In recent months, we have communicated information about several new transactions being introduced to AmeriHealth providers on the NaviNet web portal, including Eligibility and Benefits Inquiry, Claims Dashboard, and Document Exchange. New user guides are now available for these transactions, and we strongly encourage you to review them to become more familiar with the updates.

Eligibility and Benefits Inquiry

Starting on August 3, 2016, all remaining NaviNet-enabled participating providers will be given access to this new transaction.

The member search criteria will be modified, and the presentation of the eligibility and benefits information will change. The updated transaction will continue to provide you with access to real-time, detailed eligibility and benefits information for AmeriHealth members. You will be able to view information about a member?s demographics, insurance, and cost-sharing (e.g., copayment, deductible, and coinsurance). In addition, the Eligibility and Benefits Details screen will offer a list of benefit categories to view and will continue to include links to the member?s capitated site information (where applicable), ID card, and product-wide provisions associated with the member?s benefit plan.

Note: The new transaction will eventually allow you to search for a member?s eligibility and benefits record up to two years in the past from the current date. However, when the new transaction is first released, you will only be able to search retroactively for dates of service on or after October 1, 2015. Eligibility and benefits information will not be available through NaviNet for dates of service prior to October 1, 2015.

Claims Dashboard

We recently introduced the new Claims Dashboard transaction, which allows you to view your Accounts Receivable in a more comprehensive manner. Claims Dashboard provides you with access to view both pended and finalized claims.

Note: The data presented within the transaction is provided for general informational purposes. In addition, there is a lag time between finalized and pended claims data updates.

Document Exchange

Later this month, Document Exchange will be introduced to AmeriHealth providers. This new feature will allow us to share more information electronically with our provider network.

When Document Exchange is first released, your designated NaviNet Security Officer will control which end users, including himself or herself, associated with your NaviNet office will be given access to the following five unique Practice Document Categories:

• Billing/Financial Report
• Patient Roster Report
• Patient Transition Report
• Pharmacy Report
• Program Enrollment Report

Once an end user is granted permission to access a specific Practice Document Category, that individual will be able to view and download any documents associated with that category. For example, if a NaviNet Security Officer grants permission to an associate to access the Billing/Financial Reports category, all reports made available by AmeriHealth under that category will be available to the associate to view or download.

It is important that your designated NaviNet Security Officer manages permissions appropriately for each document category to ensure reports are accessed in a manner that is compliant with role-based access requirements of the Health Insurance Portability and Accountability Act (HIPAA).

Note: Third-party vendors that have access to NaviNet will not have the ability to access Document Exchange.

Initial report

The first report that will be made available under Document Exchange will be the High Risk Hospitalization Predictor report from August 2016. This report will be made available to targeted AmeriHealth New Jersey primary care physician practices and, based on a predictive model, identifies members treated who are at high risk of acute hospitalization in the next six months and who have one or more of the following chronic conditions:

• chronic obstructive pulmonary disease (COPD)
• congestive heart failure (CHF)
• coronary artery disease (CAD)
• diabetes

If you have questions or suggestions that relate to the High Risk Hospitalization Predictor report, please contact your network medical director.

For more information

You can download the recently published user guides for these new transactions in the NaviNet Resources section of our Provider News Center. If you have any questions about any NaviNet transactions, please call the eBusiness Hotline at 609-662-2565 for AmeriHealth New Jersey or at 215-640-7410 for AmeriHealth Pennsylvania.

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