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

​We will continue to transition members to our new operating platform in July 2024. These members will receive a new member ID card. Members with an AmeriHealth HMO plan in Pennsylvania who are migrating July 1, 2024, will be mailed a temporary ID card that contains the critical information they need to receive access to care, but not all information. They can use the temporary ID card until their new card arrives.

Please accept the temporary ID card for services that occur on or after July 1, 2024.

The temporary ID card will not have the plan name, plan information like copayment amounts, deductibles, out-of-pocket maximums, or Primary Care Physician (PCP). However, you can access the member’s complete information when using the Eligibility & Benefits transaction on PEAR Practice Management (PM) to confirm eligibility and benefits.

As a reminder, the new ID card will have the new number structure (10-digit format). The new ID number will be at the member level, not the subscriber level, meaning each member will have a unique ID number.

It is important to ask members for a copy of their latest ID card at every visit to ensure proper claims processing.

Claims processing

  • Claims will be processed based on the member’s ID number on the date of service or date of admission. You do not need to split claims.
  • Claims submitted with an old ID number after the new card is effective will be denied with this message: “Member did not have eligible coverage.” If this occurs, please obtain the new ID number from the member and resubmit the claim.
  • Use the payer ID ​grids to assist with claims submission instructions.

Authorizations

Keep the following in mind when searching for an existing authorization:

  • Members who have a new ID number (10-digit format) may have an existing authorization that was submitted under their old ID number (12-digit UMI). Authorizations submitted under the member's old ID number remain valid. You do not need to enter a new authorization under the member’s new ID number.
  • Use the Authorization Search transaction and search by the member’s name and date of birth. You will also need to note the appropriate location.
  • If an authorization needs to be extended, a new authorization request should be submitted under the member's new ID number.
  • If you are unable to locate an authorization that was submitted via eviCore or Carelon Medical Benefits Management (Carelon), please search for the authorization on the eviCore or Carelon portals using the member's old ID number. If there are additional questions, please work with them directly.

Stay informed

We encourage you to frequently visit our dedicated Platform Transition​ page to stay up to date on upcoming changes.