth Caritas Ohio (ACOH) has a story about why they joined the team. What’s yours?
I have seven years' experience working in managed care from provider relations to member case management. I worked with the leadership of this team in that experience, and have the highest regard for the integrity and values they embody that an opportunity to work with them could not be passed up.
What drew you to this profession?
I have a clinical background and have seen firsthand how the operation of a business impacts the client. I was drawn to the focus AmeriHealth has on working with providers. I truly believe that when there is outstanding collaboration, providers are freed from administrative burden they can focus on the amazing care that only they can provide. Ultimately, our relationships with providers can impact patient care, and I wanted to be part of a team that does that. |
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What do you like to do in your free time?
My free time is spent watching my two children and husband in sporting events. Weekends are spent state-wide watching cross country, football, basketball, track and softball. I love being a sports mom and wife.
What are 2 apps on your phone you CANNOT live without?
I love to look up things to learn more, so I could not live without Google on my phone. I have a minimum of 5 browsers open at any time so I can look back and reference the information. Also, I could not live without my calculator- math is not my area of expertise by any means!
Any interesting facts about yourself that you’d like to share?
I was born on a military base in Stuttgart, Germany. My poor mother carried me for 3 extra weeks in a hot, early fall and said she (and all the other pregnant women on base) would walk the frozen food aisles of the commissary as there was no air conditioning in the apartments.
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DEI Training - Cooking With Gas: Health Harms from Gas Stoves
AmeriHealth Caritas is collaborating with a physician-led, national non-profit organization to provide training for healthcare providers to learn how gas stoves contribute to childhood asthma and other respiratory ailments.
The online training course is being offered by Physicians for Social Responsibility (PSR), a non-profit that mobilizes physicians about the consequences of climate change and other environmental hazards to health. The March 16 webinar called
Cooking with Gas: Health Harms from Gas Stoves will inform healthcare providers about the dangerous indoor air pollutants produced by natural gas appliances, what these pollutants do to the human body, and how they as health professionals can protect their patients and their families.
Upon completion of the course, health care providers will earn continuing medical education (CME) credits or continuing education unit (CEU) credits.
Click here to register.
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In 1854, John Mercer Langston was the first Black man to become a lawyer in Ohio. He was also elected as the Town Clerk for Brownhelm, Ohio in 1855, becoming one of the first African Americans elected to public office in America.
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February is Black History Month
President Gerald Ford officially recognized Black History Month in 1976, calling upon the public to “seize the opportunity to honor the too-often neglected accomplishments of Black Americans in every area of endeavor throughout our history.” Today, Black History Month is a time to honor the contributions and legacy of African Americans across U.S. history and society—from activists and civil rights pioneers such as Harriet Tubman, Sojourner Truth, Marcus Garvey, Martin Luther King Jr., Malcolm X and Rosa Parks to leaders in industry, politics, science, culture and more.
Since 1976, every American president has designated February as Black History Month and endorsed a specific theme. |
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Need help navigating all the changes? 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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