Providers

Attention Providers

Change Healthcare System Interruption

We thank you for your partnership and patience, as we continue to work to resolve the downstream impacts of Change Healthcare’s service interruption.

Below is a summary of the current status of our systems and processes:

Eligibility verification, claim status inquiry, prior authorization submission/processing and authorization inquiry: These functionalities continue to operate normally and are available via the NaviNet provider portal. If you do not have access to NaviNet, please visit: https://register.navinet.net/ to sign up.

Claims Submission Options:

Electronic claims:

  • Availity: Providers may submit claims to AmeriHealth Caritas Louisiana through Availity. Providers or clearinghouses not currently using Availity to submit claims, must register at: https://www.availity.com/intelligent-gateway/.
    • Providers who are currently registered with Availity for another payer, or using another clearinghouse, must request to have their electronic claims for AmeriHealth Caritas Louisiana routed to Availity.
    • For registration process assistance, submit the Provider Inquiry form at the bottom of the Availity webpage or contact Availity Client Services at 1-800-AVAILITY (282-4548).  Assistance is available Monday through Friday from 8 AM to 8 PM ET.
    • 275 Claim Attachment Transactions: AmeriHealth Caritas Louisiana is accepting ANSI 5010 ASC X12 275 claim attachment transactions (unsolicited) via 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 payer ID: 27357.
  • A maximum of 10 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. 
  • There are two ways 275 claim attachment transactions can be submitted:
  • 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].
  • Specific 275 claim attachment transaction report codes must be used when submitting an attachment. Visit the provider billing page for the list of applicable codes.
  • Optum/Change Healthcare: Even though AmeriHealth Caritas Louisiana has not reconnected directly, providers may also submit claims through Optum/Change Healthcare.
    • Providers will have to establish new connectivity with Optum.
    • For new connectivity requirements, reach out to your Optum/Change Healthcare account representative.
    • If you do not know who your account representative is, you can submit an inquiry via the Change Healthcare General Inquiry form.

Manual/direct entry claims:

  • PCH Global: Providers may submit manual or direct entry claims at no cost, through PCH Global. To enroll for claims submission through PCH Global, please go to https://pchhealth.global and click the Sign-Up link in the upper right-hand corner. 
    • 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:

a.  Payer name: AmeriHealth
b.  P.O. Box: PO BOX 7322

For a detailed walk through of the registration process, refer to the PCH Global Registration manual, found on the PCH Global website in the Resource Menu.

  • 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:

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

Electronic remittance advice (ERA/835) files: Payment 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, AmeriHealth Caritas Louisiana 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.

For current claims payments, providers can view and download an electronic remittance PDF via the NaviNet provider portal. Providers may also access the ERA/835 file through the ECHO Health provider payment portal at: www.providerpayments.com. Providers who are not currently registered with ECHO for access to the portal will have to create a new account.

For questions, contact your dedicated Provider Network Account Executive or AmeriHealth Caritas Louisiana Provider Services at: 1-888-922-0007.

Medicaid provider enrollment

ACT NOW — Enroll in the Medicaid Provider Enrollment Portal Opens a new window Opens a new window

Providers who missed the initial deadline of September 30, 2022, please note that the Provider Enrollment Portal at www.lamedicaid.com remains open for providers required to enroll (see criteria listed below) who have not yet applied. Providers with multiple provider types must complete enrollment for each type. 

Providers who did not complete enrollment by June 30, 2023, have been deactivated, their patients have been assigned to another primary care physician, and they will be terminated from the program. The Provider Enrollment Portal will remain open for providers who failed to enroll but wish to complete an application at a later date. 

Providers who submitted provider enrollment applications to Louisiana Medicaid should allow several weeks for application processing.

Who is required to enroll?

  • Providers who file claims with Louisiana Medicaid (providers enrolled in Fee-for-Service (FFS) Medicaid before December 31, 2021, and providers enrolled with an MCO, DBPM, or Magellan before March 31, 2022.)
  • Ordering, Prescribing, or Referring Providers
    • Ordering, prescribing, or referring (OPR) providers do not bill Medicaid for services rendered, but may order, prescribe, or refer services/supplies for Medicaid beneficiaries.

Providers can find additional information in IB 22-4 Medicaid Provider Enrollment Portal (PDF).

Medicaid urges enrollees to update information to maintain eligibility.

The Louisiana Department of Health (LDH) is seeking provider assistance to encourage their Medicaid patients to keep their case information (address, financial, and employment) updated to ensure eligibility. This can be done through Medicaid’s new Self-Service Portal.

Updated information is increasingly important as Medicaid is conducting more frequent eligibility verifications with its new eligibility and enrollment system. Previously, income was verified annually. Additionally, renewals will be handed by mail only, making it important that recipients keep their contact information updated so they do not miss important mail.

Providers are asked to remind their Medicaid patients to respond to any mail from Louisiana Medicaid in the timeline provided in the letter. Failure to respond could result in case closure.

Providers can now update demographic information via NaviNet

AmeriHealth Caritas Louisiana providers now have the ability to attest to the accuracy of practice data and submit demographic changes (PDF) directly through NaviNet via the Provider Data Information Form feature. This feature is only available to professional provider groups at this time.

Learn about the Louisiana State Opioid Response (LaSOR) Project

LDH-OBH in Partnership with LSUHSC–Dept. of Psychiatry is seeking office-based opioid treatment (OBOT) providers. If you are interested in participating, download the LaSor Flyer for more information (PDF).

Partners in Care

As an AmeriHealth Caritas Louisiana provider, you're our partner in member care. Our goal is to help you operate effectively and efficiently. Working with providers like you, we can deliver quality, cost-effective care and better health outcomes for our members.

Get your health plan news via e-mail. Sign up for our free Network News service to receive important health plan communications from AmeriHealth Caritas Louisiana.

Quick contact numbers:

  • Provider Services: 1-888-922-0007
  • Provider Network Management: 1-877-588-2248
  • Credentialing: 1-888-913-0349

Important information:


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