In our continuing efforts to provide the most current and reliable information
to our network providers, as of September 15, 2011, we began enforcing our
policy that requires providers to 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
service codes
paid amount
member responsibility
Providers can view a webinar at www.navinet.net/intro_pss_ah 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 for NaviNet, please visit www.navinet.net 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 and 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.