Claims and Billing

Filing claims can be fast and easy for PerformCare providers. For complete claims instructions, view the Claims and Claims Disputes chapter in our Provider Manual (PDF). Here you can find the tools and resources you need to help manage your submission of claims and receipt of payments. You may also refer to our Claims Submission Overview (PDF) and our PerformCare Claims Submission Instructions (PDF) for additional information.

Timely filing limits

  • Initial claims: PerformCare’s timely filing limit is 60 days from date of service.
  • Resubmissions and corrections: 365 days from date of service.
  • Claims with explanations of benefits (EOBs) from primary insurers, including Medicare, must be submitted within 60 days of the date on the primary insurer’s EOB. When submitting an EOB with a claim, the dates and the dollar amounts must match, or the claim will be rejected.

Claims payment schedule

  • PerformCare’s payment cycle runs every Wednesday and successfully processed claims are paid the following week.

What would you like to do?

What would you like to do?

Submit an electronic claim

Submit claims through electronic data interchange (EDI) for faster, more efficient claims processing and payment. PerformCare’s EDI payer ID number is 65391.

Electronic claims may be submitted via:

Availity

  • Providers or clearinghouses not currently using Availity to submit claims must first register with Availity.
  • Providers who are currently registered with Availity for another payer, or using another clearinghouse, must request to have electronic claims for PerformCare 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 a.m. to 8 p.m. ET.

Optum/Change Healthcare

  • PerformCare has reestablished connectivity with Optum/Change Healthcare.
  • Providers who have a software vendor or use another clearinghouse to submit claims to Optum/Change Healthcare will need to consult with their vendor/clearinghouse to see if there have been changes in their process for claims submission.
  • For questions contact Optum/Change Healthcare’s call center: 1-800-527-8133, Monday through Friday from 8 a.m. to 8 p.m. CT.

Submit a manual/direct entry claim

Providers may submit manual/direct entry claims (at no cost) via:

Optum/Change Healthcare ConnectCenter™

This option is currently only available 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. Providers will be notified when the option for new registrations is reinstated.

To reconnect:

  • 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.
  • Optum/Change Healthcare also provides helpful user guides to assist providers with navigating the ConnectCenter portal. To access the user guides, visit the “Additional claims resources” section at the bottom of this page.

PCH Global

To enroll for claims submission, visit PCH Global.

  • Click the Sign-Up link in the upper right-hand corner.
  • Complete the registration process and log in to 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:
    • Payer name: AmeriHealth PerformCare
    • P.O. Box: 7308

For a detailed walk-through of the registration process, refer to the PCH Global User Manual (PDF), found on the PCH Global website in the Resource Menu.

Submit a 275 claim attachment transaction

Submit a paper claim

Send paper claims to:

PerformCare of Pennsylvania
HealthChoices
P.O. Box 7308
London, KY 40742

PerformCare recommends that providers mail claims by certified mail. Note that since the mailing address is a P.O. Box, FedEx and UPS are not accepted.

Read our paper claims submission FAQ for more information.

Check claim status

To inquire about claim status, sign in to NaviNet and select Claims Status Summary under Administrative Reports to check multiple claims or Claim Status Inquiry to check individual claims. Provider Claim Services can also check the status of up to five claims via phone at 1-888-700-7370, option 1.

Request reconsideration of a claim

Requests for reconsideration may be submitted through the NaviNet Electronic Claim Inquiry feature. For detailed information on electronic claim inquiry submission, please see the NaviNet Claims Investigation Guide (PDF).

Electronic claim payment options

PerformCare partners with ECHO Health, Inc. (ECHO Health), a leading innovator in electronic payment solutions, to offer more electronic payment options to our providers so that they can select the payment method that best suits their accounts receivable workflow.

Virtual Credit Card (VCC)

ECHO Health offers Virtual Credit Cards as an optional payment method. Virtual Credit Cards are randomly generated, temporary credit card numbers that are either faxed or mailed to providers for claims reimbursement. Major advantages to VCC are that providers do not have to enroll or fill out multiple forms in order to receive VCC, and personal information, like practice bank account information, will never be requested. Providers will also be able to access their payment the day the VCC is received.

In the future, PerformCare providers who are not currently registered to receive payments electronically will receive VCC payments as their default payment method, instead of paper checks. Your office will receive either faxed or mailed VCC payments, each containing a VCC with a number unique to that payment transaction with an instruction page for processing and a detailed Explanation of Payment/Remittance Advice (EOP/RA). Normal transaction fees apply based on your merchant acquirer relationship. If you do not wish to receive your claim payments through VCC, you can opt out by contacting ECHO Health directly at 1-888-492-5579.

