Provider File Management Guide - AmeriHealth · Introduction to Provider File Management The Provider File Management transaction on the NaviNet ® web portal (NaviNet Open) allows

Provider File Management Guide

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September 2019

AmeriHealth HMO, Inc. | AmeriHealth Insurance Company of New Jersey


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Table of Contents Introduction to Provider File Management ....................................................................... 4

Types of updates .................................................................................................................... 4

Practice-level Provider File Management edits ................................................................... 4

Individual practitioner-level Provider File Management edits ............................................... 4

For PCPs ............................................................................................................................ 5

Helpful tips .......................................................................................................................... 5

Accessing Provider File Management and submitting updates to your provider record ........... 6

Provider File Management home screen ......................................................................... 7

View group details .................................................................................................................. 8

Review submitted changes ..................................................................................................... 8

Review pended changes ........................................................................................................ 8

Locations & Practitioners tab .................................................................................................. 9

Editing existing practice location information ................................................................. 10

Editing location information ....................................................................................................10

Address Characteristics .....................................................................................................11

Contacts ............................................................................................................................12

Office Hours and Appointments .........................................................................................13

Practice availability ............................................................................................................14

Other clinical staff at this location .......................................................................................14

Office Accessibility and Services ........................................................................................15

Communication and Language Services ............................................................................15

Editing practitioner information ...........................................................................................16

Deleting an address or practitioner ........................................................................................21

Deleting an address ...........................................................................................................21

Deleting a Practitioner ........................................................................................................22

Adding a new practitioner, practice address, or updating location and information ....... 23

Adding a practitioner ..............................................................................................................23

Updating location and practice information ............................................................................26

Adding existing practitioner to existing address ..................................................................26

Removing a Practitioner .....................................................................................................27

Edit Practitioner Details ......................................................................................................28

Adding an address ................................................................................................................28

Address Characteristics .....................................................................................................30


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Contacts ............................................................................................................................31

Office Hours and Appointments .........................................................................................31

Practitioners and Other Clinic Staff ....................................................................................34

Office Accessibility and Services ........................................................................................36

Add an Address (non-practice location) .................................................................................38

Learn more .................................................................................................................... 40


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Introduction to Provider File Management The Provider File Management transaction on the NaviNet® web portal (NaviNet Open) allows professional providers to view and submit specific updates to your AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (AmeriHealth) provider record. It is not intended for use by Magellan Healthcare, Inc., facilities, skilled nursing facilities, ancillary, (e.g., urgent care centers, durable medical equipment, ambulance, etc.), or dental (oral surgeon) providers. If you have questions about the Provider File Management transaction, contact our Provider eBusiness team through our online Provider eBusiness Inquiry form for AmeriHealth New Jersey and AmeriHealth Pennsylvania.

Types of updates

Practice-level Provider File Management edits You may perform the following functions as they relate to your practice:

Add/Delete Update

• A participating practitioner to/from an existing practice

• An address* (i.e., doing business as [DBA], check, mailing, main, or practice) ‒ All practice addresses must be within

the same state. • Contact name, title, or communication

device type/number • Office hours

• “Walk-in” acceptance status • Patient and Appointment Options*

(i.e., accepting new patients) • General Practice Availability (i.e., Urgent,

Routine Visits, etc.) • Member Access number (i.e., the

telephone number that appears on the member’s identification card – which must be the location-specific telephone number for a patient to make an appointment)

• Electronic Medical Records (EMR) status • The availability of other clinical staff

(i.e., midwife, nurse practitioner, etc.) • Office accessibility and services

(i.e., handicapped, parking, and communication and language services)

*This function is not available to PCP practices due to possible impacts on capitation and/or incentive programs.

