NaviNet
What is NaviNet?
NaviNet is an easy-to-use, secure portal that links providers to AmeriHealth Caritas Next at no cost to them. 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 NaviNet
Log in or register to get started with NaviNet:
NaviNet Medical Authorizations Participant Guide (PDF)
Access member current eligibility and benefit status through NaviNet
Providers are responsible for checking the member’s eligibility status prior to rendering services. Members 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 member eligibility status:
| Member category | Delinquent period | Provider portal delinquent status message |
|---|---|---|
| APTC (advance premium tax credit) | 1st month | Active |
| 2nd to end of 3rd month | Delinquent member — 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 | |
| Non-APTC | Days 1 – 15 | Active |
| After 15 days | Inactive |
If you have questions, call Provider Services at 1-855-266-0219.
Online Medical Authorizations
AmeriHealth Caritas Next has worked with NantHealth | NaviNet to bring you Medical Authorizations — a robust, intuitive, and streamlined online authorizations workflow.
In addition to submitting and inquiring about existing authorizations, you will also be able to:
- Verify if no authorization is required.
- Receive auto-approvals, in some circumstances.
- Submit amended authorization.
- Attach supplemental documentation.
- Sign up for in-app status-change notifications directly from the health plan.
- Access a multi-payer authorization log.
- Submit inpatient concurrent reviews online if you have Health Information Exchange (HIE) capabilities. (Fax is no longer required.)
- Review inpatient admission notifications and provide supporting clinical documentation.
Video tutorials and step-by-step instructions will be available via the NaviNet Plan Central page and the NantHealth Help Center.
AmeriHealth Caritas Next will offer training on the NaviNet Medical Authorizations system. Contact your Provider Network Management Account Executive for available training dates and times.
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.