Why can't I start a new claim investigation?

Health Plans: 

  • AmeriHealth Caritas Delaware,
  • AmeriHealth Caritas District of Columbia (ACDC),
  • AmeriHealth Caritas Louisiana,
  • AmeriHealth Caritas PA Community HealthChoices,
  • AmeriHealth Caritas Pennsylvania,
  • Blue Cross Complete of Michigan,
  • Clover Health,
  • Horizon BCBSNJ,
  • Keystone First,
  • Keystone First Community Health Choices,
  • PerformCare,
  • Select Health of South Carolina,
  • NaviNet Open,
  • AmeriHealth Caritas VIP Care,
  • AmeriHealth Caritas VIP Care Plus,
  • First Choice VIP Care Plus,
  • Keystone First VIP Choice

Workflow: 

  • Claim Investigation

Depending on the health plan and the status of the claim, you may not be able to start a new claim investigation. 

For example, some health plans let you start a claim investigation on finalized claims only. In this case, if you try to start an investigation for a claim in any status other than Finalized, you'll see a message indicating that you cannot start a new investigation.

Contact the health plan directly to inquire about the claim.

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