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