Individual practitioner-level Provider File Management edits You may perform the following functions as they relate to individual practitioner profiles, providing they hold a primary affiliation with your practice:

Add Add/Delete Update

• Additional educational background

• Hospital affiliations

• The address (i.e., main, practice, or check) to which a practitioner is affiliated

• Gender, race, or ethnicity • Practitioner languages • Photos – upload/remove • Patient and Appointment Options

(i.e., accepting new patients)

https://fhnportal.amerihealth.com/providerinquiry/ahnj/dashboard


https://fhnportal.amerihealth.com/providerinquiry/ahpa/dashboard


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For PCPs The following functions are not available to primary care physician (PCP) practices due to possible impacts to capitation and/or incentive programs: • Add/Delete a practice address • Update your Patient and Appointment Options (i.e., accepting new patients) Providers can make these changes by emailing or faxing AmeriHealth: • AmeriHealth New Jersey: Providers can make these changes by contacting their Provider

Partnership Associate through the Provider Partnership Associate Tool. • AmeriHealth providers in Pennsylvania or Delaware: Providers can make these changes

by emailing or faxing AmeriHealth: ‒ Email: [email protected] ‒ Fax: 215-761-9560

If there are any questions regarding your request, you will be contacted within 72 business hours. If you are not contacted, your request will be completed within 30 business days. Change requests submitted via email or fax must include: • contact information:

‒ name ‒ phone number ‒ fax number ‒ email address

• group practice name and individual physician name, as applicable • National Provider Identifier (NPI) and effective date for group practice and individual

physician, as applicable • effective date of change • type of change (e.g., adding office location, telephone/fax, name change only, adding a

physician, removing a physician, changing an office location, tax ID number) • previous practice/physician information • new practice/physician information

If any of these changes result in a change on your W-9, you must submit a copy of your W-9 with your change request.

Helpful tips • All practice addresses should be located within the same state. • Providers that participate in a delegated arrangement must be credentialed by AmeriHealth

before joining a non-delegated practice. • It is important that the credentialing status of the practitioner is verified with AmeriHealth

prior to adding a physician to a practice. If a practitioner who is not participating with AmeriHealth is added to a practice, consequences including claim denials, inaccurate reimbursement, and immediate removal from the provider directories may be imposed.

• You can only modify information for practitioners associated with the location as a primary affiliation.

• Closed Networks. There are limitations to participation for the Pathology, Podiatry, and Chiropractic Networks. For additional information, please review the Closed Networks section of our Professional Provider Credentialing webpages for AmeriHealth New Jersey or AmeriHealth Pennsylvania.

http://www.amerihealthnj.com/html/network_providers/index.html

mailto:[email protected]?subject=Demo%20updates

https://www.amerihealthnj.com/html/providers/tools_resources/index.html?

https://www.amerihealthnj.com/html/providers/tools_resources/index.html?

https://www.amerihealth.com/providers/interactive_tools/credentialing/professional.html


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• As you move throughout the Provider File Management screens, take note of the informational icons that provide additional information that will assist you when making your updates.

• Instructional business rule pop-up windows will guide you through your processes. Please read them carefully.

• There is no Start/Save option. All updates, additions, etc., must be done in one login session.

• As you open multiple addresses/practitioners, you will see a tab for each. To avoid confusion, it would be best to close the tabs as you are done making changes or reviewing them.

• If you have more than one billing provider in the drop-down list and you would like to review a different billing provider, select Change Group to select a different group.

• To quickly view a snapshot of the address/practitioner information, select the next to the address or practitioner to expand.

Accessing Provider File Management and submitting updates to your provider record To submit an update, select the Provider File Management transaction from the AmeriHealth Workflows menu.

If more than one provider practice is associated with your NaviNet Open office, select the provider practice you wish to view or edit from the drop-down menu. Click inside the Billing provider field to make your selection and select Go. If only one provider group is associated with your NaviNet Open office, the system will continue directly to the Provider File Management home screen.


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Provider File Management home screen We ask that you review and verify your group address information contained within your profile. This review will ensure that our records are up to date and that your information is displayed accurately in our hardcopy and online provider directories. Having accurate demographic information in our provider directories helps members identify and access services from participating providers. Failure to verify your information could result in removal from our provider directories. The ribbon at the top of the Provider File Management home screen provides links to: • View group details • Review submitted changes • Review pended changes • HELP (takes you to the NaviNet Open section of the AmeriHealth Provider News Center

where you can access this guide) • Change Group (This only shows if you have multiple groups tied to your NaviNet Open

office.)


