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In mid-October, we will introduce additional functionality to the NaviNet web portal that will offer providers access to new information.
Allowance Inquiry transaction
AmeriHealth will introduce a new transaction ? called Allowance Inquiry ? to replace the retired Fee Schedule Inquiry transaction. Allowance Inquiry will be available through the Plan Transactions menu.
Allowance Inquiry will return fees for professional providers only and will indicate where primary care physician capitation is generally applicable. The fees returned via Allowance Inquiry will be for migrated members ? that is, AmeriHealth Pennsylvania members who have been migrated to the new claims processing platform. Additionally, Allowance Inquiry will not include results for Traditional or Comprehensive Major Medical members.
Please note that provider payment allowance information will be for informational purposes only and will not be a guarantee of payment for the amount displayed.
We will publish a user guide in the coming weeks in the NaviNet Transaction Changes section of our System and Process Changes site. This guide will describe the Allowance Inquiry transaction in detail. We strongly encourage you to review the user guide once it?s published. An announcement will be made on AmeriHealth NaviNet Plan Central and on our Provider News Center once it is available.
AmeriHealth New Jersey Value Network
Starting in mid-October, the Eligibility and Benefit Detail screen will display a new field called Member Network for AmeriHealth New Jersey members. This field will show if an AmeriHealth New Jersey member?s plan is affiliated with a Regional Preferred or Local Value network. Providers can use this information when referring these members for services to ensure they stay within the network designated by their benefit plan.
Questions
If you have any questions regarding these upcoming NaviNet changes, please call the eBusiness Hotline at 215-640-7410 for providers in Pennsylvania and Delaware or at 609-662-2565 for providers in New Jersey.
Attention: NaviNet office conversion postponed until 2015
Last month we announced that we would be converting NaviNet offices to the new platform in October 2014. Please be advised that this conversion has been postponed until 2015. We will communicate more specific information, as it becomes available, in future editions of Partners in Health UpdateSM.
NaviNet® is a registered trademark of NaviNet, Inc.
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