Electronic funds transfer (EFT)

Electronic funds transfers allow you to receive your payments directly in the bank account you designate rather than receiving them by VCC or paper check. When you enroll in EFT, you will automatically receive electronic remittance advices (ERAs) for those payments. All generated ERAs and a detailed explanation of payment for each transaction will also be accessible to download from the ECHO provider portal. If you are new to EFT, you will need to enroll with ECHO Health for EFT from PerformCare.

Please note: Payment will appear on your bank statement from PNC Bank and ECHO as "PNC – ECHO."

Sign up to receive EFT from PerformCare. There is no fee for this service.

To sign up to receive EFT from all of your payers processing payments on the Settlement Advocate platform, visit the Echo Health Provider EFT/ERA Enrollment page. A fee for this service may be required.

Receive electronic remittance advice (ERA)/835 transmissions

PerformCare offers ERAs through ECHO Health, Inc. ECHO is a leading provider of electronic solutions for payments to healthcare providers. ECHO consolidates individual provider and vendor payments into a single compliant format, remits electronic payments and provides an explanation of payment (EOP) details to providers.

To receive ERAs providers will need to include both the Plan payer ID and the ECHO payer ID 58379. Contact your practice management/hospital information system for instructions on how to receive ERAs from PerformCare under Payer ID 65391 and the ECHO Payer ID 58379.

All ECHO Health-generated ERAs and EOPs for each transaction will be accessible to download from the ECHO provider portal. If you are a first-time user and need to create a new account, please reference ECHO Health's Provider Payment Portal Quick Reference Guide (PDF) for instructions.

If your practice management/hospital information system is already set up and can accept ERAs from PerformCare, it is important to check that their system includes both the Plan and ECHO Health Payer IDs.

If you are not receiving any payer ERAs, contact your current practice management/hospital information system vendor to ask if your software can process ERAs. Your software vendor is then responsible for contacting Optum/Change Healthcare to enroll for ERAs under 65391 and ECHO Health Payer ID 58379.

If your software does not support ERAs or you continue to reconcile manually, but would like to start receiving ERAs only, please contact the ECHO Health Enrollment team at 1-888-834-3511.

Submit an administrative appeal

Administrative appeals are the process by which claims denials that are not approved because they do not meet contractual or administrative requirements are reviewed. Administrative denials are not denied based on medical necessity guidelines.

Administrative appeal requests

PerformCare Administrative Appeals
P.O. Box 7301
London, KY 40742

PerformCare recommends that providers mail claims by certified mail. Note that since the mailing address is a P.O. Box, FedEx and UPS are not accepted.

  • Please use the Multiple Administrative Appeals spreadsheet (XLS) when your appeal has 10 or more claims. Email the completed form to DL-PerformCareAppeals@amerihealthcaritas.com. Please note that the spreadsheet must be sent via secure email. If you need a secure email initiated, please reach out to your Account Executive.
  • Appeal decisions are made within 30 days of receipt by PerformCare.
  • The process allows only a one-time submission. PerformCare does not offer second-level appeals. Therefore, please include completed information and all appropriate supporting documentation with the first submission. All decisions are final.
  • For assistance, call PerformCare’s Claims department at 1-888-700-7370, option 1.
  • Review complete details of the Administrative Appeals Process and FAQs (PDF).

What information should be included with the administrative appeal request?

For requests related to retroactive eligibility issues:

  • If an appeal is related to an eligibility issue, always include eligibility verification system (EVS) documentation from the start date of service with your appeal request.
  • If appeal is related to substance abuse services, please include documentation of the member's American Society of Addiction Medicine (ASAM) criteria.
  • If the appeal is related to a service that requires precertification for authorization, please include the member's medical record.
  • If the appeal is related to intensive behavioral health services (IBHS), please submit the member's complete IBHS request packet.
  • If the appeal is related to family-based mental health services (FBMHS), please include all progress notes for one month before the dates of service and specify the exact number of additional units requested for each date of service.

For requests involving services that require pre-authorization:

  • The member's medical records or progress notes must be submitted.
  • Medical necessity criteria must be met.
  • Authorization from the primary insurer must be included (if applicable).

For requests related to primary claims denials:

  • EOBs or denial letters from the primary insurer must be included.
  • The appeal request must be submitted within 60 days of the date on the primary insurer's EOB/denial letter.

Additional claims resources

Providers