In order to meet the needs of employer groups and members, AmeriHealth offers a variety of products that hold members responsible for cost-sharing amounts (i.e., copayments, coinsurance, and deductibles) for covered services they receive. Cost-sharing varies based on the member?s type of coverage and benefit plan and can include applicable cost-sharing for both facility and professional services. As products with increased member cost-sharing continue to grow in popularity, we would like to take this opportunity to remind you to verify not only member eligibility but also cost-sharing amounts each time a member is seen (e.g., in the doctor?s office, outpatient facility, emergency room/department, or inpatient facility). AmeriHealth routinely audits the claims we adjudicate to ensure they are paid accurately and in accordance with the member?s benefit plan. Audits include, but are not limited to, ensuring appropriate application of cost-sharing. If a claims adjustment is required based on audit findings, it will be noted on the Statement of Remittance that you receive through the normal course of business. [

]Verifying member eligibility and cost-sharing amounts[

] To verify member eligibility and cost-sharing amounts, providers should use the Eligibility and Benefits Inquiry transaction via the NaviNet[^]?[] web portal. For information on using the Eligibility and Benefits Inquiry transaction, please review the NaviNet[^]?[]eligibility and benefits inquiry guide, posted on AmeriHealth NaviNet Plan Central in the Administrative Tools & Resources section. As a reminder, all participating providers were required to register for NaviNet by April 1, 2013. If you have not done so, go to the []NaviNet [] website and select Sign Up from the top right. Note: Cost-sharing amounts are available to members through their benefit plan documents or by logging on to our secure member website, amerihealthexpress.com. [

NaviNet^® is a registered trademark of NaviNet, Inc.

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