Welcome to the August newsletter!
August 2023
Prior authorizations
Did you know you can submit prior authorizations through the NaviNet portal?
AmeriHealth Caritas Ohio created this tool to provide a higher auto-approval rate and quicker turnaround time compared to faxing the authorizations. There is also a report function that gives a status report allowing you to have visibility to all prior authorization requests you have submitted.
We are happy to offer training or any assistance your team may need to transition to this process. Please reach out to your local Account Executive.
Transportation provided to members
Our promise, “Care Is the Heart of Our Work,” shows our commitment to every member we are privileged to serve here in the Buckeye State. Our mission is to help people get care, stay well, and build healthy communities.

AmeriHealth Caritas Ohio believes our members should have access to quality healthcare and services. We are committed to delivering healthcare through innovative services and programs that will help you to take care of their health. One of the ways is through our transportation benefit. 
For trips farther than 30 miles
If a member must travel 30 miles or more from their home to receive covered health care services, AmeriHealth Caritas Ohio will provide transportation to and from the provider's office. Please call 1-833-664-6368 at least 48 hours in advance of the trip. Member Services may also assist with scheduling transportation by calling 1-833-764-7700 (TTY 1-833-889-6446).
For trips shorter than 30 miles
If traveling less than 30 miles from home a member can get transportation for certain services through the local county department of job and family services (CDJFS) Non-Emergency Transportation (NET) program. Contact the nearest county department of job and family services for questions or assistance with NET services.

AmeriHealth Caritas Ohio provides a supplemental transportation benefit that covers up to 60 one-way trips per member per year for provider visits less than 30 miles.

For emergencies
If a member has an emergency, they should call 911 or go to the nearest emergency room.

How to schedule a trip, and how to advise of special needs (walker, no phone, ring bell, use back entrance, etc.)
You may call our transportation vendor directly at 1-833-664-6368. Or, call AmeriHealth Caritas Ohio Member Services at 1-833-764-7700 (TTY 1-833-889-6446).
  • Please call to schedule transportation at least 48 hours before the scheduled medical visit.
    • Exceptions for advance notice include urgent member needs (like same-day or next-day urgent appointments) and hospital discharges.
  • Please have the full address of the healthcare provider’s office the member will visit.
  • Please let the call center representative know of any special needs for transportation. This could be any device used to assist with walking, a wheelchair, instructions about which entrance to use or how to contact you, etc.
    • If a car seat is needed, notify the call center representative. The member must provide the car seat and be able to install and uninstall it.
How to file a complaint
If you want to file a complaint about transportation, you may call Member Services at 1-833-764-7700 (TTY 1-833-889-6446).
To cancel or reschedule a trip
To cancel or reschedule a trip, call our transportation vendor, MTM, directly at
1-833-664-6368 or call Member Services at 1-833-764-7700 (TTY 1-833-889-6446) at least 24 hours before your appointment.


NaviNet dispute process 

Provider claim disputes are any provider inquiry or request for reconsideration. They range from general questions about a claim to a provider disagreeing with a claim denial. 


Disputes can be filed directly with NaviNet using any of the following methods:

  • Phone: 1-833-644-6001 (select the prompts for the correct department and then select the prompt for claim issues)
  • Online NaviNet
  • Mail:
    AmeriHealth Caritas Ohio
    Attn: Provider Claim Inquiry
    P.O. Box 7104
    London, KY 40742
  • Fax: 1-833-216-2272

Click here to watch a tutorial video with step-by-step instructions on how to file a claim.

Access the Provider Dispute Submission Form

Sign up for NaviNet

Value-Added Benefit: CARE Card Rewards Program
Earn rewards for good health
Members can earn rewards by doing things that help them stay healthy. To begin earning rewards, a member will complete a health risk assessment or one of the recommended health screenings or tests.

Visit a Participating Retailer

Members may use the CARE Card at any participating retailer. No prescription is needed.

