As previously communicated, we will be introducing a new Claim Status Inquiry transaction on the NaviNet web portal. However, access to the new transaction will be delayed until January 2017. Check for updates regarding the release of this transaction and new user guides on the Provider News Center.

Claim Review

As a reminder, all participating providers (including third-party supporting agents) are required to be enabled with NaviNet. As part of our self-service requirements, participating providers are required to use NaviNet when checking for claim status. Additionally, providers who are looking to request a claim review must submit those requests through the Claim Investigation transaction. We will continue to redirect those providers who submit paper claim review requests to the NaviNet provider portal to initiate the claim review. Please be specific when describing the reason for the claim review.

Note: A number of providers are submitting claim review requests for lack of referral or authorization. If a claim is denied for lack of referral or authorization and one was required, you must submit a valid referral or authorization number in order for the claim to be reconsidered. The submission of medical records as a replacement for a required authorization or referral is not valid.

If, however, you are experiencing an issue that affects a significant number of claims, we recommend that you contact your Provider Partnership Associate or Network Coordinator for assistance rather than submit an adjustment request through NaviNet.

For more information

If you have any questions, 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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