Find the right department

Paper claims (timely filing 365 days from date of service).

Pharmacy provider services and pharmacy PA per the current provider reference guide (Prime Therapeutics). An older LDH bulletin line for PerformRx is also in this directory; confirm the current vendor.

Pre-service medical necessity appeals; written member medical necessity appeals go to the Member Appeals Coordinator.

Provider claim disputes by mail.

Provider Network Management.

Radiology PA through National Imaging Associates.

Care coordination, case management, EPSDT, member outreach, referrals/appointment scheduling and transportation assistance.

Medical/DME authorizations, inpatient/outpatient reviews, discharge planning and NICU concurrent review.

Behavioral health crisis line listed in the provider quick-reference guide.

Bright Start maternity services.

EDI technical support; payer ID 81671.

MTM member and provider services for non-emergency medical and ambulance transportation.

Paper claims mailing address; electronic payer ID 81671. Claim inquiries via NaviNet or provider services (1-888-738-0004).

PerformRx pharmacy provider services; pharmacy prior authorization requests by fax.

Provider grievances/appeals by mail (or online through NaviNet). The guide's grievance paragraph prints the provider services number as 1-855-738-0004, which conflicts with 1-888-738-0004 elsewhere, so no phone is given here.

Provider services fax from the NC Medicaid provider quick-reference guide (provider services phone 1-888-738-0004 handles eligibility, claim status, EDI support, demographic changes and provider grievances).

Radiology benefit vendor Evolent; PA by web portal or phone.

Care coordination (HealthCheck/EPSDT, Let Us Know program). Health risk assessment forms are mailed to PO Box 7375, London, KY.

Physical health prior authorization questions, services not found in the lookup tool, and requests beyond benefit limits. After hours, weekends and holidays call member services 1-855-375-8811.

Maternity care management / pregnancy notifications.

DentaQuest provider line for AmeriHealth Caritas Ohio dental benefits.

Fraud/abuse referrals including pharmacy/PCP coordinated services program (lock-in).

Member-facing. Member grievances by mail: Attn: Member Grievances, PO Box 7133, London, KY 40742; member appeals: PO Box 7346, London, KY 40742.

Refund checks for overpayments (include member name/ID, DOS, claim ID). Self-identified overpayment inquiries go to Attn: Claims Cost Containment, PO Box 7320, London, KY 40742.

Medical-benefit (provider-administered) drug PA only. Pharmacy (Provider Type 70) drugs are covered by the ODM SPBM (Gainwell), not AmeriHealth.

Provider appeals of denied pre-service requests within 30 days of the ABD notice (ORC 5160.34); member consent not required. Appeals on a member's behalf with consent: call 1-833-764-7700.

Claim disputes (reconsiderations) within 12 months of DOS or 60 days after payment/denial, whichever is later; also via NaviNet claims adjustment inquiry. Include dispute resolution letter copy when mailing.

Provider services fax/email (phone 1-833-644-6001 already listed): EDI technical support, demographic changes, informal complaints. Medicaid EDI claims go through ODM PNM/OMES with AmeriHealth Caritas Ohio Payer ID 35374 (1000B and 2010BB loops). Update demographics in ODM PNM first.

Quality management department.

RROT (care coordination, EPSDT manager). Phone withheld: the manual lists both 1-833-464-7768 and 1-833-646-7768.

Provider-initiated overpayment inquiries for manual review (not refund checks).

Urgent medical-benefit drug PA requests.

Medical UM/prior authorization and peer-to-peer; NaviNet portal also accepts PA. Outpatient advanced radiology PA is through NIA; transplants through the Ohio transplant consortia.

Care management/care coordination line. Bright Start maternity: 1-877-364-6797 (fax 1-866-755-9935).

All ACPA claims. Payer ID 22248. Initial claims 180 days; resubmissions/corrections 365 days.

'Let Us Know' member-intervention program phone and fax.

Member services, 24/7.

Pharmacy services and pharmacy prior authorization for ACPA.

ACPA (HealthChoices Medicaid outside southeastern PA) prior authorization phone and fax; concurrent review via prompt. Payer ID 22248. Guide revised October 2026.

Informal provider disputes: P.O. Box 7316; formal clinical provider appeals: Clinical Provider Appeals Department, P.O. Box 7307, London, KY 40742. Peer-to-peer hotline 1-877-693-8480.

Toll-free alt 888-656-2383.

Bright Start maternity program phone and fax.

Care management/care coordination referrals. 'Let Us Know' program: phone 1-800-573-4100, fax 1-800-647-5627.

All Keystone First claims (mark 'Resubmitted' or 'Corrected Claim' if applicable). Payer ID 23284. Timely filing: initial claims 180 days, resubmissions/corrections 365 days, COB 60 days after primary payment, EPSDT initial 90 days.

Concurrent review Units 1-4 faxes: Unit 1 1-215-937-7368, Unit 2 1-215-937-7370, Unit 3 1-215-937-7369, Unit 4 1-215-937-7365. Call 1-800-521-6622 (concurrent review prompt) to learn the assigned unit. Unit 1 fax shown in the fax field.

Credentialing department phone for Keystone First.

Electronic billing questions line on the Keystone First provider reference guide.

Informal provider disputes (dissatisfaction not about medical necessity) go to P.O. Box 7316; formal appeals of medical denials go to Clinical Provider Appeals, P.O. Box 7307, London, KY 40742. Peer-to-peer hotline 1-877-693-8480.

Member services, 24 hours a day, 7 days a week; also family planning self-referral line.