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Reminder: Provider self-service requirements

May 31, 2013

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As previously communicated, we have instituted a number of provider self-service requirements where providers must use the NaviNet web portal or the Provider Automated System to obtain certain information. These requirements pertain to participating providers, facilities, Magellan-contracted providers, and billing agencies that support provider organizations.

Eligibility and claims status

All participating providers and facilities are required to use NaviNet (or call the Provider Automated System) to verify member eligibility and check AmeriHealth claims status information. The claim detail provided through either system includes specific information, such as check date, check number, service codes, paid amount, and member responsibility.

Claim adjustments

Participating providers who call Customer Service to question a claim payment or to request a claim adjustment will be directed to submit the request via NaviNet using the Claim INFO Adjustment transactions.

Authorizations*

All participating providers and facilities must use NaviNet in order to initiate the following authorization types:

  • medical/surgical procedures
  • chemotherapy/infusion therapy
  • durable medical equipment
  • emergency hospital admission notification
  • home health (dietitian, home health aide, occupational therapy, physical therapy, skilled nursing, social work, speech therapy)
  • home infusion
  • outpatient speech therapy

All office locations were required to register for NaviNet by April 1, 2013. If you have not yet done so, visit NaviNet and select Sign Up from the top right. If your office is currently NaviNet-enabled but would like training on these self-service requirements, please contact our eBusiness Provider Hotline at 215-640-7410 for providers in Pennsylvania and Delaware or at 609-662-2565 for providers in New Jersey.

*This information does not apply to providers contracted with Magellan Behavioral Health, Inc. (Magellan). Magellan-contracted providers should contact their Magellan Network Coordinator at 1-800-866-4108 for authorizations.

Magellan Behavioral Health, Inc. manages mental health and substance abuse benefits for most AmeriHealth members.
NaviNet? is a registered trademark of NaviNet, Inc.

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