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View group details

Under View group details you will find some general information about the selected group: • NPI • (internal) Provider ID • Tax ID • Network participation • Practice locations • Practitioners linked to the practice

Review submitted changes Select Review submitted changes to view and print a copy of the requested provider record changes submitted to AmeriHealth. It also indicates the date and NaviNet Open username of the individual who submitted the requested edits. We recommend you retain a copy for your records, as the report will not be saved after you exit the Provider File Management transaction.

Review pended changes Should your submitted provider record changes pend for review by AmeriHealth, notification will be provided upon submission and can be viewed through the Review pended changes option. A request could pend for one of three reasons: 1. If new educational information is added for a practitioner. 2. A practitioner is deleted and is not affiliated with any other practice. 3. If the last practitioner affiliated with a group is deleted, which could result in termination of

the group. We encourage you to monitor the status of pended requests after submitting provider record additions and modifications through the Provider File Management transaction. Please allow 30 business days for a response to pended requests. If your pended request exceeds the allotted time, contact our Provider eBusiness team through our online Provider eBusiness Inquiry form for AmeriHealth New Jersey and AmeriHealth Pennsylvania.




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Locations & Practitioners tab This tab provides locations and addresses as well as affiliated practitioners related to the provider group selected upon entering Provider File Management. There are several functions you can complete via this tab: • Edit/Delete an address • Edit/Delete a Practitioner • Add a Practitioner • Add an Address • Update Location/Practitioner Information To initiate an update to the address or practitioner of a provider record, you must check the box of the location or practitioner you wish to update, select Edit and then proceed with the necessary changes or Delete as applicable.


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Under the Locations and Addresses section, you can find detailed information related to each address. If you click on the in front of an address, additional details will be displayed.

Under the Practitioners Affiliated with section, you can find detailed information related to each practitioner. If you click on the in front of a practitioner, additional details will be displayed.

Editing existing practice location information The Provider File Management transaction allows you to modify specific updates to your AmeriHealth provider record, including: • locations and addresses • practitioners affiliated To initiate an update to the address or practitioner of a provider record, you must check the box of the location or practitioner you wish to update, select Edit and then proceed with the necessary changes or Delete as applicable.

Editing location information First, select the office location that requires changes by checking the box to the left of the location address. Select Edit if you need to modify any of the location details listed. Please note the following when editing an office’s location information: • The editable address characteristics has been limited to the Suite or Room. If any other

parts of the address have changed, to update it, delete and add the changed information as a new address. If it is the only address for the practice, add the new address information first, then delete the original address.


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• Practice deletions may not be submitted through the Provider File Management transaction for PCP practices. You are requested to contact AmeriHealth when closing a practice location: ‒ AmeriHealth New Jersey: Providers can make these changes by contacting their

Provider Partnership Associate through the Provider Partnership Associate Tool. ‒ AmeriHealth providers in Pennsylvania or Delaware: Providers can make these

changes by emailing or faxing AmeriHealth: o Email: [email protected] o Fax: 215-761-9560

You will notice that the address you are viewing is now on its own tab. As you open multiple addresses, you will see a tab for each. To avoid confusion, it would be best to close the tabs as you are done making changes or reviewing them. From the following screen, select Expand All to edit additional fields.

Address Characteristics To modify Address Characteristics, select the Edit button on the right side of the screen.




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The below screen allows you to modify: • DBA name: This is an optional field and indicates the name an office uses when doing

business in a community. • Suite/Room: This is an optional field. • Address type: This is a required field. An address can be flagged with one or more types

(i.e., check, mailing, main, or practice).

For additional detail regarding the specific fields, select the icon.

Select OK when complete. If a change will affect another address that is currently on file, you will receive a notification giving you a chance to reconsider your request.

Choosing Continue will take you back to the tab for the address being edited.

Contacts To modify location contact information, first identify the contact line by checking the box to the left of the line item. Then select Edit.


