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On January 1, 2015, all AmeriHealth New Jersey Medicare Advantage
HMO members will be migrated to the new operating platform. Therefore, if you
render services to these members on or after January 1, 2015, the claim will be
processed on the new platform.
These members received a letter from AmeriHealth New Jersey that highlighted
the changes they would experience post-migration, including new ID cards and a
new, easier-to-read billing statement.
Check member ID cards at every visit
All AmeriHealth New Jersey Medicare Advantage HMO members have been issued a
new member ID card, which includes a new member ID and pharmacy ID number. New
member ID numbers contain 12 digits, called a "unique member ID" (UMI). The
subscriber and any members covered under the subscriber's policy, if
applicable, share the same UMI.
Because all AmeriHealth New Jersey Medicare Advantage HMO members have a new
member ID number, it is imperative that provider offices do the following at
every visit:
- Obtain a copy of the member's current ID card to ensure that you submit the
most up-to-date information to AmeriHealth.
- Verify eligibility and benefits using the NaviNet® web
portal prior to rendering service.
Note: Members with AmeriHealth Medigap, our new Medicare supplement
plan, have a 13-digit ID number, with the last digit being an alpha
character.
Update on the migration of commercial members to the new
platform
Commercial members are also in the process of being migrated to the new
platform:
- AmeriHealth Pennsylvania.
Since January 2014, we have been in the
process of migrating our commercial AmeriHealth Pennsylvania members to the new
platform, generally based on when the customer/member's contract renews. We
anticipate that all AmeriHealth Pennsylvania members will be migrated to the
new platform by March 2015.
- AmeriHealth New Jersey.
All commercial AmeriHealth New Jersey
members will be migrated to the new platform by October 1, 2015. More
information will be provided on when this process will begin.
Resources
We will continue to work closely with you and our entire provider network as
we complete this transition. For more information, visit our System and Process Changes
site. On this site you will find a communication archive as well as
frequently asked questions. If you still have questions after reviewing these
resources, please email
us.
Reminders:
- Once a member has been migrated to the new platform, the Provider Automated
System is no longer available for eligibility inquiries, submitting or
retrieving referrals, submitting encounters, or checking claims status.
Providers should use NaviNet to retrieve this information.
- For members who have been migrated to the new platform, providers will no
longer receive a Statement of Remittance (SOR). Professional providers will
receive a Provider Explanation of Benefits (EOB), and facility providers will
receive a Provider Remittance.
NaviNet® is a registered trademark of
NaviNet, Inc.
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