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Billing & Reimbursement

Processes for AmeriHealth Pennsylvania post-service appeals and grievances  

October 9, 2019    

As a reminder, AmeriHealth Pennsylvania has streamlined the process for post-service professional appeals and enhanced access to the provider grievance process. Below is a summary of the procedures.

Billing disputes

There are two levels of internal review for professional providers. All first-level billing disputes must be received within 180 days of receipt of your Provider Explanation of Benefits (EOB). If a provider disputes the first-level billing dispute determination, he or she may then submit a second-level billing dispute by sending a written request within 60 days of receipt of the decision of the first-level billing dispute. 

To facilitate a first- or second-level billing dispute review, submit inquiries to:

    Provider Billing Dispute
    P.O. Box 7930
    Philadelphia, PA 19101-7930

Provider grievances

There is a one-level external review, performed by a clinically matched specialist for professional providers. All grievances must be filed within 180 days of receiving the Provider EOB. AmeriHealth Pennsylvania reserves the right to conduct a preliminary internal assessment. Appeals not overturned during the original assessment will automatically be forwarded for an external, matched-specialty review.

To facilitate a grievance review, submit to:

    Provider Grievances
    P.O. Box 7930
    Philadelphia, PA 19101-7930

Learn more

For a complete outline of the post-service professional provider appeals and grievances processes, please review the Appeals section of the Provider Manual for Participating Professional Providers (Provider Manual). The Provider Manual is available on the NaviNet® web portal (NaviNet Open) in the Current Publications section of the AmeriHealth NaviNet Open Plan Central page.

If you have any questions, please call Customer Service at 1-800-275-2583.

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