As a reminder, the Provider File Management transaction on the NaviNet web portal allows professional providers to view and submit specific updates to their AmeriHealth provider record.
Note: The Provider File Management transaction is not intended for use by facilities, skilled nursing facilities, ancillary providers, or providers contracted with Magellan Healthcare, Inc. (Magellan).*
Professional providers can initiate the following updates as it relates to their practice:
- Add/Delete a participating practitioner to/from an existing practice
- Add/Delete an address (i.e., doing business as [DBA], check, mailing, main, or practice)
- Add/Delete contact name, title, or communication device type/number
- Add/Delete office hours
- Update ?Walk-in? acceptance status
- Update Patient and Appointment Options (i.e., accepting new patients)
- Update General Practice Availability (i.e., Urgent, Routine Visits, etc.)
- Update Member Access number (i.e., the telephone number that appears on the member?s identification card ? which must be the location-specific telephone number for a patient to make an appointment)
- Update Electronic Medical Records (EMR) status
- Update the availability of other clinical staff (i.e., midwife, nurse practitioner, etc.)
- Update office accessibility and services (i.e., handicapped, parking, and communication and language services)
Additional tips to help you update your practice information:
- All practice addresses should be located within the same state.
- Providers that participate in a delegated arrangement must be credentialed by AmeriHealth before joining a non-delegated practice.
- It is important that the credentialing status of the practitioner is verified with AmeriHealth prior to adding a physician to a practice. If a practitioner who is not participating with AmeriHealth is added to a practice, consequences including claim denials, inaccurate reimbursement, and immediate removal from the provider directories may be imposed.
- Closed Networks. There are limitations to participation for the Pathology, Podiatry, and Chiropractic Networks.
Important information on updating your provider record
Providers are strongly encouraged to use the Provider File Management to update provider records. If AmeriHealth receives provider record updates that can be submitted using the Provider File Management transaction, a member of our eBusiness team may reach out to that provider to assist them in using the transaction to make the necessary updates. This will allow our team to receive user feedback on the transaction and help improve the overall user experience for our network.
More information
A Provider File Management Guide is available to assist you in navigating this transaction and ensure accurate submissions. The guide is available in the NaviNet Resources section. If you have any further questions on this transaction, please contact the eBusiness Hotline at 609-662-2565 for AmeriHealth New Jersey and at 215-640-7410 for AmeriHealth Pennsylvania.
*Behavioral health providers must submit any changes to their practice information to Magellan via their online Provider Data Change form by selecting the ?Display/Edit Practice Info? link.
NaviNet is a registered trademark of NaviNet, Inc.
Magellan Healthcare, Inc. manages mental health and substance abuse benefits for most AmeriHealth members.