Billing and Claims

AmeriHealth Caritas Louisiana can accept claim submissions via paper or electronically (EDI). For questions about claims submissions, call Provider Services at 1-888-922-0007.

Requests for reconsideration may be submitted through the NaviNet Electronic Claim Inquiry feature. For detailed information on electronic claim inquiry submission, please see the NaviNet Claims Investigation User Guide (PDF).

Submit a 275 attachment claim transaction

AmeriHealth Caritas Louisiana is accepting ANSI 5010 ASC X12 275 unsolicited claim attachment transactions. The 275 attachments are accepted via Optum/Change Healthcare and 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.

Availity

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].

Optum/Change Healthcare 

  • There are two ways 275 claim attachments can be submitted:
    • Batch — You may either connect to Optum/Change Healthcare directly or submit via your EDI clearinghouse.
    • API (via JSON) — You may submit an attachment for a single claim.

View the Optum Change Healthcare 275 claim attachment transaction video for detailed instructions on this process.

General guidelines

  • A maximum of 10 claim 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.
  • The 275 claim attachments must be submitted prior to the 837. After successfully submitting a 275 claim attachment, an Attachment Control Number will be generated. The Attachment Control Number must be submitted in the 837 transactions as follows:
    • 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.

Attachment type Claim assignment attachment report code
Itemized Bill 03
Medical Records for HAC review M1
Single Case Agreement (SCA)/LOA 04
Advanced Beneficiary Notice (ABN) 05
Consent Form CK
Manufacturer Suggested Retail Price /Invoice 06
Electric Breast Pump Request Form 07
CME Checklist consent forms (Child Medical Eval) 08
EOBs – for 275 attachments should only be used for non-covered or exhausted benefit letter EB
Certification of the Decision to Terminate Pregnancy CT
Ambulance Trip Notes/ Run Sheet AM

Submit claims electronically via Change Healthcare

Change Healthcare uses a 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.

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 enable 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.

To register for ConnectCenter, visit ConnectCenter Sign Up Opens a new window. Use vendor code: 21462. If you need assistance, Change Healthcare customer support is available through online chat or by phone at 1-800-527-8133, option 2.

Electronic claims will need to be submitted to Change Healthcare using a 4-digit ConnectCenter payer identifier (CPID). The CPIDs for AmeriHealth Caritas Louisiana are:

Institutional claims: 4638

Professional claims: 6156

To learn how to navigate ConnectCenter visit the resources below.

User guides

Providers