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Modify the following information as needed: • Contact Name: First and last name of practice location contact. • Title: Optional field denoting the title of the practice location contact. • Communication Device Type: Select from one of the options provided in the drop-down

menu (i.e., after-hours phone number, cellular phone, etc.). • Communication Device Number: Enter the number associated with the selected

communication device type (The phone number format is: 999-999-9999 [x9999].). You also have the option to delete a communication type or add a new communication type as needed. To delete location contact information, first identify the contact line by checking the box to the left of the line item. Then select Delete.

To add new location contact information, select Add New Row and follow the instructions provided later in this user guide on page 31. More than one contact can be associated with a single location.

Office Hours and Appointments To modify office hours and/or appointment information, select the Edit button for the appropriate section (Office Hours or Appointments) and enter your changes.

You also have the option to delete, copy, and add office hours when selecting the appropriate option.


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Practice availability Select the Edit button to the right of the Practice availability header.

Respond to the below questions concerning general practice availability and select OK when complete.

Other clinical staff at this location If you need to add additional clinical staff such as mid-wife, nurse practitioner, physician assistant, or registered nurse, click Edit and select as applicable.

After making selection(s) select OK to confirm.


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Office Accessibility and Services To update your location conveniences such as handicap access, availability of patient parking, and public transportation, select Edit and edit the fields as necessary.


Communication and Language Services To update any communication services available in your office (e.g., braille materials, large print materials, etc., as well as languages spoken within the office) select Edit and check the boxes as applicable.



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Editing practitioner information Provider File Management allows you to make changes to: • Demographic and Plan Participation • Addresses • Educational Background • Hospital Affiliations First, select the practitioner that requires changes by checking the box to the left of the practitioner name. Select Edit if you need to modify any of the practitioner details listed.

You can only modify information for practitioners associated with the location as a primary affiliation. All recredentialing information is sent to the practitioner’s primary practice affiliation. If your office is not listed as the practitioner’s primary affiliation, but edits are needed, your request must be submitted to AmeriHealth: • AmeriHealth New Jersey: Providers can make these changes by contacting their Provider



For reference the screen indicates the practitioner’s Primary Affiliation status.

You will notice that the practitioner you are viewing is now on its own tab. As you open multiple practitioners, you will see a tab for each. To avoid confusion, it would be best to close the tabs as you are done making changes or reviewing them. From the following screen, select Expand All to edit additional fields.




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Demographics and Plan Participation To make demographic changes to a practitioner related to gender, race, and/or ethnicity, select Edit.

The following screen will be returned for you to make the updates. Upon completion of the changes, select OK.

To make updates to the languages spoken by the selected practitioner, select Edit.


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The following screen will be returned. After completing the necessary updates, select OK.

Educational Background You are permitted to add new educational levels for the selected practitioner by selecting Add New Row. If you need to update existing education information on file, you will need to contact AmeriHealth: • AmeriHealth New Jersey: Providers can make these changes by contacting their Provider



After selecting Add New Row, a new line with blank fields will display:




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1. Type: Indicate the education type by selecting a value from the drop-down menu: a. Additional years b. Chiropractic school c. Dental school d. Fellowship e. Graduate f. Internship g. Medical school h. None i. Not applicable j. Optometry school k. Podiatry school l. Post-doctoral m. Postgraduate n. Preceptorship o. Professional school p. Residency q. Sleep medicine program r. Undergraduate

2. Institution: Select Lookup to search for the name of the institution.

From the following window, use the below options to find the institution:

Then select Search.

3. From: Indicate the education start date using the provided calendar icon. 4. To: Indicate the education end date using the provided calendar icon.


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Hospital Affiliations To add a new hospital affiliation, select Add New Row.

Search for the institution name using the Lookup button. Then indicate the Effective Date.

To terminate a hospital affiliation, first select X to the right of the institution name.

You will be prompted to enter a termination date using the calendar icon. If the practitioner’s affiliation is in a pending status and you wish to terminate the request, the termination date must be equal to the effective date. Select OK when finished.

When making updates to provider records, you must select Submit to finalize your changes with AmeriHealth. If you do not select Submit, the requested updates will not be considered for processing.


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After selecting Submit, you will receive a message that “Your changes have been saved.”

Once your changes are complete, you can select the Review submitted changes link and see the summary of changes submitted.

