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 Billing & Reimbursement

This section is designed to keep you and your office staff up-to-date on claims, billing, and reimbursement information and changes. Topics include clean claims, proper codes used for accurate disbursement, remittances, and specific billing procedures and procedural changes. Posted below are user guides and a communication archive of billing-related information that we have published.

ICD-10: The migration from ICD-9 to ICD-10 on October 1, 2015, represented one of the greatest challenges in health care transformation, and has changed the way we conduct business. To see a complete archive of ICD-10 articles, please click here.

Provider EOB/Remittance


  Communications


Hide details for [<div class= 'YearCat'>&nbsp&nbsp2019 Updates</div><hr style='width:749px; color:#b6b6b6;background-color: #b6
  2019 Updates

Avoid documentation cloningPosted: 11/01/2019
Processes for AmeriHealth Pennsylvania post-service appeals and grievances Posted: 10/09/2019
Claim investigation and corrected claim submission proceduresPosted: 09/17/2019
Now in effect: Enhanced claim edits to align with industry standard billing rules for injectable drugs and biological agentsPosted: 09/04/2019
Now in effect: New claim payment policy for multiple therapies Posted: 09/03/2019
Professional Injectable and Vaccine Fee Schedule updates effective October 1, 2019 Posted: 08/26/2019
ICD-10 in Action: Chapter-specific guidelinesPosted: 08/15/2019
Enhanced claim edits to align with industry standard billing rules for injectable drugs and biological agents beginning September 1, 2019Posted: 08/05/2019
Now in effect: Enhanced claim edits to align with industry standard billing rules for DME and P&O billing providers Posted: 08/05/2019
New claim payment policy for multiple therapies Posted: 08/01/2019
Billing and cost-sharing for individuals enrolled in the Qualified Medicare Beneficiary programPosted: 07/26/2019
Claim reprocessing for multiple procedure payment reductions on certain diagnostic services for AmeriHealth New Jersey membersPosted: 07/03/2019
National Drug Code submission guidelines for co-packaged products listed as kits and multi-level packaged productsPosted: 06/25/2019
Claim investigation and corrected claim submission proceduresPosted: 06/12/2019
Enhanced claim edits to align with industry standard billing rules for DME and P&O billing providers beginning August 1, 2019Posted: 06/12/2019
Enhanced claim edits to align with industry standard billing rules for injectable drugs and biological agents Posted: 06/03/2019
Professional Injectable and Vaccine Fee Schedule updates effective July 1, 2019 Posted: 05/24/2019
Enhanced claim edits to align with industry standard billing rules for DME and P&O billing providersPosted: 04/15/2019
Claim reprocessing for multiple procedure payment reductions on certain diagnostic services for AmeriHealth Pennsylvania membersPosted: 03/28/2019
Claim investigation and corrected claim submission proceduresPosted: 03/19/2019
Reminder: Guidelines for billing with taxonomy codes Posted: 03/07/2019
Professional Injectable and Vaccine Fee Schedule updates effective April 1, 2019 Posted: 03/01/2019
Changes coming to application of Modifier 59 in 2019Posted: 01/11/2019
Updated payer ID grids now available for AmeriHealth New JerseyPosted: 01/07/2019
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  2018 Updates

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  2017 Updates

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  2016 Updates

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  2015 Updates

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  2014 Updates

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  2013 Updates

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  2012 Updates

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  2011 Updates












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