In October 2017, we introduced additional links to benefit categories to help direct providers to specific member information more easily while using the Eligibility and Benefits transaction on the NaviNet web portal.

We encourage providers to utilize the Health Plan Provisions (AmeriHealth NJ Regional Preferred HMO Provisions, in this example) and Additional Benefit Provisions links for more detailed member benefit information. These links can be found on the right-hand side of the Eligibility and Benefits Details screen.

Health Plan Provisions

Select the Health Plan Provisions link to see a general overview of the member?s coverage as well as group-specific information. Below is an example of some of the information provided, which includes In-Network and Out-of-Network deductible information.

Additional Benefit Provisions

Select the Additional Benefit Provisions link to see additional benefit categories with provisions specific to that benefit category. Below is an example of the additional benefit provisions.

For further instructions on using this transaction, please see the Eligibility and Benefits Inquiry Guide, which can be found in the NaviNet Resources section. If you have additional questions after reading the guide, please call our eBusiness Hotline at 609-662-2565 for AmeriHealth New Jersey or at 215-640-7410 for AmeriHealth Pennsylvania.

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