To promote better coordination of health care for our members and physicians,
we will soon introduce the Clinical Care Report. Unless a member chooses to opt
out, this tool will be accessible through the NaviNet? web portal and offers
participating physicians a snapshot view of care that their patients have
received based on AmeriHealth-paid medical and prescription drug claims. The
Clinical Care Report is part of a larger strategy to utilize our member claims
data and expand the use of health information technology to improve care.
The Clinical Care Report is intended for viewing by the following participating
health care providers:
-
a member?s personal or primary care physician;
-
physicians who have treated a member in the past year;
-
a new physician with whom a member has an upcoming scheduled appointment;
-
a physician who is addressing a current emergency medical need.
Information available in the Clinical Care Report
The information populated in our members? Clinical Care Report is derived from
member claims data and includes:
-
disease conditions reported in the past two years;
-
visits to the emergency room in the past year;
-
hospital admissions in the past four years;
-
outpatient procedures in the past two years;
-
specialists seen in the past two years;
-
prescriptions filled in the past six months;
-
alerts by condition (i.e., gaps in care), if any;
-
lab tests with results (when available);
-
diagnostic imaging in the past two years;
-
immunizations in the past four years.
This report is not a complete medical record of all services, tests, or
products that a member may have received. It does not include data for
sensitive health conditions such as mental/behavioral health, substance abuse,
HIV/AIDS, sexually transmitted diseases, genetic testing, or for services for
which AmeriHealth did not pay a claim.
How to grant or remove access to the Clinical
Care Report
Beginning August 22, 2011, only the designated Security Officer(s) in each
provider office will have access to the Clinical Care Report, and he or she
will be able to control user access through the User Management
transaction on NaviNet. Note: In order for providers to access the
Clinical
Care Report, a designated Security Officer must enable individual users or all
users.
Granting access to all users within an office
To update the settings to allow all users within an office access to the
Clinical Care Report, the designated Security Officer must first select
NaviNet Administration from the NaviNet Central menu.
Select Office Management from the drop-down menu on the left, and then
select Office Transaction Management.
Scroll down the Transaction Management for Office screen until you find
the transaction called Eligibility & Benefits ? Clinical Care Report in
the Name column. Click Enable to turn on access to all individuals in
your office.
To turn off access for all users in your office, follow the same steps and
click Disable instead.
Granting access to only select individuals within an office
The designated Security Officer can also limit access to the Clinical Care
Report to certain individuals within a provider office. To do so, first select
NaviNet Administration from the NaviNet Central menu.
Select User Management from the drop-down menu on the left, and then
select User Transaction Management.
The designated Security Officer must search for the appropriate user by
entering a last and first name and then clicking Search. Select the
appropriate user from the list that populates, and then select Edit
Access to view the list of transactions.
Scroll down the Transaction Management for User screen until you find
the transaction called Eligibility & Benefits ? Clinical Care Report in
the Name column. Click Enable to turn on access to the individual.
To turn off access for certain individuals in your office, follow the same
steps and click Disable instead.
How enabled users can view a member's Clinical Care Report
Once enabled, physicians can view the Clinical Care Report by selecting the
Eligibility and Benefits Inquiry option from the Plan Transactions menu.
To determine if a member has a Clinical Care Report, the user should enter the
member's information (either the member ID number or date of birth and last and
first name) and select the Search button.
If the member has not opted out of the tool, there will be a flag in the column
labeled "CCR". The blue flag in that column indicates that the member's
Clinical Care Report is available for you to view once you have agreed to abide
by the terms and conditions. Click the blue flag to view the report.
We hope you?ll find this tool valuable as you care for your patients, our
members. If you have questions regarding this new tool, please call the
eBusiness Provider Hotline at 215-640-7410 in Pennsylvania or Delaware
or 856-638-2701 in New Jersey.
If you are not yet NaviNet-enabled at your office location, register by going
to www.navinet.net and selecting Sign
up from the top right.