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Beginning October 18, 2014, the changes listed in this article will
be made to the NaviNet web portal. Please review this information to understand
how these changes may affect how you do business with AmeriHealth.
Member ID cards
For migrated members, providers will now be able to view member ID cards
through NaviNet. To view a migrated member's ID card, select the View
Current Member ID Card link from the Eligibility and Benefits Details
screen.
NaviNet will present printable images of the front and back of the member's
current ID card in a new browser window. Please note that only medical ID cards
will display. ID cards will not be displayed for members who have stand-alone
coverage (e.g., pharmacy or vision only).
Note: This enhancement provides access to an image of a member's
current ID card. Therefore, when conducting an Eligibility and Benefits
Inquiry search for a migrated member using a past or future date of service,
the information found on the member ID card image may differ from the
information provided on the Eligibility and Benefits Details screen.
AmeriHealth New Jersey member network
AmeriHealth New Jersey has a variety of network options to meet the needs of
members. To help providers identify an AmeriHealth New Jersey member's coverage
and network affiliation, we are adding a new Member Network field within the
Eligibility and Benefits Details screen. This field will indicate which network
the AmeriHealth New Jersey member has coverage under: Regional Preferred or
Local Value (a subset of the Regional Preferred network). If this information
does not appear for an AmeriHealth New Jersey member, you may contact Customer
Service at 1-888-YOUR-AH1 (1-888-968-7241) to verify his or her network.
Drug pre-authorizations
There will be screen changes within the Drug Pre-Authorization transaction.
Providers will now need to select their provider group and location first from
the Prescribing Provider Group drop-down menu. Then providers will be able to
enter the member's ID number and the date of request.
After selecting the member, providers will be prompted to select the
appropriate practitioner from the Prescribing Provider drop-down menu. Only
those practitioners linked to the previously selected office location will
display. Then the provider will select the prescribed drug from the Medication
drop-down menu.
Once complete, the provider will be presented with the Drug
Pre-Authorization Response Form. The office contact, telephone number, and
fax number remain required fields. Providers will continue to receive a faxed
response for approved requests.
Postponements
The NaviNet office conversion, which impacts provider drop-down menus, has
been postponed until early 2015. Additionally, the new Allowance Inquiry
transaction, which replaces the retired Fee Schedule Inquiry transaction, will
not be released until early 2015.
More information about upcoming changes, including the availability of
detailed user guides, will be communicated in future editions of Partners in
Health UpdateSM.
If you have any questions regarding the NaviNet transaction changes, please
call the eBusiness Hotline at 215-640-7410 for
providers in Pennsylvania and Delaware and at 609-662-2565 for providers in New Jersey.
NaviNet® is a registered trademark of
NaviNet, Inc.
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