Amerihealth dc provider phone number. Provider resources AmeriHealth wants to help lighten your burden when dealing with health insurance. Phone For the most direct service, call the number on the back of your AmeriHealth ID card. Log inOpens a new windowRegisterOpens a new window Member and provider services For information about your AmeriHealth Caritas health plan or product, choose your health plan from the list below and see how to get in touch. This FAQ outlines key information on eligibility, ID numbers, authorizations, and benefit differences from Medicaid. Email provrelations@ahatpa. For additional program details, please visit: AmeriHealth Caritas District of Columbia has contracted with PalmQuest to assist with the annual medical record review process. If you are a consumer member, call 1-844-937-2448. PalmQuest is required to comply with Health Insurance Portability and Accountability Act (HIPAA) privacy requirements throughout the retrieval process and utilizes specialists trained in medical record retrieval for HEDIS, the Centers for Medicare & Medicaid Services An MUE represents the maximum units of service allowed for the same service or supply, reported by a CPT or HCPCS code, on the same date of service by the same provider. AmeriHealth Caritas District of Columbia is not responsible for the content of these sites. If the request is denied, you and your patient will receive a denial letter. AmeriHealth Caritas DC is developing a network of high-quality Healthy DC Plan health care providers to support your health care needs. Pharmacy Benefits Manager Call the phone number listed on the patient’s AmeriHealth Administrators ID card. Enrollees should call us before their provider appointments if they need interpretation If you have any questions or want to know more about the survey, please call Enrollee Services at 202-408-4720 (TTY 1-800-408-7511), 24 hours a day, seven days a week. View specialties, credentials, and contact information for AmeriHealth Caritas providers. The listings contain provider and pharmacy addresses and contact information, as well as other details such as days and hours of Who can a provider contact at the AmeriHealth Caritas District of Columbia if they have questions or concerns? Contact AmeriHealth Caritas District of Columbia provider services at 1-800-408-7510. Want to become a participating dental Jan 24, 2025 · Important notice This tool provides general information for outpatient services performed by a participating provider. Have a question or want more information about AmeriHealth Caritas District of Columbia? Use the contact information below to get in touch. Quick reference guide – You'll always know whom to contact (PDF) with this at-a-glance resource. The Availity Platform for Providers Get paid quickly, accurately Managing revenue cycle operations has grown increasingly more complex. Getting care AmeriHealth Caritas District of Columbia (DC) will pay for your care when you go to one of our doctors or other health care providers. DUTIES INCLUDE (BUT ARE NOT LIMITED TO): This Provider and Pharmacy Directoryincludes information about the provider and pharmacy types in AmeriHealth Caritas District of Columbia’s (DC) network and listings of all the AmeriHealth Caritas DC providers and pharmacies as of the date of this directory. Your Medicaid coverage will end on December AmeriHealth Caritas DC will provide enrollees oral interpretation services if they need them, including at the hospital. The policy As of March 1, 2026, the District of Columbia Department of Healthcare Finance (DHCF) transitioned to a new Medicaid Management Information System (MMIS) and moved from Conduent to Gainwell as its fiscal agent. dc. *All W-9s will be verified before claims are processed. Call us AmeriHealth Caritas DC located at 1250 Maryland Ave SW, Washington, DC 20024 - reviews, ratings, hours, phone number, directions, and more. we value you as a provider in our network. Once we have received a completed application and any required supplemental documents, someone from the AmeriHealth Caritas DC Credentialing team will respond to your inquiry within 30 days. Additional details for scoring the condition can be found in the HLD Index Scoring Instructions included at the bottom of the form. AmeriHealth Caritas DC has reverted to the prior authorization guidelines for select services below that . Pharmacy Benefits PerformRx, an affiliate of AmeriHealth Caritas DC and an enrollee of the AmeriHealth Caritas Family of Companies, is the delegated manager of pharmacy services covered by the AmeriHealth Caritas DC health plan. Make sure you include your office telephone and fax numbers. Find the care you need Search for a health care provider Search for a primary care practitioner (PCP), hospital, dental provider, or other health care provider. Effective 01/11/2024, EviCore will cease processing for AmeriHealth Caritas District of Columbia prior authorization