Deleting an address or practitioner The Provider File Management transaction allows you to delete an address or a practitioner.

Deleting an address To delete an address, from the Locations & Practitioners home screen, check the box of the address that you wish to update, and select Delete:

You will be presented with the following screen allowing you to enter the effective date of the deletion:

The current date will display as the effective date. You can change the effective date to a future date if needed.

If the address is not the main location and all practitioners are affiliated with another address in the group, the address will be terminated. If the location being termed is the only Main/Practice location for the group AND there is only one practitioner in the group, the practitioner will be deleted, and the group account could be terminated. This type of request will pend for review.


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In addition, the deletion of practice locations may not be submitted through the Provider File Management transaction for PCP practices due to the possible impacts to capitation and/or incentive programs. You are requested to contact AmeriHealth: • AmeriHealth New Jersey: Providers can make these changes by contacting their Provider



You must always select Submit at the top or bottom of the screen to finalize your changes with AmeriHealth. If you do not select Submit, the requested updates will not be considered for processing.

Deleting a Practitioner To delete a practitioner, from the Locations & Practitioners home screen, check the box of the practitioner that you wish to update, and select Delete.

The following screen will be returned for you to enter the deletion date of the selected practitioner.

You are only allowed to delete a practitioner with an effective date a maximum of one year retroactively. If this is the only practitioner in the group, the practitioner affiliated with this request will pend for review. Select OK and the practitioner will be deleted.




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If all practitioners under the group are selected for deletion, the following warning message will be returned:

You must always select Submit at the top or bottom of the screen to finalize your changes with AmeriHealth. If you do not select Submit, the requested updates will not be considered for processing.

Adding a new practitioner, practice address, or updating location and information To add a new practitioner, add a new practice location, or update location/practice information, select the appropriate option to the right in the Locations & Practitioners header.

Adding a practitioner

After selecting Add a Practitioner, to add a new practitioner to an existing location, select the Yes option as shown below and then Continue Adding Practitioners.

STOP: If adding a new practitioner and a new location address to a vendor record, you must add the location first. (Refer to page 33 to add address)


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If both the practitioner and the address are new, select the No option and click on Cancel as shown below.

When adding a new practitioner, you will need to submit the request in a single session. Additionally, the new practitioner must have been previously credentialed.

It is important that the credentialing status of the practitioner is verified with AmeriHealth prior to adding a physician to a practice. You can access our online Find a Doctor tools for AmeriHealth New Jersey or AmeriHealth Pennsylvania to confirm the practitioners participation status. If a practitioner is added to a practice and they are not participating with AmeriHealth, this could result in claim denials, inaccurate reimbursement, and immediate removal of the provider from the provider directories. Note: The added practitioner must hold the same specialty as the practice to which he or she is being added. To begin, you will first need to search for your practitioner using one of the following: • NPI • Individual (internal) Provider ID • State Medical License Number (alpha and numeric characters are required)

Once complete, select Search.

If the practitioner is found, it will display the practitioner with the current date as the effective date. You can change this date to a past or future date if needed within one year in either direction.

http://www.amerihealthnj.com/providerfinder

http://www.amerihealthnj.com/providerfinder

http://www.amerihealth.com/providerfinder


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After locating the appropriate practitioner, select Add.

Once you make the selection to add the practitioner to the applicable location(s), you will need to verify whether the practitioner regularly accepts appointments at that location, at least one day per week.

Next, you will be prompted to select the network and specialty roles for the practitioner in the Plans and Specialties section. Once complete, select Submit.


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Note: Once you have completed adding a practitioner and only the “AmeriHealth Processing Network” appears, please contact: • AmeriHealth New Jersey: Providers can contact their Provider Partnership Associate

through the Provider Partnership Associate Tool. • AmeriHealth providers in Pennsylvania or Delaware: Providers can contact Provider

Network Services at [email protected].

Updating location and practice information

Adding existing practitioner to existing address If the practitioner is already affiliated with an existing address and you are looking to add him to a different address under the practice, you would select the Update Location/Practitioner Information option.

Select the location where you want the practitioner to be affiliated, and then select OK.

