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This article details more changes on the NaviNet webportal, including the upcoming release of Clinical Alertsand Clinical Care Reports and the availability of theAdvanced Premium Tax Credit (APTC) indicator.
Clinical Alerts and Clinical CareReports
Starting in mid-April, Clinical Alerts and Clinical CareReports will once again be available to providers fortheir IBC patients. Providers can access both of thesefeatures through links on the Eligibility and BenefitsDetails screen. In the new release, Clinical Alertswill be available to all professional providers (theywere previously limited to primary care physicians,cardiologists, endocrinologists, and OB/GYNs).
Clinical Alerts are clinical practice tools that alertproviders when their patients have not received arecommended service. Clinical Care Reports offerparticipating physicians a snapshot view of care thattheir patients have received based on IBC-paid medicaland prescription drug claims.
APTC indicator
The APTC is part of the Patient Protection andAffordable Care Act, also known as Health CareReform. The APTC helps qualifying individuals andfamilies obtain health insurance by reducing monthlypremiums.
Health Care Reform mandates a three-month(i.e., 90-day) grace period for individual APTCmembers who are delinquent in paying their portionof the premiums. Under the mandate, insurers arerequired to pay medical claims received during thefirst 30 days of the grace period, but they may pendmedical claims for services rendered to those membersand their eligible dependents during the second andthird months of the grace period. If payment is notreceived by the end of the grace period, the pendedclaims will be denied and the member?s policy will beterminated.
Providers can now see a field on the Eligibility andBenefits Details screen called APTC. This fieldindicates that the member is in the grace period, thelength of delinquency, and a status of the member?smedical claim (i.e., whether the claim will pay or pend).
Note: The APTC field will only display when an APTCmember is in a delinquency status.
Resources available
User guides are now available for these features andinclude detailed instructions regarding functionality.We encourage you to review these guides, which arepublished in the NaviNet Transaction Changes sectionof our Business Transformation site.
If you have any questions about NaviNet updates,call the eBusiness Hotline at
215-640-7410.
NaviNet® is a registered trademark of NaviNet, Inc., an independent company.
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