As previously communicated, providers must use the
NaviNet? web portal or the Provider Automated
System when requesting member eligibility.
In addition, providers must use NaviNet or call
the Provider Automated System to check claims status information. The claim
detail provided through either system includes specific information, such
as:
- check date
- check number
- member responsibility
- paid amount
- service codes
Providers can view a webinar for more
information on these requirements. The presentation offers guidance on where to
obtain member eligibility and claims status information through NaviNet.
If your office location is not yet registered,
please visit NaviNet and select Sign up
from the top right. If your office is currently NaviNet-enabled but would like
assistance with accessing member or claims information, please call the
eBusiness Provider Hotline at
215-640-7410 for providers in Pennsylvania or
Delaware or 856-638-2701 for providers in New
Jersey.
Providers without access to NaviNet must obtain
eligibility and claims status information through the Provider Automated
System by calling 1-800-275-2583 and following
the voice prompts.
NaviNet? is a registered trademark of NaviNet,
Inc.