Claims Submission Process

AmeriHealth Caritas Florida strongly encourages our providers to submit claims electronically through Electronic Data Interchange (EDI). The advantages of submitting an electronic claim versus a paper claim include:

  • Faster, more expedient payment of your claims
  • An electronic receipt acknowledging your claim (through Change Healthcare)
  • Improved claims tracking
  • Improved claims status reporting
  • Improved turnaround time for timely reimbursement
  • Elimination of paper and waste
  • Improved cost effectiveness

Electronic claims submission (EDI)

To initiate the electronic claims submission process or to get more information, contact Change Healthcare at 877-363-3666. The AmeriHealth Caritas Florida Payer ID # is 77003.

Paper claims submission

Paper claims should be submitted to AmeriHealth Caritas Florida at the following address:

AmeriHealth Caritas Florida
P.O. Box 7367
London, KY 40742

Direct claim entry through Change Healthcare

Some small to medium size health care practices have a small volume of claims to submit and/or may not use a practice management system. For these providers, direct claim entry through our Change Healthcare clearinghouse provides a valuable service that helps reduce cost while improving workflow and efficiencies.

Benefits
Submitting claims electronically benefits your practice in many ways:

  • No capital investment required to purchase a practice management system
  • Increases provider automation, efficiency and accuracy
  • Improves your office workflow
  • Reduces errors associated with manual claim entry
  • Claims are submitted to the plan usually within 24 hours from initial submission

Features

  • Enables submission of HCFA claims
  • Provides methods to submit claim adjustment
  • Provides mechanism to submit claims attachment
  • Provides tool to also view real time eligibility and claim status information
  • Built-in edits to ensure clean claim submission
  • Tools to monitor claim submission status

How do I access this service?

Visit Change Healthcare.

Is there a cost?

Since there is no specialized software, there's no cost or per-transaction fee typically associated when purchasing a practice management system or contracting with an EDI clearinghouse.

Training

Get started with Change Healthcare's educational materials, including online training, reference guides, and custom training.

Need help?  Use the online "Help" links within the product. If you need extra assistance, call Change Healthcare Customer Service at 877-469-3263, option 2.

Refunds for improper payment or overpayment of claims

AmeriHealth Caritas Florida encourages providers to conduct regular self-audits to ensure receipt of accurate payment(s) from the health plan. Medicaid program funds must be returned when identified as improperly paid or overpaid.

If a plan provider identifies improper payment or overpayment of claims from AmeriHealth Caritas Florida, the improperly paid or overpaid funds must be returned to AmeriHealth Caritas Florida within 60 days from the date of discovery of the overpayment. Providers may return improper or overpaid funds to the health plan by:

  1. Completing page one of the Provider Claim Refund Form (PDF).
  2. Using page two of the form, as needed, to list multiple claims connected to the return payment.
  3. Submitting the completed form and refund check by mail to the claims processing department:

AmeriHealth Caritas Florida
Attn: Provider Refund Unit
P.O. Box 7367
London, KY 40742

Providers