As previously communicated, Document Exchange will soon be
introduced to providers on the NaviNet web
portal. 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 end users are granted permission from their NaviNet Security Officer to
access a specific Practice Document Category, they 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 for your NaviNet Security Officer to manage 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.
Reports will not be made available to AmeriHealth providers under Document
Exchange until later this year. We will publish more information in future
editions of Partners in Health UpdateSM as it becomes
available.
For more information
A new user guide for Document Exchange is now available in the NaviNet Resources section of our Provider News Center. It
provides detailed instructions on how to use this new feature.
If you have any questions about Document Exchange, call the eBusiness
Hotline at 609-662-2565 for AmeriHealth New Jersey or at
215-640-7410 for AmeriHealth Pennsylvania.
Reminder: Provider self-service requirements
All participating providers (including
third-party administrators supporting the
organization) are required to have access
to NaviNet. In addition, all participating
providers are required to use NaviNet for
specific activities, including:
- Member Eligibility. The Eligibility and Benefits Inquiry transaction
provides you with detailed information relating to our members'
eligibility.
- Claim Status Inquiry. This transaction allows you to view the
progress of your accepted claim submission. You can view claims with service
dates up to 18 months in the past. The claim detail includes specific
information, such as check date, service codes, paid amount, and member
responsibility.
- Claim Investigation. Providers who call Customer Service to question
claim payment or to request a claim adjustment must submit those requests
through the Claim Investigation transaction. A link to Claim Investigation can
be found when searching for a specific claim through Claim Status Inquiry. 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.
If you have not yet registered for NaviNet, you can request access by going to
the
NaviNet
website.
NaviNet is a registered trademark of NaviNet, Inc.