Provider Tools and Services

Our user-friendly tools and resources are designed to support AmeriHealth Caritas Next’s providers and its staff in giving our enrollees excellent and efficient health care.

Working With AmeriHealth Caritas Next

We offer the following resources to assist you and your staff.

  • Provider and billing manual (PDF)
    This manual will help you and your office staff provide services to our enrollees.
  • Provider quick reference guide (PDF)
    Print and use this document to have important plan contact information right at your fingertips.
  • Claims and billing
    Electronic claims submission and electronic payment options.
  • Enrollee benefits
    This section includes information on the 10 essential benefits, metal-level benefits, and summaries of coverage.
  • Fraud, waste, and abuse
    Learn how you can help report fraud, waste, and abuse.
  • Jiva
    Use Jiva, a tool that offers prior authorization and admission-related functions through NaviNet.
  • Let Us Know Program
    Collaborate in engaging our enrollees and managing their health care.
  • National Imaging Associates ― Diagnostic Imaging Services
    AmeriHealth Caritas Next contracts with National Imaging Associates, Inc. (NIA), a subsidiary of Magellan Health, to manage diagnostic imaging services such as MR/CT/PET.
  • NaviNet
    Navinet is an easy-to-use, no-cost to providers, secure portal that links providers to AmeriHealth Caritas Next.
  • Prior authorizations and look-up tool
    A fast, easy way to find out if a service requires prior authorization.

Enrollee care