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NaviNet® Open Registered Users

AmeriHealth provides a variety of resources and information to ensure that you and your staff are comfortable with NaviNet web portal (NaviNet Open).

User Guides

AmeriHealth and NaviNet Open have worked together to create a variety of helpful user guides that provide easy step-by-step instructions for completing tasks and transactions via NaviNet Open.

Visit the NaviNet Open section of our Provider News Center site and download a variety of user guides covering such topics as eligibility and benefits, referral submissions, EOB and remittance inquiries, claim status inquiries, and more.

Training

Participating provider offices can contact AmeriHealth for training. We provide NaviNet Open training over the phone and on-site for larger groups. Provider Network Services Hotline:

  • NJ providers: 609-662-2565
  • PA & DE providers: 215-640-7410

Provider Self-Service Requirements

AmeriHealth-participating providers must use NaviNet Open or the Provider Automated System to obtain certain information. These requirements pertain to participating providers, facilities, Magellan-contracted providers, and billing agencies that support provider organizations.

This document details the self-service requirements for which providers must use NaviNet Open.

Provider Self-Service Requirements

Eligibility and Claims Status

All participating providers and facilities are required to use NaviNet Open (or call the Provider Automated System) to verify member eligibility and check AmeriHealth claims status information. The claim detail provided through either system includes specific information, such as check date, check number, service codes, paid amount, and member responsibility.

Claim Adjustments

Participating providers who call Customer Service to question a claim payment or to request a claim adjustment will be directed to submit the request via NaviNet Open using the Claim Investigation transaction.

Authorizations*

All participating providers and facilities must use NaviNet Open in order to initiate the following authorization types: medical/surgical procedures, chemotherapy/infusion therapy, durable medical equipment, emergency hospital admission notification, home health (dietitian, home health aide, occupational therapy, physical therapy, skilled nursing, social work, speech therapy), home infusion, outpatient speech therapy.

* This information does not apply to providers contracted with Magellan Behavioral Health, Inc. (Magellan). Magellan-contracted providers should contact their Magellan Network Coordinator at 1-800-866-4108 for authorizations.

If you have questions regarding these requirements, please contact our eBusiness Provider Hotline at 215-640-7410 for providers in Pennsylvania and Delaware or at 609-662-2565 for providers in New Jersey.

Not Registered?

Complete an online registration form to register for NaviNet Open.

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NaviNet Open Resources

To help you navigate our secure, online provider portal and various transactions, we have created a central location for a variety of NaviNet Open resources, including user guides, webinars, and a communications archive.

NaviNet Open

NaviNet® is a registered trademark of NantHealth.