Select Add Non-Affiliated Practitioner.


mailto:[email protected]


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You will then be prompted to add Non-Affiliated Practitioners and confirm whether they E-Prescribe and are Accepting Appointments at the selected location as follows:

When you have completed the updates related to E-Prescribe and/or Accepting Appointments, select OK.

Removing a Practitioner Select the location where the practitioner is currently affiliated, then OK. Select the applicable practitioner and Remove.

You will be prompted to save changes. Select the Accepts Appointments box to attest the changes, and then select OK. If you are removing all the affiliated practitioners from a location, you will be presented with a warning, if you would like to submit the changes, select OK.


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Edit Practitioner Details You can only update E-Prescribe and Accepting Appointments via this selection. Any additional edits required for the individual practitioner refer to page 16. Select the appropriate practitioner, and then select Edit Practitioner Details.

Select whether or not the practitioner can E-Prescribe or is accepting new appointments, and then select Submit.

Adding an address To add an address, select the Add an Address option to the right of the Locations & Practitioners header. The addition of PCP-practice locations may not be submitted through the Provider File Management transaction due to the possible impacts to capitation and/or incentive programs. You are requested to contact AmeriHealth: • AmeriHealth New Jersey: Providers can make these changes by contacting their Provider







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If the address to be added is a practice location, select the second option, Yes, this address will be affiliated with one or more existing practitioners, and then select the Continue Adding Address button.

You will need to complete the following sections as applicable when adding an address: • Address Characteristics • Contacts • Office Hours and Appointments • Practitioners and Other Clinic Staff • Office Accessibility and Services Select Expand All to view section details for completion.


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Address Characteristics Complete the following fields (those designated by an asterisk are required):

• Address effective: The date the new location was opened. • Street: The street address location. • Building/location: An optional building name or building location/floor. • Suite/room: An optional suite or room number. • City: The city of the practice location. • State: The state of the practice location. • ZIP: The ZIP code of the practice location. • Doing business as: An optional field indicating the name a group uses when doing

business in a community. • Address type: One or more address types can be associated with a location (e.g., Practice

and Check). - Check: The address where remittance and its supporting documentation is sent. - Main: The primary physical practice location. - Mailing: The address where administrative documentation is sent. - Practice: The physical location where patients are seen for services. Must be selected

to affiliate practitioners to the location. Note: If you select Check, Main, and/or Mailing for the location you are adding another location as that address type designation, the following pop-up warning will be returned advising that this type of location already exists.


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Contacts Contacts are only applicable for practice locations and the main location. You are required to list a phone number that can be listed as the Member Access number (a phone number to be published in the Provider Directory). • Contact Name: The first and last name of practice location contact. Note: More than one

contact can be associated with a single location. Select Add New Row to enter multiple contacts (see an example on the next page).

• Title: An optional field denoting the title of the practice location contact. • Communication Device Type: Select from one of the options provided in the

drop-down menu (e.g., After Hours Phone Number, Cellular Phone, etc.). • Communication Device Number: Enter the number associated with the selected

communication device type (The phone number format is: 999-999-9999 [x9999].). • Member Access Number: Indicate (Y or N) if this is a phone number used by members to

make an appointment.

Office Hours and Appointments As a participating provider in the AmeriHealth network, you are required to meet our access and availability standards, which are based on applicable federal and state regulations and accreditation standards. This would include office hours, appointment availability, etc. Use this section to make edits to this information as needed. Note: Detailed requirements are in the Quality Management section of the Provider Manual for Participating Professional Providers. Office hours are required for practice locations. The Start and Stop times should be entered in the following format: hh:mm. Please review the following fields and edit as needed: • Day: Select the appropriate day of the week from the drop-down menu. • Start Time: Enter the location start time in the appropriate format and indicate AM or PM. • Stop Time: Enter the location stop time in the appropriate format and indicate AM or PM. • Frequency: Enter Bi-weekly (every other), monthly, none, or weekly.


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Another option to add Office Hours is to select Copy From Loc if there is another address already listed with the same hours as the new address.

Just select the appropriate office and select Copy.

To indicate walk-in appointment availability, select Edit to the right of the Appointments header.