  • Walgreens
  • Walmart
  • CVS
  • Dollar General
  • Family Dollar
  • Rite Aid

CARE Card Purchases
Eligible items up to your available card balance can be paid for with your card. Eligible items for purchase include, but are not limited to:

  • Baby care
  • Eye care
  • Children's medicines - over-the-counter (OTC)
  • Healthy foods
  • Family planning
  • Women's care
  • Diabetic supplies
  • Over-the-counter medicines
  • Digestion medicines
  • Wellness items
  • Home health items
  • Plus, more everyday needs






Provider Network Management module refresher training

Ohio Department of Medicaid (ODM), in partnership with Maximus, the Provider Network Management (PNM) module vendor, is continuing provider awareness and training efforts. Registration for the August 16 - 23 PNM module refresher training is now open. The training schedule is available on the PNM and Centralized Credentialing page. Below you will find how to register and a list of training topics. 


Learning Management System training registration steps 

Access the Absorb learning management system (LMS) job aid and follow the steps to create your account and register for training. Absorb is where you can access virtual and self-paced training sessions. If you do not have an account in the LMS, you must create one to access all training sessions, answer forms, and view a variety of PNM module resources.  


Training module topics 

  • Account administration and dashboard 
  • New enrollment 
  • Affiliations 
  • Updates 
  • Revalidation


For more information

To learn more about the PNM module and Centralized Credentialing, visit the PNM and Centralized Credentialing page on the Next Generation website. If you are experiencing technical issues accessing the PNM module or have specific questions, please contact the ODM Integrated Helpdesk (IHD) at 800-686-1516 or IHD@medicaid.ohio.gov. The IHD is open 8 a.m.-4:30 p.m. Eastern time Monday - Friday.


Ohio Department of Medicaid fraud warning

Criminals are targeting Medicaid recipients for sensitive, personal, and financial information. If your patient gets a call, text, or email about Medicaid benefits asking for a Social Security number, payment, bank, debit, or credit card information, advise your patient to not respond. They’re not from the State of Ohio or any agency. Instead, it should be reported to the Ohio Attorney General at 800-282-0515 or https://www.ohioprotects.org/.


Claim submission and adjudication FAQ is now available

ODM updated the Claims and Prior Authorization Submission Frequently Asked Questions (FAQ) to make it easier for you to find the information you need. It covers fee-for-service, managed care, and OhioRISE billing procedures, adjudication processes, and other answers to common provider questions. Review this document on the submitting claims and prior authorizations page on the Next Generation website and share it within your practice or organization. 


If you have additional questions, providers can contact the ODM Integrated Helpdesk (IHD) at 800-686-1516 or IHD@medicaid.ohio.gov. Representatives are available 8 a.m. - 4:30 p.m. ET Monday - Friday.



Dental Services 

AmeriHealth Caritas Ohio offers extra dental benefits to our members. In addition to the basic benefit of one (1) cleaning and one (1) exam per calendar year, adults age 21 and over are eligible to receive:
  • One (1) additional cleaning*
  • One (1) additional exam per calendar year by a participating dental provider*

*Some restrictions and limitation may apply


DentaQuest is our dental benefits vendor. You may contact DentaQuest directly to join the network, or inquire about benefits, billing, and more detailed information. There are multiple ways to contact the DentaQuest:

Resources and reminders

Specialty PNM Reminder

It is important for all Radiology and Anesthesiology providers to be sure to update their specialty information in the PNM Module. Discrepancies in the rosters AmeriHealth Caritas Ohio receives and the PNM Module specialty information can lead to claim processing delays and payment issues. Ensuring the PNM Module reflects the most current specialty information helps ensure accurate and timely claims payment. For more information on adding or updating a specialty, please visit ODMs PNM & Centralized Credentialing webpage or the Quick Reference Guide.


