What is NaviNet?
NaviNet is an easy-to-use, no-cost to providers, secure portal that links providers to the AmeriHealth Caritas Next website.
Log in or register to get started with NaviNet:
NaviNet offers web-based solutions that allow providers and health plans to share critical administrative, financial, and clinical data in one place. This tool can help you manage patient care with quick access to:
- Member eligibility and benefits information.
- Panel roster reports.
- Care gap reports to identify needed services.
- Member clinical summaries.
- Social determinants of health information.
- Admission and discharge reports.
- Medical and pharmacy claims data.
- Electronic submission of prior authorization requests.
Access enrollee current eligibility and benefit status through NaviNet
Providers are responsible for checking the enrollee’s eligibility status prior to rendering services. Enrollees in good standing can be confirmed in the eligibility and benefits section of NaviNet, which can be accessed in the left-hand navigation of the NaviNet Plan Central page.
Below are the provider portal delinquent status messages that will be displayed based on AmeriHealth Caritas Next enrollee eligibility status:
|Member Category||Delinquent Period||Provider Portal Delinquent Status Message|
|Non APTC||Days 1 – 15||Active|
|After 15 days||Inactive|
|2nd to end of 3rd month||Delinquent enrollee — All Claims will be pended until outstanding premium payment is received. Claims will be rejected if payment is not received by the end of the grace period.|
|After 3rd month||Inactive|
If you have questions, call Provider Services at 1-855-266-0219.
Learn how to navigate NaviNet
NaviNet helps speed up the provider-health plan connection and can often replace paper transactions. If you're not a NaviNet user, learn more about NaviNet.