This month updates will be made to the NaviNetweb portal, including the upcoming release ofClinical Alerts, Clinical Care Reports, and theAdvanced Premium Tax Credit (APTC) indicator..

Clinical Alerts and Clinical CareReports

Starting in mid-April, Clinical Alerts and Clinical CareReports will once again be available to providers fortheir AmeriHealth patients. Providers can access bothof these features through links on the Eligibility andBenefits Details screen. In the new release, ClinicalAlerts will be available to all provider specialties (theywere previously limited to primary care physicians,cardiologists, endocrinologists, and OB/GYNs).

Clinical Alerts are clinical practice tools that alertproviders when their patients have not received arecommended service. Clinical Care Reports offerparticipating physicians a snapshot view of care thattheir patients have received based on AmeriHealth-paidmedical and prescription drug claims.

APTC indicator

The APTC is part of the Patient Protection andAffordable Care Act, also known as Health CareReform. The APTC helps qualifying individuals andfamilies obtain health insurance by reducing monthlypremiums.

Health Care Reform mandates a three-month(i.e., 90-day) grace period for individual APTCmembers who are delinquent in paying their portionof the premiums. Under the mandate, insurers arerequired to pay medical claims received during thefirst 30 days of the grace period, but they may pendmedical claims for services rendered to those membersand their eligible dependents during the second andthird months of the grace period. If payment is notreceived by the end of the grace period, the pendedclaims will be denied and the member?s policy will beterminated.

Starting in mid-April, providers will see a field on theEligibility and Benefits Details screen called APTC.This field indicates that the member is in the graceperiod, the length of delinquency, and a status of themember?s medical claim (i.e., whether the claim willpay or pend).

Note: The APTC field will only display when an APTCmember is in a delinquency status.

Resources available

User guides are now available for these features andinclude detailed instructions regarding functionality.We encourage you to review these guides, which arepublished in the NaviNet Transaction Changes sectionof our System and Process Changes site.

If you have any questions about NaviNet updates, callthe eBusiness Hotline at 215-640-7410 for providers inPennsylvania and Delaware and at 609-662-2565 forproviders in New Jersey.

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