Providers

Change Healthcare System Interruption

Change Healthcare, our electronic data interchange (EDI) clearinghouse for claims and payment cycle management, continues to address their network interruption related to a security incident. Below are updates for our systems and processes:

  1. Claims payments: We have resumed payments for claims submitted prior to the incident. Since Change Healthcare is still unable to accept claims submissions, providers who submitted claims during the outage may be able to resubmit them either through additional solutions identified below through Availity and PCH Global, or once Change Healthcare’s connectivity is restored, through Change Healthcare. We appreciate the inconvenience this is causing.
  2. Electronic claims submission: We have established a connection with Availity to receive electronic claims. If you or your clearinghouse do not currently use Availity to submit claims, you may register at: https://www.availity.com/Essentials-Portal-Registration. You will find registration options for Healthcare and Atypical Provider, so please choose the one that aligns with your business. For registration process assistance and other resources, access the training site link on the Availity registration page.
  3. Manual claims submission: We have established a direct claims entry process through PCH Global. To submit claims directly, please go to https://pchhealth.global and click the Sign-Up link in the upper right-hand corner to register.  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:

  1. Payer name: AmeriHealth Caritas District of Columbia (DC)
  2. PO Box:

Medicaid Enrollees

AmeriHealth Caritas District of Columbia
Attn: Claims Processing Department
P.O. Box 7342
London, KY 40742

Alliance Enrollees

AmeriHealth Caritas District of Columbia
Attn: Claims Processing Department
P.O. Box 7354
London, KY 40742

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.

  1. Electronic remittance advice: Electronic remittance are available at this time. However, some individual remittance advices may not be available due to Change Healthcare’s security incident.
  2. Prior authorization submission and processing: The prior authorization systems continue to operate normally.
  3. Eligibility verification, claim status inquiry, and authorization inquiry: These capabilities continue to be available via NaviNet. If you do not have access to NaviNet provider portal, please visit https://register.navinet.net/ to sign up.

Please note, in the interim, our Provider Services Department will not be able to assist with processing of your payments any sooner. If you have other questions, you may contact Provider Services at 1-888-922-0007.

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

eviCore healthcare

Effective January 12, 2024, AmeriHealth Caritas DC will be the single point of contact for all new prior authorization requests, prior authorization requests for continuation of services, and retrospective authorization requests previously managed by eviCore (PDF).

We can help enrollees manage their health.

Learn about the Let Us Know program.

NaviNet provider portal

Submit referrals and claims and view enrollee eligibility and benefits.

Log inRegister

Pharmacy prior authorization form

View the online pharmacy prior authorization form.

Enrollee Programs and Resources

Visit our Health Programs page to learn more about our offerings for enrollees.

Will you Let Us Know?

Use the Let Us Know program to partner with AmeriHealth Caritas District of Columbia to better engage with and manage the health care needs of our enrollees — your patients. The program helps connect enrollees with resources, such as the Rapid Response and Outreach Team and Care Management.

Check out our provider orientation and quick reference materials for easy access to the information you need.

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Important contact information

  • Provider Account Executives (PDF)
  • Provider Services: 202-408-2237 or 1-888-656-2383
  • Provider Services fax: 202-408-1277
  • Utilization Management: 1-888-605-4807
  • Utilization Management fax: 1-877-759-6216
  • Credentialing: 1-877-759-6186