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This article details changes that are scheduled to be made in February to the NaviNet web portal. Please review this information to understand how these changes may affect how you do business with AmeriHealth.
NaviNet office conversion
We are converting all NaviNet offices to the new platform in February as part of our ongoing transition to the new operating platform. Most providers will see a difference in their provider group drop-down menus within many individual transactions on NaviNet.
Some of the more significant changes that providers will see on the new platform include:
- expanded drop-down lists for all office locations associated to a group record;
- elimination of PPO/HMO lines of business designators;
- elimination of customized provider group name descriptions.
As there may be significant impacts to your NaviNet office, we strongly encourage you to review the NaviNet Office Conversion Guide.
Allowance Inquiry transaction
A new Allowance Inquiry transaction will be added as an option in the transactions menu, replacing the retired FeeSchedule Inquiry transaction. This new transaction will return fees for professional providers only and will indicatewhere primary care physician (PCP) capitation is generally applicable. The fees returned via Allowance Inquiry will beassociated with migrated members only and will not include results for Traditional or Comprehensive Major Medicalmembers. A detailed user guide will be posted to the NaviNet Transaction Changes section of our System and Process Changes site.
Network Provider Inquiry and Network Facility Inquiry transactions
Two new transactions will be available in February to help you locate physicians or facilities affiliated with a specific AmeriHealth network (e.g., HMO/POS, PPO). Detailed user guides will be posted in February to the NaviNet Transaction Changes section of our System and Process Changes site.
Tiering information enhancements
In order to better serve our Community Advantage and Tier 1 Advantage members, we are introducing NaviNetenhancements in February that will:
- assist providers in identifying appropriate member cost-sharing (e.g., copayment);
- help providers with the referral and preapproval submission processes.
The following NaviNet transactions will be enhanced with tiering information:
- Eligibility and Benefits Inquiry.
A Billing Provider drop-down menu will be added to the search screen. Whensearching for member eligibility and benefits information, you will need to select the appropriate provider group or facility before entering the member search criteria. The combination of provider and member information entered will assist in identifying the appropriate member cost-sharing. The Eligibility and Benefits Details screen offers several links to benefit provisions (e.g., professional services, outpatient facility services). When selecting a benefitprovision link, the member's tier benefit cost-sharing will be highlighted based on the provider group or facility you selected.
Note: Selecting an incorrect provider group or facility on the Eligibility and Benefits Search screen may result in incorrect member cost-sharing being highlighted.- Authorization Submission.
Where applicable, you will see an additional column in the search results screen whenlooking for a physician or facility while submitting an Emergency Room Admission Notification or an authorization request for one of the following:
–medical/surgical procedures
–chemotherapy/infusion services
–home health
–home infusion
–durable medical equipment
This new column will identify the benefit tier placement associated with that physician or facility. Members with tieredprograms pay the lowest cost-sharing when they use providers on the lowest tier.- Referral Submission.
Where applicable, PCPs will see an additional column in the search results screen when looking for a physician or facility while submitting a referral. This new column will identify the benefit tier placement associated with that physician or facility.
For more information
To help you better understand these changes, we will continue to publish more details in future editions of Partnersin Health UpdateSM. In addition, we strongly encourage you to review the NaviNet Transaction Changes section of our System and Process Changes site.
If you have any questions about upcoming changes to NaviNet, call the eBusiness Hotline at 215-640-7410 forAmeriHealth Pennsylvania and at 609-662-2565 for AmeriHealth New Jersey.
NaviNet® is a registered trademark of NaviNet, Inc.
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