Urgent Care Claim Billing Reminder
AmeriHealth Caritas Ohio does not require Prior Authorization for Urgent Care claims. However, to ensure your claim processes correctly, please note the correct place of service code is 20. Claims for Urgent Care with place of service code 11 billed are invalid and this will result in a denial. 


Important requirements for Hospice Billing of (HCPC T2046) and Ventilator/Ventilator Weaning Services

  • Hospice Nursing Facility R&B should be billed on a HCFA form. Be sure to include the name of the facility where services were rendered in box 32a.
  • Vent and Vent weaning claims should be billed on a UB form with Type of bill 81X/081X. If this bill type is not used the claim will deny.
  • On Vent and Vent weaning claims, the diagnosis of Z99.11 should be present.
  • Vent and Vent weaning claims require the provider to include the name and NPI of the NF where services were rendered in box 80 (Remark code).

If the above conditions are not met, the claim may be denied and require submission of a corrected claim. 

Do not send paper claims

The Next Generation of Ohio Medicaid program's guidelines require all claims to be submitted via the Electronic Data Exchange (EDI). If you have submitted a paper claim, you will be advised that your claim has not been processed and what your next steps should be. You can get started on our website with claims how-tos, quick guides, links and contact info.


Billing guidelines

Clarifying language is being added to the behavioral health section of our billing guidelines: for services billed under the provider’s primary license, modifiers are not to be used.


Access AmeriHealth Caritas Ohio's provider resources

Step 1: Visit our provider webpage
Step 2: Sign up for NaviNet
Step 3: Attend a Provider Orientation Meeting
Step 4: Submit claims through Electronic Data Interchange (EDI)

Claims Payment Systemic Error (CPSE) Report

The Claims Payment Systemic Errors (CPSE) report is updated and posted on the ‘Alerts and Newsletter’ page monthly. AmeriHealth Caritas Ohio encourages you to review this log frequently and before contacting our Provider Services team. If after reviewing you still have additional questions, please feel free to reach out to Provider Services at 1-833-644-6001 and, as always, you can reach out to your local account executive.

Have you registered for a new provider orientation session yet?

AmeriHealth Caritas Ohio has provider orientation sessions scheduled through the end of the year. Join your personal account executives online via Zoom from 10 a.m. - 11 a.m. on any of the dates below.


New provider orientations inform our providers about Next Generation and Plan updates, claims and billing resources, prior authorizations resources, EFT information, and member and provider resources. 

September 19 - click here to register

October 17 - click here to register

November 14 - click here to register

December 19 - click here to register


If you attended an orientation session and need to complete the attestation, click here to get started.

Tell us a little bit about where you’re from.  I’m from New Carlisle, Ohio which is a smaller town outside Dayton. I went to Ohio University for my undergraduate and shortly after graduating I moved for Chicago for five years. While working in Chicago I was fortunate enough to also get my master’s degree from DePaul University. Last year I decided to move back to Ohio to be closer to some friends and family. It’s been fun as I am “rediscovering” Ohio and doing so many different things than when I previously lived here.  


Everyone at AmeriHealth Caritas Ohio (ACOH) has a story about why they joined the team. What’s yours? I’m really drawn to helping people and this seemed like a great role to explore that. I appreciate diversity and I love that my position with ACOH brings me closer to work in the community.


Me and my dog, Bash, on a hike in a nature preserve. I’m an indoor girl but my dog really enjoys the outdoors so we do what we can in the summer to be in nature.

What drew you to this profession?  As I mentioned previously, I’m really drawn to helping people. This is actually a new industry for me. I had been doing something different in Illinois when I decided I needed a change. It has been exciting learning something new and presenting myself with a new challenge.


What do you like to do in your free time? I really enjoy reading, watching TV, traveling, taking care of my plants, and spending time with my dog. I’m someone that has a lot of interests so I am in the middle of many books and tv shows. I am a part of the office book club as well as a personal book club with some friends. One of my current reads is Tomorrow, and Tomorrow, and Tomorrow by Gabrielle Zevin.