requests. com Medicaid Managed Care Plans (MCPs) The District contracts with 3 MCPs to provide access to services for the DC Healthy Families Program (DCHFP), the DC Health Care Alliance (Alliance) and the Immigrants Children’s Program (ICP). Receive dedicated support Account executives – Designated account executives provide on-site education and help with issue resolution. District of Columbia Medicaid Provider Resource Guide This Resource Guide shall be used to address issues which may occur during the 90-day open enrollment and continuity of care period between October 1, 2020 - December 31, 2020, as a result of newly awarded Medicaid managed care contracts in the District of Columbia. The information below includes key contact numbers, addresses, and frequently asked questions to support care delivery and claims processing for Healthy DC Plan enrollees. 5400). Please call Enrollee Services at 202‑408‑4720 or 1‑800‑408‑7511 (toll-free) to get your AmeriHealth Caritas DC Medicaid ID number. 0097. You will get a letter from AmeriHealth Caritas Next notifying you of any adverse benefit determination. Sincerely, Nathan Fletcher, DDS Dental Director AmeriHealth Caritas DC Dear Provider, Effective February 1, 2026, AmeriHealth Caritas District of Columbia (DC) will implement updates to its Hemodialysis Reimbursement Policy (RPC. If you have additional questions regarding your payment options, please contact ECHO Health at 1-888-492-5579. Provider services Call 1-844-352-1706. navinet. Call the toll-free service phone number on your patient’s AmeriHealth Administrators ID card. Claims resources and guides General information Claims Requiring Submission of Clinical Information Referral submission rules Payer ID provider number reference guides Use these guides as a reference tool when submitting facility claims or professional claims. Update your information at districtdirect. The following services always require prior authorization: Inpatient services (elective and urgent). Now hiring. AmeriHealth Caritas District of Columbia *The benefits described within this document are intended to be a high-level summary of the covered services available to AmeriHealth Caritas DC enrollees as of April 1, 2022. Make sure your provider has the correct birth dates for you and your children who are AmeriHealth Caritas DC enrollees. Find a medicine Check AmeriHealth Caritas District Of Columbia in Washington, DC, Maryland Avenue Southwest on Cylex and find ☎ (202) 408-4, contact info. Our user-friendly tools and helpful clinical resources are designed to support you and your staff every day. Providers \When completing a prior authorization form, be sure to supply all requested information. gov. Through NaviNet, you can access and submit: Real-time clinical Healthcare Effectiveness Data and Information Set (HEDIS) alerts Eligibility information Claims information and updates Benefits information Drug authorizations AmeriHealth Caritas DC wants you to keep your health coverage! To make sure that you don’t miss any important information, please be sure that the Department of Health Care Finance (DHCF) has your current address, phone number, and email address so that DHCF knows where to send your renewal letter. Contact AmeriHealth We’re here to help. AmeriHealth Caritas is proud to offer award-winning health plans, but we also work to treat all aspects of our members’ lives. Walk-in hours: Monday - Friday: 8:15 a. Timely filing limits Initial claims: 365 days from date of service. Interpreter services do not cost you any money. Extended evening and weekend hours may vary. Customer service hours are Monday – Friday, 8 a. District residents should visit here to learn about Alliance and Medicaid services. A provider dispute is not a pre-service appeal of a denied or reduced authorization for services or an administrative complaint. As AmeriHealth Caritas DC enrollees transition from Medicaid to the Healthy DC Plan, providers play an important role in helping ensure accurate eligibility verification and clear communication about covered benefits. – 6 p. Consistent eligibility verification and clear communication Dear Provider, On January 1, 2026, AmeriHealth Caritas District of Columbia (DC) launched the Healthy DC Plan for enrollees. For Medicaid enrollees, please call Enrollee Services at 202-408-4720 or toll free at 1-800-408-7511 to get interpretation services. This policy provides guidance for the submission and reimbursement of hemodialysis services furnished to enrollees with End-Stage Renal Disease (ESRD) when provided in a facility setting or in the patient’s home. 6 Best AmeriHealth In-Home Respite Care Providers near Washington, DC 20001 AmeriHealth Caritas DC does not require prior authorization for emergency services provided by in-network or out-of-network providers when a Medicaid enrollee seeks emergency care. Dental Provider Resources Welcome to the AmeriHealth Caritas DC dental provider network. Government of the District of Columbia Department of Health Care Finance New Contracts with AmeriHealth, CareFirst Community Health Plan and MedStar Family Choice To begin the contracting process, please contact the Provider Account Executive for your area or call Provider Services at 202-408-2237 or 1- 888-656-2383. DUTIES INCLUDE (BUT ARE NOT LIMITED TO): Provider resources AmeriHealth wants to help lighten your burden when dealing with health insurance. 