Plan Closure and Transition FAQs
We will continue to serve our members of AmeriHealth Caritas VIP Care (D-SNP) and AmeriHealth Caritas Next (Health Insurance Marketplace) health plans in Florida. The decision from the Florida Agency for Health Care Administration regarding the Medicaid contract does not impact our D-SNP and Health Insurance Marketplace plans in Florida.
AmeriHealth Caritas Florida members will continue to have access to health care and services through the end of our Medicaid contract on January 31, 2025, or any applicable continuity of care period.
Yes, the Florida Agency for Healthcare Administration mailed a letter to our members in early November with the effective date of the change and the information they need to choose a new Medicaid plan. AmeriHealth Caritas Florida will also be mailing notifications of this change to our members and providers by December 30, 2024.
There is no impact to existing prior authorizations. Any active prior authorization that has an end date beyond January 31, 2025, will transition to their new health plan as part of continuity of care.
Go to www.NaviNet.net. For assistance with NaviNet please access the NaviNet Customer Care Line 1-888-482-8057.
Yes, AmeriHealth Caritas Florida (Medicaid) will continue to process and pay claims for covered services provided to our members through January 31, 2025, in accordance with the terms of your provider contract. Please see information below on important time frames that will continue to be enforced.
| Initial claims | ||
|---|---|---|
| Submission type | Submission time frame | Submission location |
| AmeriHealth Caritas Florida (ACFL) is primary payer | 6 months* from the date of service or date of discharge (inpatient) | EDI: Payer ID 77003 Paper: P.O. Box 7367, London KY 40742 |
| ACFL is secondary to non-Medicare plan | 90 days* from the date of the primary payer’s final determination | EDI: Payer ID 77003 Paper: P.O. Box 7367, London KY 40742 |
| ACFL is secondary to Medicare plan AND claim submitted by provider | 6 months* from the date of the Medicare’s final determination or 12 months* from the date of service; whichever is greater | EDI: Payer ID 77003 Paper: P.O. Box 7367, London KY 40742 |
| ACFL is secondary to Medicare plan AND claim is sent electronically by Medicare plan (COBA) | 3 years* from the date of service or date of discharge (inpatient) | N/A |
| Corrected claims | ||
|---|---|---|
| Submission type | Submission time frame | Submission location |
| AmeriHealth Caritas Florida (ACFL) is primary payer | 6 months* from the date of service or date of discharge (inpatient) | EDI: Payer ID 77003 Paper: P.O. Box 7367, London KY 40742 |
| ACFL is secondary payer to non-Medicare plan | 90 days* from the date of the primary payer’s final determination | EDI: Payer ID 77003 Paper: P.O. Box 7367, London KY 40742 |
| ACFL is secondary payer to Medicare plan AND claim submitted by provider | 6 months* from the date of the Medicare’s final determination or 12 months* from the date of service; whichever is greater | EDI: Payer ID 77003 Paper: P.O. Box 7367, London KY 40742 |
| ACFL is secondary payer to Medicare plan AND claim is sent electronically by Medicare plan (COBA) | 3 years* from the date of service or date of discharge (inpatient) | N/A |
| Other documents | ||
|---|---|---|
| Submission type | Submission time frame | Submission location |
| Submission of requested documents (e.g. itemized bill, primary EOB, medical records, sterilization form) | 35 days* from the date of the remittance advice | EDI: Payer ID 77003 – utilize 275 Claim Attachment Transaction Paper: P.O. Box 7367, London KY 40742 |
| Overpayment dispute | 40 days from the date of the overpayment notice | Mail to: P.O. Box 7367, London KY 40742 |
| Authorization dispute | 60 days from the Notice of Adverse Benefit Determination (NABD) | Mail to: P.O. Box 7367, London KY 40742 |
| Claim payment dispute | 90 days from the date of the remittance advice | Mail to: P.O. Box 7367, London KY 40742 |
If you have additional questions, please call Provider Services at 1-800-617-5727.