Provider Tools and Services

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

Working with AmeriHealth Caritas Next

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

• Provider manual (PDF)
  This manual will help you and your office staff provide services to our members.
• Provider quick reference guide (PDF)
  Print and use this document to have important plan contact information right at your fingertips.
• Reimbursement policies
  Reimbursement policies ensure providers are aware of guidelines governing claims submission and payment.
• Claims, billing, and payment
  Electronic claims submission and electronic payment options.
• Member 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.
• Online Medical Authorizations
  AmeriHealth Caritas Next has worked with NantHealth | NaviNet to bring you online Medical Authorizations — a robust, intuitive, and streamlined online authorizations workflow.
• Let Us Know program
  Collaborate in engaging our members and managing their health care.
• National Imaging Associates ― Diagnostic Imaging Services
  AmeriHealth Caritas Next contracts with NIA, a subsidiary of Magellan Health, to manage diagnostic imaging services such as MR/CT/PET.
• NaviNet
  NaviNet is an easy-to-use, secure portal that links providers to AmeriHealth Caritas Next at no cost to them.
• Prior authorization lookup tool
  A fast, easy way to find out if a service requires prior authorization.
• Quality Assurance and Performance Improvement (QAPI) program
  AmeriHealth Caritas Next’s Quality Assurance and Performance Improvement (QAPI) program provides a framework for the evaluation of the delivery of health care, behavioral health care, and services provided to members. Learn how to help us with our quality-related efforts.

Member care

• Member rights and responsibilities