• Communications

• Policies and Guidelines

• Claims and Billing

• National Provider Identifier (NPI)
• 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

• Physician Advisory Committee

• Contact Information

Electronic Data Interchange (EDI) Services

Electronic claims submission

EDI claims submission is the best way to submit your claims electronically. EDI claims submission reduces payor rejections, administrative concerns, and increases the speed of claims payment. To ensure maximum efficiency and productivity in your office and to increase the accuracy of claims processing, we encourage you to streamline the submission of your claims through an electronic method. Regardless of the method you use for delivery, electronic claims are tracked from the moment of submission through receipt by the health plan. Error reporting allows you to quickly and easily edit claims prior to submission, eliminating duplicate claims submission and delays in claim payment.

When submitting claims electronically for AmeriHealth, the National Association of Insurance Commissioners (NAIC) code must be 54704 to direct your files to Amerihealth in the EDI header record. Product codes are also assigned by NAIC for each of our product lines. A list of professional and facility payer ID codes are available at the following links:

• Professional Payer ID
• Facility Payer ID

Clearinghouses may update their submission rules from time to time. Always contact your clearinghouse for confirmation of up-to-date, specific submission requirements.

If you are interested in submitting electronic claims and have existing practice management software, please contact your vendor as they will more than likely have an existing clearinghouse vendor that connects to our gateway. Otherwise, you can reference the list of clearinghouse vendors attached that have a connection or can connect directly to our gateway.

• Clearinghouse Vendor List

If you are moving from paper to EDI or changing clearinghouse vendors and would like for a Provider Network eServices Analyst to assist you through the implementation phase by monitoring initial claim submissions, please call 215-640-7410.