In April, AmeriHealth introduced a new urgent care benefit designed to provide
members with a lower cost alternative to emergency rooms, when appropriate.
This new benefit allows members to receive services for urgent medical issues
when they cannot access their physician's office but do not require the
advanced medical services of an emergency department.
Note: In order to be recognized as an approved AmeriHealth urgent care
provider, centers must meet specific criteria (including network need) and be
credentialed and contracted as an urgent care provider by AmeriHealth. Only
providers who are specifically contracted and credentialed with AmeriHealth as
an urgent care provider can charge an urgent care copayment.
If you have any questions about the urgent care network, please call
1-800-275-2583.
Member eligibility and cost-sharing
Under the urgent care benefit, cost-sharing for commercial HMO, POS/DPOS, and
PPO members varies based on their benefits plan, but generally will be about 70
percent of their ER copayment, or for coinsurance plans, the equivalent
coinsurance level for ER. The cost-sharing for Medicare Advantage HMO members
is their full specialist copayment for 2012.
We recently enhanced our Eligibility and Benefits Inquiry transaction on the
NaviNet
® web portal to include copayment information for urgent
care services. To view the urgent care copayment for eligible members, select
Eligibility and Benefits Inquiry from the Plan Transactions menu, enter the
search criteria for the member, and click Select next to the appropriate
member. The urgent care copayment (if applicable) will be listed under Copays.
The copayment, as well as any applicable coinsurance, will also appear on the
Additional Copays screen. Please note that not all members are eligible for the
urgent care benefit. As always, continue to check NaviNet for member
eligibility and copayment amounts.
If you have questions about viewing copayment information on NaviNet, please
contact NaviNet Customer Care at
1-888-482-8057 or
our eBusiness Provider Hotline at
215-640-7410.
Providers without access to NaviNet must obtain eligibility and claims status
information through the Provider Automated System by calling
1-800-275-2583 and following the voice prompts.
NaviNet® is a registered trademark of
NaviNet, Inc.