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You will begin to see additional changes to the NaviNet web portal.
Reminder: When conducting transactions from AmeriHealth NaviNet
Plan Central, search results will include information
only for members covered under AmeriHealth plans.
New transactions
The following are new transactions that will be introduced:
- EOB and Remittance Inquiry. This new transaction will be
available in December to all participating providers who
are NaviNet-enabled (i.e., no enrollment for the transaction is necessary).
This transaction will provide claims payment
information for AmeriHealth Pennsylvania claims processed on the new operating
platform (i.e., for AmeriHealth
Pennsylvania members who have been migrated to the new platform). The
statements will include A/R detail, when
appropriate. Through this transaction, providers will also be able to download
and/or print remittances.
Note: Providers currently enrolled for the Online Statement of
Remittance (SOR) will continue to have access to
remittance data for claims processed on the current AmeriHealth platform
(i.e., for AmeriHealth New Jersey and
Delaware members and for AmeriHealth Pennsylvania members who have not yet been
migrated to the new platform).
- Network Provider Inquiry/Network Facility Inquiry. These
two new transactions will be available later this month to
help you locate physicians or facilities affiliated with a specific AmeriHealth
network (e.g., HMO/POS).
Changes to existing transactions
Enhancements to the Diagnosis Code Inquiry and Procedure Code Inquiry
transactions will be implemented this month.
These two transactions allow you to search for diagnosis codes or procedure
codes maintained by the National Center
for Health Statistics (NCHS). The search criteria and data display will be
enhanced to better assist you with inquiries.
Note: We previously communicated that the Clear Claim
ConnectionTM transaction would be disabled; however, a decision has
been made to keep this transaction. Therefore, no changes are being made to the
Clear Claim Connection
transaction at this time.
For more information
To help you better understand these changes, we will make available new user
guides that will describe the transactions
in greater detail. We encourage you to review these new guides on our Upcoming System and
Process Changes. Announcements will be made on AmeriHealth NaviNet Plan
Central and
on our Provider News Center once
the new guides are posted.
If you have any questions regarding the NaviNet transactions changes, please
call the eBusiness hotline at
215-640-7410 for providers in Pennsylvania and
Delaware and at 609-662-2565 for providers in New
Jersey.
NaviNet® is a registered
trademark of NaviNet, Inc.