The Clinical Care Report was introduced in 2011 to promote better coordination of health care for our members and physicians. Unless a member has opted out, this tool is accessible through the NaviNet® web portal and offers participating physicians a snapshot view of care that their patients have received based on AmeriHealth-paid medical and prescription drug claims.

The Clinical Care Report is intended for viewing by the following participating health care providers:

• a member's personal or primary care physician;
• a new physician with whom a member has an upcoming scheduled appointment;
• a physician who is addressing a current emergency medical need.

Information available in the Clinical Care Report

The information populated in the Clinical Care Report is derived from member claims data and includes the following information:

• disease conditions reported in the past two years;
• visits to the emergency room in the past year;
• hospital admissions in the past four years;
• outpatient procedures in the past two years;
• specialists seen in the past two years;
• prescriptions filled in the past six months;
• alerts by condition (i.e., gaps in care), if any;
• lab tests with results (when available);
• diagnostic imaging in the past two years;
• immunizations in the past four years.

Note: The Clinical Care Report is not a complete medical record of all services, tests, or products that a member may have received. It does not include data for sensitive health conditions such as mental/behavioral health, substance abuse, HIV/AIDS, sexually transmitted diseases, genetic testing, or for services for which AmeriHealth did not pay a claim.

How to grant or remove access to the Clinical Care Report

Initially, only the designated Security Officer(s) in each provider office has access to the Clinical Care Report, and he or she can control user access through the User Management transaction on NaviNet.

Therefore, in order for providers to access the Clinical Care Report, a designated Security Officer first must enable individual users or all users.

Granting access to all users within an office

To update the settings to allow all users within an office access to the Clinical Care Report, the designated Security Officer must first select NaviNet Administration from the NaviNet Central menu.

Select Office Management from the drop-down menu on the left, and then select Office Transaction Management.

Scroll down the Transaction Management for Office screen until you find the transaction called Eligibility & Benefits – Clinical Care Report in the Name column. Click Enable to turn on access to all individuals in your office.

To turn off access for all users in your office, follow the same steps and click Disable instead.

Granting access to only select individuals within an office

The designated Security Officer can also limit access to the Clinical Care Report to certain individuals within a provider office. To do so, first select NaviNet Administration from the NaviNet Central menu.

Select User Management from the drop-down menu on the left, and then select User Transaction Management.

The designated Security Officer must search for the appropriate user by entering a last and first name and then clicking Search. Select the appropriate user from the list that populates, and then select Edit Access to view the list of transactions.

Scroll down the Transaction Management for User screen until you find the transaction called Eligibility & Benefits – Clinical Care Report in the Name column. Click Enable to turn on access to the individual.

To turn off access for certain individuals in your office, follow the same steps and click Disable instead.

How enabled users can view a member's Clinical Care Report

Once enabled, physicians can view the Clinical Care Report by selecting the Eligibility and Benefits Inquiry option from the Plan Transactions menu.

To determine if a member has a Clinical Care Report, the user should enter the member's information (either the member ID number or last name, first name, and date of birth) and select the Search button.

If the member has not opted out of the tool, there will be a flag in the column labeled "CCR". The blue flag in that column indicates that the member's Clinical Care Report is available for you to view once you have agreed to abide by the terms and conditions. Click the blue flag to view the report.

We hope you'll find this tool valuable as you care for your patients, our members. If you have questions regarding this tool, please call the eBusiness Provider Hotline at 215-640-7410 for providers in Pennsylvania or Delaware or at 856-638-2701 for providers in New Jersey.

If you are not yet NaviNet-enabled at your office location, register by going to the NaviNet website and selecting Sign up from the top right.

NaviNet® is a registered trademark of NaviNet, Inc.