• Communications

• Policies and Guidelines

• Claims and Billing

• National Provider Identifier (NPI)
• HIPAA 5010
• ICD-10
• Electronic Data Interchange (EDI) Services
• Claims Requirements and Communications
• Claims Submission Addresses
• Claims Requiring Submission of Clinical Information
• Provider Claim Appeals Process (NJ Only)
• Chiropractic Billing Guide
• Clear Claim Connection and Significant Edits Disclosure Report
• Kentucky Family Planning

• Interactive Tools and Resources

• Pharmacy Information

• Resources for Patient Management

• Contact Information

EDI Forms & Guides

Electronic Data Interchange Services is your electronic way to submit information.

AmeriHealth has provided you with following links of guides and samples in order to enable you to use your EDI application with more ease and efficiency.

Claims Preprocessing Edits Claims Resolution

4010

• Claims Preprocessing Edits Claims Resolution Document (11/2010)

5010

• Claims Preprocessing Edits Claims Resolution Document (10/2011)

HIPAA Transaction Companion Guides*

4010

• Remittance Advice (835)
• Claim – Institutional (837-I)
• Claim – Professional (837-P)
• Incoming Transaction Envelope

5010

• Remittance Advice (835)
• Claim – Institutional (837-I)
• Claim – Professional (837-P)
• Incoming Transaction Envelope

Trading Partner Specification

4010

• U277 Trading Partner Specification (Claim Status Notification)

5010

• U277 Trading Partner Specification (Claim Status Notification)

Sample Transactions (file formats & data elements)

4010

• Remittance (835)
• Claim – Institutional (837)
• Claim – Professional (837)
• Claim Acknowledgement (997)
• Unsolicited Claim Status (U277)

5010

• Sample Transaction (834)
• Remittance (835)
• Claim – Institutional (837)
• Claim – Professional (837)
• Claim Acknowledgement (999)
• Unsolicited Claim Status (U277)

Payer ID List

The payer ID codes are to be used when electronically submitting claims to AmeriHealth. Note: You may also have separate clearinghouse-specific payer ID codes to use when billing from your office to your clearinghouse vendor.

• Professional Payer ID and Provider Number Reference
• Facility Payer ID and Provider Number Reference

Update on Regulations

• Centers for Medicare and Medicaid Services (CMS)
• Partners in Health Update
• Provider Bulletins
• Privacy Information (HIPAA)

For more information or assistance, please contact the EDI team or call the EDI Business Help Desk at 215-241-2305.

* Companion guides are under construction and subject to change post implementation.

Important information about links to other sites