2025 Facility claims Professional claims 2024 Facility claims Professional claims Provider user guides CMS-1500 claims submission AmeriHealth Caritas District of Columbia Attn: Claim Disputes P. Dec 18, 2025 · Aetna PA – 1/1/2025 Highmark Wholecare/UCD – 1/1/2025 All WV Plans – 4/1/2025 AmeriHealth DC – 5/1/2025 AmeriHealth MI – 6/1/2025. Providers should verify member eligibility and benefits with AmeriHealth Caritas on the secured provider log-in section at: www. For additional details, or if you are uncertain that prior authorization is needed, please see the provider manual on the AmeriHealth Caritas DC website. If you have questions about this communication, please contact Dental Provider Services at 1-855-609-5170. Important contact information for AmeriHealth providers. On January 1, 2026, AmeriHealth Caritas District of Columbia (DC) launched the Healthy DC Plan for enrollees. M Cranbury, NJ 08512-3706 Providers should verify member eligibility and benefits with AmeriHealth Caritas on the secured provider log-in section at: www. Inpatient services and non-participating providers always require prior authorization. We’ve gathered resources and tools to help you work as efficiently and productively as possible and do what you do best – care for our members. We know it is important for providers to get information quickly and easily. Call us at 202-408-4720 or 1-800-408-7511 (TTY/TDD Important contact information for AmeriHealth providers. All non-participating providers must submit requests for prior authorization, except as may be required by law. C. If you are losing your AmeriHealth Caritas DC Medicaid coverage because DC Medicaid eligibility is changing, you may be automatically enrolled into the AmeriHealth Caritas DC Healthy DC Plan. As an AmeriHealth Caritas District of Columbia (DC) enrollee, you are not responsible to pay for medically necessary covered services provided by an AmeriHealth Caritas DC provider. Please call Enrollee Services at 1-800-408-7511 to confirm benefits, coverage, and eligibility. With the partnership of providers like you, we aim to move forward and to Healthy Dc Plan Contact Page Have a question or want more information about AmeriHealth Caritas District of Columbia Healthy DC Plan? Use the contact information below to get in touch. Medicaid Drug Formulary Prior authorization criteria (PDF) There’s no more critical person on this team than you, the provider. Please see Terms of Us, Privacy Notice, and Third-Party Data Privacy and Educational Materials. Those MCPs are Wellpoint DC, AmeriHealth Caritas DC, and MedStar Family Choice DC. PLEASE SUBMIT CLINICAL INFORMATION, AS NEEDED, TO SUPPORT MEDICAL NECESSITY OF THE REQUEST. CareSource GA – 6/16/2025. M Cranbury, NJ 08512-3706 Submit referrals and claims and view enrollee eligibility and benefits. Directory of PROVIDERS AmeriHealth Caritas® District of Columbia Provider Directory May 26, 2023 GENERAL DENTIST TAWAKALI, LAJOYOUS, DDS Additional Locations Mar 15, 2025 · Sometimes, AmeriHealth Caritas Next may decide to deny or limit a request your provider makes for you for benefits or services. netor call Provider Services at: AmeriHealth Caritas District of Columbia| 1-202-408-2237 or 1-888-656-2383 Claims and Billing Filing claims is fast and easy for AmeriHealth Caritas DC providers. AmeriHealth: 1-800-315-3485 (MTM Network) Welcome, Healthy DC Plan Providers AmeriHealth Caritas District of Columbia offers the Healthy DC Plan to eligible enrollees This is a federally-funded, no-cost health insurance program for residents with low incomes who are no longer eligible for Medicaid but would qualify for coverage under the Affordable Care Act through DC Health. We are proud that you will provide dental services to our enrollees directly through your agreement with us. AmeriHealth Caritas District of Columbia Attn: Claim Disputes P. All billing requirements must be adhered to by the provider in order to ensure timely processing of claims. Claims, benefits, and eligibility Log in to the PEAR portal. Find a medicine We accept all patients including those with Medicare, Medicaid, AmeriHealth Caritas District of Columbia, Amerigroup District of Columbia, MedStar Family Choice, and private insurance. In this part of the site, you will find these resources: At Wellpoint District of Columbia Inc. Medicaid Managed Care Plans: Medicaid Managed Care Plans (MCPs) The District contracts with 3 MCPs to provide access to services for the DC Healthy Families