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From the following window, edit Walk-in appointment information as necessary, and then select OK when complete. Any other patient and appointment options must be requested by contacting AmeriHealth: • AmeriHealth New Jersey: Providers can make these changes by contacting their Provider



To edit practice availability, select the Edit button to the right of the Practice availability header.

Respond to the below questions concerning general practice availability and select OK when complete.




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Practitioners and Other Clinic Staff You have the option to associate practitioner(s) with the office location in one of two ways: 1. Practitioners who work at this location and E-prescribe status, OR; 2. Select a location to copy practitioners from.

If attempting to associate practitioners using both options in the same session, copying from a location will take precedence and only practitioners from the selected location will be affiliated with the new location/address. Select practitioners After clicking Select to add Practitioners who work at this location and confirming their E-prescribe status, make your selection from the list of practitioners that is returned and select OK.


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The selected practitioners will now be updated on the main screen.

Select a location By choosing the Select a location button, you will be able to choose a location to copy practitioners from. All practitioners associated with the selected location will be copied to your new location. Select the appropriate location and then OK.

The copied location will now display on the updated screen:

To indicate if this practice location supports other clinical staff and/or electronic medical records, select Edit.


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On the screen returned, check the appropriate boxes under Other Clinical Staff and E-Records for New Address. Select OK when complete.

Office Accessibility and Services You can make the following edits from this screen: • location accessibility and services • communication and language services Location accessibility and services To edit Location accessibility and services, select Edit to answer questions related to location conveniences available at the new office location.

Check the appropriate radio buttons under Edit Location Conveniences for New Address. Select OK when complete.


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Communication and language services Select Edit to answer questions related to available communication services and languages spoken at the new office location.

Check the appropriate boxes under Edit Communication and Language Services for New Address. Select OK when complete.

After entering all required information, select Submit.

If your changes can be processed, you will receive a message that “Your changes have been saved.”


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Add an Address (non-practice location) To add a non-practice location address, select the Add an Address option to the right of the Locations & Practitioners header.

If the address to be added is not a practice location (e.g., check address), select the first option, This address is not for a practice location, and then select the Continue Adding Address button.

Then, select Expand All.


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Complete the sections under Address Characteristics and Contacts. Required fields are marked with an asterisk (*). Then select Submit.

1. Address Characteristics Complete the following fields (some are required): • Address effective: The date the new location was opened. The Effective date will

default to current date. You can change the effective date to a future date if needed. • Street: The street address location. • Building/location: An optional building name, building location, or floor. • Suite/room: An optional suite or room number. • City: The city of the practice location. • State: The state of the practice location. • ZIP: The ZIP code of the practice location. • Doing business as: An optional field indicating the name a group uses when doing

business in a community. • Address type: One or more address types can be associated with a location:

- Check: The address where remittance and its supporting documentation is sent. - Mailing: The address where administrative documentation is sent.


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2. Contacts Contacts are only applicable for practice locations and the main location. You are required to list a phone number that can be listed as the Member Access number (a phone number to be published in the Provider Directory). • Contact Name: The first and last name of practice location contact. Note: More than

one contact can be associated with a single location. Select Add New Row to enter multiple contacts (see an example on the next page).

• Title: An optional field denoting the title of the practice location contact. • Communication Device Type: Select from one of the options provided in the

drop-down menu (e.g., After Hours Phone Number, Cellular Phone, etc.). • Communication Device Number: Enter the number associated with the selected

communication device type (The phone number format is: 999-999-9999 [x9999].). • Member Access Number: Indicate (Y or N) if this is a phone number used by members

to make an appointment.

3. Submit After entering all required information, select Submit.

Learn more If you have questions about the Provider File Management transaction, contact our Provider eBusiness team through our online Provider eBusiness Inquiry form for AmeriHealth New Jersey and AmeriHealth Pennsylvania. NaviNet® is a registered trademark of NantHealth.

Magellan Healthcare, Inc. manages mental health and substance abuse benefits for most AmeriHealth members.




Documents

Provider File Management Guide - AmeriHealth · Introduction to Provider File Management The Provider File Management transaction on the NaviNet ® web portal (NaviNet Open) allows