Platform Transition

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​​​​​​​​​​​​​​​​​​​​​​​​​Our phased migration to a new platform

AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey are working to move our core business to a new claims processing platform, a process that will continue through 2025. AmeriHealth Administrators will continue to use its existing platform for claims processing, with enhanced capabilities to come. This transition to a next generation platform will help us efficiently deliver new and innovative products and services.

Visit this dedicated section of the Provider News Center frequently to stay apprised of our transition activity. We are dedicated to providing a smooth transition for our doctors, hospitals, and health care facilities, with a focus on and commitment to service and stability.

Topics include:

• General
• EDI Gateway transition
• Member ID cards/eligibility
• Authorization workflow changes
• Provider Payment Transition
• Billing/Claim submissions
• Training and Resources

General

Self-service requirements in the PEAR portal March​ 11, 2025

Ninth session of platform transition training now available December 27, 2024

Effective January 2025, transitioning a larger volume of your patients (our members) to the new platform Dec​ember 10, 2024

Eighth session of platform transition training now available September 16, 2024

Reminder: Use the proper channels to connect with us August 13, 2024

Seventh session of platform transition training now available July 18, 2024

Update on our transition to a new platform May 15, 2024

Sixth session of platform transition training now available May 6, 2024

Fifth session of platform transition training now available March 25, 2024

Fourth session of platform transition training now available February 8, 2024

Important! New menu options when calling Provider Services December 19, 2023

Third session of platform transition training now available December 18, 2023

Reminder: New Jersey now offering 2024 Medicare Advantage plans December 13, 2023

Second session of platform transition training now available November 21, 2023

New Jersey introduces 2024 Medicare Advantage plans  October 20, 2023

Platform transition training now available  October 17, 2023

Information session on platform transition coming soon! October 9, 2023

AmeriHealth to offer individuals who qualify for Medicare in New Jersey new health care coverage options in October September 12, 2023

Stay informed: Update on our phased migration to new platform September 1, 2023

Preparing a three-year, phased migration to new platform February 8, 2023

EDI Gateway Transition

Updated Claims Resolution Matrix now available April 23, 2025 ​

Remember to review and reconcile your 277CAs February 13, 2025​

Prepare now for your migration to SDS, our new EDI gateway vendor March 26, 2024

New Claims Resolution Matrices now available December 20, 2023

Now available: Payer ID grids for 2024 December 18, 2023

Action to come: AmeriHealth to transition to new EDI Gateway vendor April 3, 2023

Member ID cards/eligibility

New ID cards to be issued for members transitioning to the new platform on February 1, 2025 – be sure to use new ID numbers February​ 3, 2025

New ID cards to be issued for members transitioning to the new platform on December 1, 2024 – be sure to use new ID numbers November​ 27​​, 2024

Important tips for successful member eligibility checks and claims submission to ensure patient access to care is uninterrupted​ November 20​, 2024

New ID cards for members enrolled with the New York (NY) Access or Cigna National Access network November​ 20​​​, 2024

Temporary ID cards to be issued for some members transitioning to the new platform on November 1, 2024 – be sure to use new ID numbers October 29​, 2024

Temporary ID cards to be issued for some members transitioning to the new platform on October 1, 2024 – be sure to use new ID numbers September 25, 2024

Temporary ID cards to be issued for some members transitioning to the new platform on September 1, 2024 – be sure to use new ID numbers August 28, 2024

Temporary ID cards to be issued for some members transitioning to the new platform on August 1, 2024 – be sure to use new ID numbers July 25, 2024

New ID cards for members enrolled with the New York (NY) Access or National Access network July 9, 2024

Temporary ID cards to be issued for members transitioning to the new platform on July 1, 2024 – be sure to use new ID numbers June 20, 2024

Tips for successful 270/271 transactions January 3, 2024

Reminder: New member ID card structure for members on the new platform December 14, 2023

Starting in 2024: New member ID card structure September 14, 2023

Authorization workflow changes

Now available: New streamlined authorization workflow for behavioral health services in PEAR Practice Management August 1, 2024

Behavioral Health providers: Ensure you have access to the PEAR portal June 18, 2024

Authorization Submission: Dosing and frequency January 5, 2024

Upcoming changes to the authorization workflow in PEAR Practice Management September 28, 2023

Provider Payment Transition

Updates to the EPP: View using the EOB & Remittance transaction on PEAR Practice Management March 21, 2025​

New! Explanation of Provider Payment March 7​, 2024

Managing and accessing your EFT and 835/ERA information December 28, 2023

Capitation Rosters accessible via PEAR portal December 11, 2023

Upcoming transition of provider payments to PNC’s CPR service September 29, 2023

Billing/Claim submissions

Billing for oral surgery claims: Ensuring accuracy and avoiding denials April​ 11, 2025

Paper claim billing: Missing or inappropriate values being submitted February​ 12, 2025

Reminder: Use proper submission channel for claim review requests​ January 24, 2025

Now available: Updated payer ID grids January 2, 2025

Use proper reporting for physical therapy and occupational therapy re-evaluations December 20​, 2024

Ensure proper reporting for discharge status code 30​​ December 18​, 2024

New ID cards for members enrolled with the New York (NY) Access or Cigna National Access network​​ November 20​, 2024

Important tips for successful member eligibility checks and claims submission to ensure patient access to care is uninterrupted​ November 20​, 2024

Important information on payments for some claims processed on the new platform​ November 11, 2024

Review diagnosis sequencing guidelines to ensure proper claims processing October 18, 2024

Reporting multiple units of service October 8​​, 2024

Reminder: Change to message codes for our Enhanced Claim Editor Program October 2​, 2024

Ensure proper submission of claim review requests August 12​, 2024

Differences in claims processing for Multiple Procedure Payment Reduction policy for Always Therapy services​ July 18, 2024

Review diagnosis age guidelines to ensure proper claims processing June 27, 2024

Upcoming change to message codes for our Enhanced Claim Editor Program April 4, 2024

Issue with processing claims with authorizations that include dosing and frequency detail March 21, 2024

Change in reimbursement display for inpatient stays March 19, 2024

Avoid claim rejections for missing taxonomy codes February 6, 2024

Billing reminders for ambulance providers February 5, 2024

Tips for successfully submitting claims January 17, 2024

Reminder: Corrected claim submission procedures January 11, 2024

Now available: Payer ID grids for 2024 December 18, 2023

Requirements for billing with taxonomy codes December 13, 2023

Billing reminders to ensure proper claims processing November 21, 2023

Guidelines for billing with taxonomy codes October 10, 2023

Continue to follow policy and industry standard correct coding guidelines September 14, 2023

Training and Resources

Next generation platform transition: FAQ April 15​​, 2025

Platform Training Session 9 December 24, 2024

Platform Training Session 8 September 16, 2024

Platform Training Session 7 July 18, 2024

Platform Training Session 6 May 6, 2024

Platform Training Session 5 March 25, 2024

Platform Training Session 4 February 8, 2024

Platform Training Session 3 December 18, 2023

Platform Training Session 2 November 21, 2023

Platform Training Session 1 October 17, 2023

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