Providers who call Customer Service to question claim payments or to request a claim adjustment will now be directed to submit the request via the NaviNet web portal. This requirement includes those contracted with Magellan Behavioral Health, Inc. for PPO business. NaviNet offers the Claim INFO Adjustment transactions to ensure that your claim adjustment requests are addressed in the most efficient manner available.

Using the Claim INFO Adjustment Submission transaction

The Claim INFO Adjustment Submission transaction allows ancillary, facility, and professional providers to submit adjustment requests or question claim payments for paid or denied claims for a period of up to 18 months after adjudication of the original claim or as required by applicable law. Each submission is assigned a unique adjustment identification (ID) number.

To access the Claim INFO Adjustment Submission transaction, select Claim Inquiry and Maintenance from the Plan Transactions menu. You can access the AmeriHealth response within ten business days through the Claim INFO Adjustment Inquiry transaction. If you do not receive a response within ten business days of the submission, please call Customer Service and have your adjustment ID number available.

Detailed user guides for both of these transactions are available on our Plan Central page under Administrative Tools & Resources.

Note: Your office location was required to register for NaviNet by April 1, 2013. If you have not yet done so, visit NaviNet and select Sign Up from the top right. If your office is currently NaviNet-enabled but would like training on how to submit a claim adjustment or retrieve a response to a submitted request through NaviNet, please contact our eBusiness Provider Hotline at 215-640-7410 for providers in Pennsylvania and Delaware or at 609-662-2565 for providers in New Jersey.

Magellan Behavioral Health, Inc. manages mental health and substance abuse benefits for most AmeriHealth members.

NaviNet^® is a registered trademark of NaviNet, Inc.