If you could have dinner with anyone in the world, dead or alive, who would it be? Why? This is a hard question to answer for me, but I think I am going to go with Julia Louis Dreyfus. Seinfeld and Veep are some of my favorite TV shows. She is so funny and seems so smart and fun- a true icon!


What are two apps on your phone you CANNOT live without?  I can’t live without Safari (for Googling) or Instagram (for mindless entertainment and pop culture news). 


Any interesting facts about yourself that you’d like to share? This year I was able to start the CASA (Court Appointed Special Advocate) volunteer program in Greene County. I love working with children and being in the social services space. It has been an eye-opening experience. One of my fellow AEs introduced me to this program and I am so grateful for it. Special shout out to Emily Kling for sharing that with us!

My contact info and territory
Counties: Pike, Jackson, Scioto, Lawrence, and Gallia
Click here to find your Account Executive
Coffee and conversation with AmeriHealth
We are inviting providers in the Cincinnati & Dayton areas to join our Account Executives for coffee and conversation as you head into work. Stop by and meet Nicki Fleming and Emily Kling at Panera for a cup of coffee. Our treat!
Time: Monday, August 28, 7:00 a.m. - 9:00 a.m
Location: Panera, 9444 Civic Centre Boulevard, West Chester Township, 45069  

Your voice matters!

We would love to hear your thoughts regarding participation in AmeriHealth Caritas Ohio's Population Health and Quality initiatives. Click here to take the one-minute survey. 

August is National Breastfeeding Awareness month 

August is National Breastfeeding Month, a month dedicated to advancing advocacy, protection, and promotion of breastfeeding. The Ohio Department of Health, in alignment with the American Academy of Pediatrics (AAP), recommends exclusive breastfeeding for the first six months of life. This should be followed by continued breastfeeding as complementary foods are introduced and continued for two years or longer as mutually desired by mother and child. Breast milk is the optimal source of nutrition for most infants.


Breastfeeding can reduce the risk for some short- and long-term health conditions for both infants and mothers. Infants who are breastfed have reduced risks of:

  • Asthma
  • Obesity (during childhood)
  • Type 2 diabetes
  • Ear infections
  • Lower respiratory infections
  • Sudden Infant Death Syndrome (SIDS)
  • Diarrhea and vomiting
  • Necrotizing enterocolitis (NEC) for preterm infants

    Breastfeeding can help lower a mother's risk of:

    • Type 2 diabetes
    • Ovarian cancer
    • Breast cancer
      Health professionals play an integral role in educating women about breastfeeding and encouraging them to achieve their breastfeeding goals. Often a woman’s success in breastfeeding depends on the reinforcement she receives from the broader medical community. Ohio Department of Health has resources for health professionals on their website. 

      Upcoming webinars 

      Provider Network Management module refresher training

      Ohio Department of Medicaid (ODM), in partnership with Maximus, the Provider Network Management (PNM) module vendor, is continuing provider awareness and training efforts. Registration for the August 16 - 23 PNM module refresher training is now open. The training schedule is available on the PNM and Centralized Credentialing page
      Improving Outcomes for People with Disabilities 2023 virtual roundtable
      Ohio Association of Health Plans and Ohio Center for Autism and Low Incidence (OCALI) are hosting a series of virtual roundtables. This series provides attendees the opportunity to hear from and engage with national experts and local leaders and deepen their understanding of people with disabilities as a focus of population health. The one-hour roundtables include lived experience, didactic presentation, and opportunity for interaction. Each session is designed to both challenge your thinking and change your practice, providing you with tools and resources you can use immediately. 
      • August 22 - Education Access & Quality: School Experiences, Outcomes & Resources 
      • September 19 - Economic Stability: Poverty & Food Insecurity 
      • October 24 - Economic Stability: Employment 
      • November 28 - Social & Community Context: Family Caregivers
      Click here to register. 
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