Over the past several years, AmeriHealth has instituted a number of provider self-service requirements under which providers must use the NaviNet web portal to obtain certain information. All participating providers, facilities, Magellan-contracted providers, and billing agencies that support provider organizations are required to use self-service options for the following:

• Eligibility and claims status information. All participating providers and facilities are required to use NaviNet to verify member eligibility and obtain AmeriHealth claims status information. The claim detail provided through NaviNet includes specific information, such as check date, check number, service codes, paid amount, and member responsibility.
• Claim adjustments. All participating providers and facilities must submit claim adjustment requests using the Claim Investigation Inquiry transaction on NaviNet. Providers must supply the necessary information to support an adjustment request. For example, if a provider is requesting a claim adjustment related to the payment amount, the provider must supply the member's benefit product for the date of service at issue and the relevant terms in the provider's contract in order for a review and adjustment consideration to occur.
• Authorizations.* All participating providers and facilities must use NaviNet to initiate the following authorization types:
  • –medical/surgical procedures
  • –chemotherapy/infusion therapy
  • –durable medical equipment
  • –emergency hospital admission notification
  • –home health (dietitian, home health aide, occupational therapy, physical therapy, skilled nursing, social work, speech therapy)
  • –home infusion

Resources available

Detailed user guides and webinars for many NaviNet transactions are available in the NaviNet Resources section of the Provider News Center.

All office locations are required to have NaviNet access. If you are not yet NaviNet-enabled, go to the NaviNet website to sign up. If your office is NaviNet-enabled but would like training on any of the self-service transactions, call the eBusiness Hotline at 609-662-2565 for AmeriHealth New Jersey or at 215-640-7410 for AmeriHealth Pennsylvania.

*This information does not apply to providers contracted with Magellan Healthcare, Inc. (Magellan). Magellan-contracted providers should contact their Magellan Network Coordinator at 1-800-866-4108 for authorizations.

Magellan Healthcare, Inc. manages mental health and substance abuse benefits for most AmeriHealth members.

NaviNet is a registered trademark of NaviNet, Inc.