Welcome, Providers

Attention Providers

Change Healthcare System Interruption

We thank you for your partnership and patience, as we continue to work to resolve the downstream impacts of Change Healthcare's service interruption.

Below is a summary of the current status of our systems and processes:

Eligibility verification, claim status inquiry, prior authorization submission/processing and authorization inquiry: These functionalities continue to operate normally and are available via the NaviNet provider portal. If you do not have access to NaviNet, please visit: https://register.navinet.net/ to sign up.

Claims Submission Options:

Electronic claims:

• Availity: Providers may submit claims to Keystone First Community HealthChoices through Availity. Providers or clearinghouses not currently using Availity to submit claims, must register at: https://www.availity.com/intelligent-gateway/.
• Providers who are currently registered with Availity for another payer, or using another clearinghouse, must request to have their electronic claims for Keystone First Community HealthChoices routed to Availity.
• For registration process assistance, submit the Provider Inquiry form at the bottom of the Availity webpage or contact Availity Client Services at 1-800-AVAILITY (282-4548).  Assistance is available Monday through Friday from 8 AM to 8 PM ET.
• 275 Claim Attachment Transactions: Keystone First Community HealthChoices is accepting ANSI 5010 ASC X12 275 claim attachment transactions (unsolicited) via Availity. Please contact your Practice Management System Vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 claim attachment transaction submissions via payer ID: 42344.
• A maximum of 10 attachments are allowed per submission. Each attachment cannot exceed 10 megabytes (MB) and total file size cannot exceed 100MB. The acceptable supported formats are pdf, tif, tiff, jpeg, jpg, png, docx, rtf, doc, and txt.
• There are two ways 275 claim attachment transactions can be submitted:
  • Batch — You may either connect to Availity directly or submit via your EDI clearing house.
  • Portal — Individual providers may also register at: https://www.availity.com/Essentials-Portal-Registration to submit attachments.
• After logging in, providers registered with Availity may access the Attachments - Training Demo for detailed instructions on the submission process via: Training Link [apps.availity.com].
• Specific 275 claim attachment transaction report codes must be used when submitting an attachment. Visit the Claims and Billing page for the list of applicable codes.
• Optum/Change Healthcare: Even though Keystone First Community HealthChoices has not reconnected directly, providers may also submit claims through Optum/Change Healthcare.
• Providers will have to establish new connectivity with Optum.
• For new connectivity requirements, reach out to your Optum/Change Healthcare account representative.
• If you do not know who your account representative is, you can submit an inquiry via the Change Healthcare General Inquiry form.

Manual/direct entry claims:

• PCH Global: Providers may submit manual or direct entry claims at no cost, through PCH Global. To enroll for claims submission through PCH Global, please go to https://pchhealth.global and click the Sign-Up link in the upper right-hand corner. 
  • 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. P.O. Box: 7146
  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.
• Optum/Change Healthcare ConnectCenter™: The direct entry claims portal, ConnectCenter, is available for reconnection, at no cost, for providers who were registered with ConnectCenter prior to the security incident. 
  • It is not necessary to complete a new registration, and usernames will remain the same.
  To reconnect:
  • Access the login page via the Claims submission link in the NaviNet provider portal or via one of the direct links below: connectcenter.changehealthcare.com or physician.connectcenter.changehealthcare.com.
  • Follow the instructions on the login page to reset your password and to set up the required multi-factor authentication.

  For more information on available functionality, please review the release notes in the Product News section after signing into the ConnectCenter portal.

Electronic remittance advice (ERA/835) files: Payment recovery details are currently provided on the remittance advice or 835 you receive with your payments for claims processed on and after May 6, 2024.

For claims processed February 21, 2024, through May 5, 2024, Keystone First Community HealthChoices has generated a comprehensive claims recovery report available in the NaviNet provider portal. The claims recovery report provides payment recovery details by your member's account number, claim number, provider tax ID, payee/group ID and NPI.

To access the claims recovery report:

1. Log in to the NaviNet provider portal.
2. Select applicable health plan.
3. Go to Report Inquiry under Workflows for this Plan.
4. Click on Administrative Reports > Claim Recovery Report.

For current claims payments, providers can view and download an electronic remittance PDF via the NaviNet provider portal. Providers may also access the ERA/835 file through the ECHO Health provider payment portal at: www.providerpayments.com. Providers who are not currently registered with ECHO for access to the portal will have to create a new account.

For questions, contact your dedicated Provider Network Account Executive or Provider Services at: 1-800-521-6007.

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.

What your MA patients need to do and how you can help

Latest updates

• CPT II Code Reimbursement Guidelines (PDF)
• Update: Formulary Changes (PDF)
• Orthodontic Continuation of Care (PDF)
• Electronic visit verification (EVV) indicator requirement (PDF)
• Update: Formulary Changes (PDF)

Coronavirus (COVID-19)

Important information for providers regarding COVID-19

Important reminders

• J Code Prior Authorization Transition Update (PDF)
• Frequently Asked Questions — Service Authorizations, HHA eXchange, Reporting Critical Incidents, and Billing (PDF)