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Primary care physicians (PCP) currently receive two different forms of payment from AmeriHealth:
- electronic funds transfer (EFT) for EFT-enabled providers and for all members who have been migrated to the new operating platform;
- paper checks for non-EFT-enabled providers and for non-migrated AmeriHealth New Jersey commercial members.
As previously communicated, AmeriHealth New Jersey commercial members will be migrated to the new operating platform on September 1, 2015, and October 1, 2015. Therefore, PCP payments for AmeriHealth New Jersey commercial members will switch to EFT as they are migrated.
This article is intended to assist our PCPs in understanding how capitation (CAP) payments are made for migrated and non-migrated members using the NaviNet® web portal. Please note, the process described applies only to provider offices set up to receive EFT payments.
Distribution of your CAP payments
The process flow below outlines how CAP payments are distributed and how to access the payment information through NaviNet.
Accessing CAP rosters and payments through NaviNet
From the AmeriHealth Workflows menu, select ePayment and then PCP CAP Rosters. Be sure to use the online roster to obtain the most up-to-date information.
Next you will see the PCP Cap Rosters screen, which allows you to search by month, provider (office location), or tax ID number. Once the appropriate information is entered, select Search.
The results that appear reflect member-level detail of your CAP payment for all members ? both migrated and non-migrated. The total CAP payment amount is displayed within the Capitation Statement summary.
For more information
A user guide that describes the PCP CAP Rosters transaction in greater detail is available in the NaviNet Resources section of our Provider News Center. If you have any questions regarding NaviNet transactions, call the eBusiness Hotline at 215-640-7410 for providers in Pennsylvania and Delaware and at 609-662-2565 for providers in New Jersey.
NaviNet is a registered trademark of NaviNet, Inc.
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