In 2013, AmeriHealth announced its plans to transitioncore processing activities for AmeriHealth Pennsylvaniamembers to a new platform managed and operated byHighmark, Inc. (Highmark).

One of the key early steps in this process was thetransition of X12 transactions from the former X12Gateway to the Highmark Gateway. This task wascompleted before November 1, 2013, and as a resultof this transition, all trading partners send and receivetransactions to/from the Highmark Gateway.

As of January 1, 2014, we have begun migratingAmeriHealth Pennsylvania members to the new platform.As a result, providers will notice growing numbers ofmigrated AmeriHealth Pennsylvania members by wayof newly issued ID cards. We will continue to migrateour AmeriHealth Pennsylvania membership to the newplatform through mid-2015.

Dual claims-processing environment

Due to the migration of AmeriHealth Pennsylvaniamembers, we will be working with you in a dualclaims-processing and business-operating environmentuntil all AmeriHealth Pennsylvania members are on thenew platform. In other words, we will begin to processa larger portion of AmeriHealth Pennsylvania claimsand business transactions on the new platform asthese members are migrated, and we will continue toprocess claims and conduct business transactions onthe current platform for AmeriHealth New Jersey andDelaware members and for AmeriHealth Pennsylvaniamembers who have not yet been migrated. The date ofservice will determine the platform on which AmeriHealthPennsylvania member claims will be processed.

Here are some of the important changes wecommunicated in 2013 that will affect the way you dobusiness with us:

• Member ID cards/numbers. As AmeriHealthPennsylvania members are migrated to the newplatform, they will be issued a new member ID cardwith a new ID number. The subscriber and all memberscovered under the subscriber?s policy will share thesame ID number. Due to these changes, it is imperativethat you obtain a copy of the member?s current IDcard at every visit to ensure that you submit the mostup-to-date information to AmeriHealth.
• Provider payment. For claims processed on the newplatform, you will receive a different format of theStatement of Remittance (SOR). On the new format forfacility claims, services will be combined and displayedon one line. You will continue to receive our currentformat of the SOR for claims processed on the currentplatform. In addition, 835 transactions generated onthe new platform will contain additional and updatedinformation.
• Claims processing. Additional data elements arerequired to ensure proper claims processing onthe new platform. For example, taxonomy codesare required on all claims submissions. Informationregarding the specific data elements required canbe found in the AmeriHealth HIPAA TransactionStandard Companion Guides, which are available atwww.highmark.com/edi-amerihealth.
• Provider Automated System. The Provider AutomatedSystem is being retired in stages, as previouslycommunicated. Once an AmeriHealth Pennsylvaniamember has been migrated to the new platform,providers will no longer be able to use the ProviderAutomated System for that member for any functionality(e.g., eligibility, claims status, authorizations). Providersmust use the NaviNet^? web portal to retrieve thisinformation.
• NaviNet. Many changes have been implemented onAmeriHealth NaviNet Plan Central, including adding,removing, and enhancing transactions. For morespecific details, please refer to the NaviNet TransactionChanges section of our Upcoming System andProcess Changes site. This section of our site contains userguides and webinars for many updated transactions.

Resources

We are committed to working closely with you and ourentire provider network as we complete these changes.During this interim state, we will continue to providecomprehensive communications and tools to support ourmembers and provider network, both during and after thetransition to the new platform.

For more information about our Upcoming Systemand Process Changes, please visit our dedicated siteat www.amerihealth.com/pnc/upcomingchanges. On thissite you will find a communication archive as well as aFrequently Asked Questions (FAQ) document. If you stillhave questions after reviewing the FAQ, send us an email.

NaviNet^? is a registered trademark of NaviNet, Inc.