Program (DCHFP), the DC Health Care Alliance (Alliance) and the Immigrants Children’s Program (ICP). Along with day-to-day pre- and post-claim operations, you have to prioritize connectivity, reliability, and security. Directory of PROVIDERS AmeriHealth Caritas® District of Columbia Provider Directory May 26, 2023 GENERAL DENTIST TAWAKALI, LAJOYOUS, DDS Additional Locations Find the care you need Search for a health care provider Search for a primary care practitioner (PCP), hospital, dental provider, or other health care provider. Horizon Find doctors, hospitals, medical equipment, and specialty services in AmeriHealth's network based on what health plan you have. You will need this number to register for the portal and mobile app. We give you the technology and tools you need to tackle health literacy challenges and deliver high-quality, patient-centered care. From health outreach to opioid prevention to job training and more, our approach to managed care encompasses the whole person. Apply today on CareerBuilder. For additional program details, please visit: Focus on what’s most important to you — your patients — with AmeriHealth Caritas’ resources and support. Tools and information to help providers work more effectively with AmeriHealth. Our language line service has representatives who speak languages other than English. Additional information related to a prior authorization request or appeal AmeriHealth Caritas District of Columbia's Compliance Hotline: 1-800-575-0417 Hours: 24 hours a day, seven days a week To report fraud Enrollee Services: 1-202-408-4720 or 1-866-408-7511 TTY/TDD: 1-202-216-9885 or 1 Use the tools below to find a doctor, hospital or other AmeriHealth Caritas District of Columbia participating provider. Services with a non-participating provider (Join Our Network). m. Provider Resources AmeriHealth District of Columbia is your true partner in care. If you receive a bill, call Enrollee Services right away at 1-800-408-7511 (TTY 202-216-9885). Provider Web Portal access will be lost starting 8/16/2025 and must use Dental Hub. In conjunction with our purchase of D. Fax completed forms to 1-888-671-5285 for review. PROVIDER NETWORK MANAGEMENT IS RESPONSIBLE FOR MANAGING THE RELATIONSHIP BETWEEN CONTRACTED PROVIDERS AND AMERIHEALTH CARITAS DC. This document does not guarantee coverage or eligibility. Please stay tuned for updated information. For questions, contact Provider Services at 202-408-2237 or 1-888-656-2383. Providers may access the AmeriHealth Caritas District of Columbia portal: amerihealthcaritasdc. They can tell you why you were billed. Mailing Address 1901 Market Street Philadelphia, PA 19103 259 Prospect Plains Road, Bldg. When it comes to provider network relations and management, we are industry experts. Claim Filing AmeriHealth Caritas District of Columbia, hereafter referred to as the Plan (where appropriate), is required by District of Columbia and federal regulations to capture specific data regarding services rendered to its enrollees. Dec 31, 2019 · Amerihealth Caritas Phone Number, Payer ID and Claim address December 31, 2019 Channagangaiah As soon as any of your personal profile information changes (such as your name, address, or telephone number), please notify the District of Columbia Economic Security Administration (ESA) Service Center by calling 202-727-5355. Find the care our enrollees need Searchable provider directory Provider directory - machine readable (TXT) Medicaid provider directory - printable (PDF) Medicaid behavioral health provider directory - printable (PDF) If you have any questions or want to know more about the survey, please call Enrollee Services at 202-408-4720 (TTY 1-800-408-7511), 24 hours a day, seven days a week. Find doctors, hospitals, medical equipment, and specialty services in AmeriHealth's network based on what health plan you have. We are committed to offering a dental benefit program that provides access to high quality oral health care. Find doctors, hospitals, medical equipment, and specialty services Search for a participating provider by name, location, specialty, or medical procedure. All these "in-network" doctors can be found in our provider directory. The District of Columbia offers Alliance and Medicaid Managed Care Plans: AmeriHealth Caritas District of Columbia, Health Services for Children with Special Needs (HSCSN), MedStar Family Choice District of Columbia. Should you have any questions, please contact AmeriHealth Caritas District of Columbia Utilization Management at 1-202-408-2237 or 1-888-656-2383. You will be notified by fax if the request is approved. Access to the Gainwell Provider Web Portal requires Trading Partner registration. Here you can find the tools and resources you need to help manage your submission of claims and receipt of payments. Chartered Health Plan, we will assume operations and begin serving members on May 1, 2013. AmeriHealth Caritas DC follows the Centers for