Welcome, Providers

Change Healthcare System Interruption

Change Healthcare, our electronic data interchange (EDI) clearinghouse for claims and payment cycle management, continues to address their network interruption related to a security incident. Below are updates for our systems and processes:

  1. Claims payments: Providers who were unable to successfully submit claims during the outage may submit them either through Availity, or PCH Global or through Change Healthcare’s once connectivity is restored. We have extended the claims timely filing deadline for claims that would have been rejected due to untimely filing during the service interruption. For more details, see the recent Claims Timely Filing Deadline Extension provider notice

  2. Electronic claims submission through Availity: If you or your clearinghouse do not currently use Availity to submit claims, you must register with Availity at: https://www.availity.com/Essentials-Portal-Registration Opens a new window. Please choose the registration option that aligns with your business: Healthcare or Atypical Provider. For registration process assistance and other resources, access the training site link on the Availity registration page. If you are currently registered with Availity for another payor, or if you use another clearinghouse, you must request that they route your electronic claims for Keystone First to Availity.  For additional information and resources see the recent Additional Information for Availity provider notice (PDF) Opens a new window.

  3. Manual claims submission through PCH Global: To enroll claims submissions through PCH Global, please go to https://pchhealth.global and click the Sign-Up link in the upper right-hand corner to register.  

    Complete the registration process and log into your account. You will be asked how you heard about PCH Global; select Payer, then AmeriHealth. Access your profile by clicking on Manage User and then My Profile. You will need to complete all the profile information. When you go to the Subscription Details screen, select the More option on the right-hand side to see how to enter the promo code Exela-EDI.

    When you are ready to submit claims, use the following information to search for our payer information:

    1. Payer name: AmeriHealth 
    2. PO Box: 7115

    For a detailed walk through of the registration process, refer to the PCH Global Registration manual, found on the PCH Global website in the Resource Menu.

  4. Electronic remittance advice (ERA/835): Electronic remittance are available at this time. Providers can view and download an electronic remittance pdf via the NaviNet provider portal. Providers may also access the (ERA/835) file through ECHO Health. For additional information, please see the recent 835 Access  provider notice. NOTE: Due to the Change Healthcare security incident, remittance advices generated after February 21, 2024 may not include all of the information previously provided.  As Change Healthcare continues to restore services, this information will become available.

  5. Prior authorization submission and processing: The prior authorization systems continue to operate normally.

  6. Eligibility verification, claim status inquiry, and authorization inquiry: These capabilities continue to be available via NaviNet. If you do not have access to NaviNet provider portal, please visit https://register.navinet.net Opens a new window/ to sign up.

Please note, in the interim, our Provider Services Department will not be able to assist with processing of your payments any sooner. If you have other questions, you may contact Provider Services at 1-800-521-6007.

We thank you for your participation and patience. We will continue to provide updates as we work to resolve the downstream impacts of Change Healthcare’s service interruption.

Public health emergency ending: What you need to know

As you know, the Pennsylvania Department of Human Services (DHS) was able to keep Medical Assistance (MA) coverage open for most people during the COVID-19 Public Health Emergency (PHE) even if they were no longer eligible for MA. DHS is now in the process of making sure that everyone who is receiving MA is still eligible by reviewing each person’s information.

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Learn about our program developed to assist your practice in engaging and managing the healthcare needs of chronically ill Keystone First members. 

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