As previously communicated, we are in the process of transitioning AmeriHealth Pennsylvania members to a newclaims processing platform. Through mid-2015 AmeriHealth Pennsylvania members will be migrated to this newplatform in stages, generally based on when the customer/member?s benefit contract renews.
Primary care physicians (PCP) will receive two different forms of payment from AmeriHealth: electronic fundstransfer (EFT) for migrated members and EFT-enabled providers and paper checks for non-migrated membersand nonEFT-enabled providers. The following information was developed to assist our PCPs in understandingCapitation (CAP) payments for migrated and non-migrated members using the NaviNet® web portal. Please note,this process only applies to provider offices set up to receive EFT payments.
Note: To view reports for members of our affiliates, providers must access the appropriate NaviNet Plan Central.
Distribution of your CAP and QIPS payments
The process flow below outlines how CAP payments are distributed and how to access the payment informationthrough NaviNet.
Example CAP payment
Total CAP Payment Amount (NaviNet) $ 13,066.27Paper Check Amount - $ 789.25
EFT CAP Payment for Migrated Members = $ 12,277.02 Accessing CAP Rosters and Payments
The following are brief instructions to help you navigate the PCP CAP Rosters transactions through NaviNet. Please use the online roster to obtain the most up-to-date information.
CAP Roster ? Contains both migrated and non-migrated members
From the Plan Transactions menu, select ePayment, then PCP CAP Rosters.
Next, you will see a screen that allows you to search by month, provider (office location), or tax ID number. Once the appropriate information is entered, select Search.
The results that appear reflect member-level detail of your CAP payment for all members ? both migrated and non-migrated. The total CAP payment amount is displayed within the Capitation Statement summary.
For more information
A user guide that describes this transaction in greater detail is available on our dedicated System and Process Changes site. We encourage you to review the guides and check back for any updates.
If you have any questions regarding NaviNet transaction changes, call the eBusiness Hotline at 215-640-7410 for providers in Pennsylvania and Delaware and at 609-662-2565 for providers in New Jersey.
NaviNet® is a registered trademark of NaviNet, Inc.