Medicare & Medicaid Services (CMS) Medicaid National Correct Coding Initiative (NCCI) MUE program when adjudicating claims. AmeriHealth Caritas District of Columbia | 1250 Maryland Avenue, SW , Washington, DC, 20024 | Upon receipt of a completed form, an AmeriHealth Caritas DC provider ID number will be assigned and returned to you via fax. You have 180 days from the date on the letter to ask for an appeal. Help in other languages If you do not speak English, we can help you. O. You may also refer to our provider manual (PDF) for helpful information. Wellpoint providers use Availity--a secure, full-service website offering a claims clearinghouse and real-time transactions at no charge to health care professionals to submit claims, check the status of claims, and appeal a claim decision. Call us PROVIDER NETWORK MANAGEMENT IS RESPONSIBLE FOR MANAGING THE RELATIONSHIP BETWEEN CONTRACTED PROVIDERS AND AMERIHEALTH CARITAS DC. We call these doctors and other health care providers our "network" providers. The updates reflect that AmeriHealth Caritas DC, effective January 12, 2024, is 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 healthcare. AmeriHealth offers affordable health coverage to individuals, families, and businesses in New Jersey and select Pennsylvania-based employer groups. ID Card View your ID card or request a new one. Find a pharmacy Find a pharmacy This tool will help you find a pharmacy that takes AmeriHealth Caritas Pennsylvania in your area. Introduction This Behavioral Health Provider Directory includes listings of all the AmeriHealth Caritas District of Columbia (DC) behavioral health providers as of the date of this directory. Please verify benefit coverage prior to rendering services. Want to become a participating dental Jun 11, 2025 · NaviNet is an easy-to-use, free, web-based platform that links providers to AmeriHealth Caritas District of Columbia. Jan 1, 2026 · A new health care plan providing quality health coverage for DC adult residents who have moderate incomes and do not meet the DC Medicaid income requirements. PROVIDERS ARE RESPONSIBLE FOR OBTAINING PRIOR AUTHORIZATION FOR SERVICES PRIOR TO SCHEDULING. The type of assistance or mobility aide(s), if any, you require For those who are enrolled in a DC Medicaid Managed Care Program such as AmeriHealth, Health Services for Children with Special Needs, MedStar Family Choice, or Trusted Health Plan, please call your insurer to request transportation services. com. If you are not happy with AmeriHealth Caritas District of Columbia’s decision about your appeal, you may request a fair hearing Expedited (emergency) grievances and appeals process If your appeal is determined to be an emergency, AmeriHealth Caritas District of Columbia will give you a decision within 72 hours. Provider Web Portal access will be lost starting 7/1/2025 and must use Dental Hub. Find 1+ AmeriHealth Caritas in-network doctors in Elizabethtown, PA. If you have questions about this tool, a service or to request a prior The AmeriHealth Caritas payer ID (77002) must be used for electronic billing along with the ECHO Health payer ID (58379). Healthy Dc Plan Contact Page Have a question or want more information about AmeriHealth Caritas District of Columbia Healthy DC Plan? Use the contact information below to get in touch. Codes not on the Medicare Fee Schedule. Provider Network Account Executive I opening in Philadelphia, PA posted Today by AmeriHealth Caritas. Box 7358 London, KY 40742 dispute is defined as a request from a health care provider to change a decision made by AmeriHealth Caritas District of Columbia related to a claim payment. To find your account executive, or to request a visit, please contact Provider Services. Tools, resources, and guides to assist AmeriHealth network providers with claims and billing. View the Provider Directory (PDF) Provider services Call 1-844-352-1706. Use the links below to find a doctor, hospital or other AmeriHealth Caritas District of Columbia participating provider. AmeriHealth District of Columbia: Transition Guide for Medical Providers Welcome to AmeriHealth District of Columbia, the newest member of the AmeriHealth Caritas Family of Companies (AFC). The listings contain provider addresses and contact information, as well as other details such as days and hours of operation, specialties, and skills. - 4:45 p. We start by providing all of the tools and resources to make claims processing as simple and efficient as possible. netor call Provider Services at: AmeriHealth Caritas District of Columbia| 1-202-408-2237 or 1-888-656-2383 Dear Provider, On January 1, 2026, AmeriHealth Caritas District of Columbia (DC) launched the Healthy DC Plan for enrollees. Contact Us Member and provider services For information about your AmeriHealth Caritas health plan or product, choose your health plan from the list below and see how to get in touch. ace hyat ktbu mnqyj pabee lzqoml ujdi uwplbq uyhgo tqmv