Make it AmeriHealth, for coverage and services that meets your needs.

NaviNet® Provider Portal

AmeriHealth offers network providers a way to simplify health care administration through our NaviNet web portal.

NaviNet gives providers fast, secure, HIPAA-compliant access to provider and member information, and enables real-time transactions. Best of all, NaviNet is free and requires no additional software.

Information at Your Fingertips

  • Eligibility and benefits. Determine a patient’s plan type, their primary care physician (HMO only), capitated sites (when applicable), coverage dates, copayments, etc.
  • Claims data. Retrieve up to two years of historic claims data (including paid, denied, and in-process/pended claims).
  • Clinical alerts. Receive patient-specific preventive care reminders for due, or past due, services (available to PCPs, OB/GYNs, endocrinologists, and cardiologists).
  • Clinical care reports. Get a quick snapshot of the care that patients have received based on AmeriHealth-paid medical and prescription drug claims (available to professional and facility providers only).
  • Authorization status. Review the status of inpatient, outpatient, and concurrent reviews.
  • Referrals. Retrieve electronic referrals (within 365 days of the referral date).
  • Statement of remittance. Don’t wait to receive paper — review your SORs online.
  • Service accumulators. Determine if a member has exhausted a particular benefit during the benefit year.
  • Capitation rosters. Access up-to-date rosters of your assigned HMO members.
  • Code inquiries. Perform code-to-English/English-to-code procedure and diagnosis code inquiries.

Submit Info Quickly Through NaviNet

  • Authorization requests. Submit authorization requests for inpatient and outpatient procedures, home health care, home infusion care, and durable medical equipment. Edit admission dates or service dates for approved authorizations (when appropriate).
    Note: This includes requests for extensions to approved authorizations, the addition of new services to already existing approved authorizations, and new services not associated with existing approved authorizations.
  • Adjustments to claims. Submit adjustments for finalized claims.
  • Electronic payments. Easily submit a one-time application for Electronic Funds Transfer (EFT) for claim payments.
  • Referrals. Submit electronic referrals to AmeriHealth and to NaviNet-enabled specialists and facilities.
    Note: You can use the optional NaviNet auto-fax feature to fax referrals to specialists and facilities — even to those who are not registered with NaviNet.
  • Encounters. Report covered services performed by PCPs that are part of the PCP capitation arrangement with the plan (for use by PCPs only).
  • Practice changes. Submit changes to your practice information, HMO capitated specialists (PCPs only), and additions of newly credentialed or participating providers and/or additions of hospital affiliations.
  • Drug prior authorization requests. Submit prior authorizations.
  • Emergency admissions. Submit notification of emergency admissions (for use by hospitals only).

What are the Requirements for NaviNet Portal Registration?

You must be an AmeriHealth-participating provider.

Technical requirements include:

  • Windows 98 (or more recent) Microsoft operating system;
  • Internet connection (high-speed recommended; minimum 56k dial-up speed);
  • Internet Explorer 8.0 web browser (NaviNet may not work with Firefox, Chrome, Safari and others).

How Can I Get NaviNet for My Office?

Just complete the online registration request form to register.

Contact NaviNet Customer Care at 1-888-482-8057 with questions regarding NaviNet.

Register Today

Complete an online registration form to register for NaviNet.

Register Now

NaviNet Customer Care: 1-888-482-8057.

Existing NaviNet Users

Already signed up?

Visit the Registered Users web page for more information.

NaviNet Transaction Changes

The NaviNet web portal is undergoing a series of changes and enhancements that will affect your day-to-day operations. Beginning September 27, 2013, AmeriHealth providers will begin to see a difference in the look and feel of the provider portal, as well as in transaction functionality.

Given the significant number of changes to be implemented, we urge you to visit the Provider News Center for more information, including updated NaviNet User Guides and an archive of all communications.

NaviNet Transaction Changes

NaviNet® is a registered trademark of NaviNet, Inc.