As of January 1, 2014, AmeriHealth Pennsylvania members who have been migrated to the new operating platformand have spending accounts will have a new payment option called Direct Pay to Provider (DPTP). DPTP allowsmembers to pay providers directly from their Health Savings Account (HSA), Health Reimbursement Account (HRA), orFlexible Spending Account (FSA). For HRA and FSA participants, DPTP is an employer-configuration option only; HSAparticipants can set up their preferences through our secure member website, amerihealthexpress.com.

Providers will be able to view HRA details through the Eligibility and Benefits Inquiry transaction on the NaviNet^? webportal, including the deductible amount and who is responsible for payment first (the employer or the member), and howmuch they would pay. Unless informed by the member, providers are unable to determine whether a member has an FSAor HSA.

For medical claims that require processing to determine the member liability, the claim is processed and thenautomatically sent to the spending account system to determine if the claim is covered and if funds are available underone or more spending accounts. If the account is an FSA or HRA and the employer offers DPTP, the payment is eitherautomatically sent to the provider or sent after the member has approved it. In this case, the provider will receive aspending account Explanation of Payment (EOP). Providers will be able to view EOPs through the EOB and RemittanceInquiry transaction on NaviNet. A spending account payment related to a medical claim will generally arrive a week afterthe claim has been completely processed.

Provider and facility EOPs

EOPs will differ depending upon the method of payment (check vs. electronic funds transfer [EFT]). The example belowshows a sample provider EOP. A guide explaining how to read your EOP will be available in the Claims Submission andPayment section of our Upcoming System and Process Changes site in the coming weeks.

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