New Claim Status Workflow

Health Plans: 

  • AmeriHealth Caritas VIP Care

Workflow: 

  • Claim Status

AmeriHealth Caritas VIP Care has transitioned its Claim Status Inquiry transaction to the new NaviNet Open Claim Status workflow. You will enjoy the same comprehensive claims information you've come to expect, but in a more streamlined, easier-to-use workflow.

The new Claim Status workflow includes:

  • A simple-to-use Claim Search screen that includes a Billing Entity box that searches as you type.
  • A simplified patient data entry section.
  • New calendar widgets for easier date entry.
  • A Claim Status Details screen that provides the same information in a format that is easy to read and digest at a glance.

Accessing the Claim Status Workflow

You can access the new Claim Status workflow as you always have, under Workflows for This Plan on the Plan Central screen.

Claim Search Screen

The screenshot below highlights the features of the new Claim Search screen.

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Claim Status Search Results Screen

If more than one claim matches the search criteria, the Claim Status Search Results screen appears. The Status column is color coded and uses icons to let you take in the status of each claim at a glance.

Click a Claim ID to go to the Claim Status Details screen for that claim.

If you do not see your claim in the search results, click Back to Claim Status Search to change your search criteria.

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Claim Status Details Screen

The Claim Status Details screen shows the status of the claim on the color-coded claim status bar. You'll see a summary of the claim, including the total amount billed and paid, at the top of the screen and service line details at the bottom of the screen. Use the Print link to print the contents of the screen.

Click Additional Payment Details for more information on each service line.

If electronic remittance advice is available for this claim, click View ERA to display this information.

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Additional Payment Details

Clicking Additional Payment Details on the Claim Status Details screen displays more detailed information on each service line in the claim, including the patient responsibility for each line item.

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