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Amerihealth caritas next provider portal


NaviNet

What is NaviNet?

NaviNet is an easy-to-use, free, web-based platform that links providers to AmeriHealth Caritas Delaware. Through NaviNet, you can access and submit:

  • Real-time clinical Healthcare Effectiveness Data and Information Set (HEDIS) alerts.
  • Eligibility information.
  • Claims information and updates.
  • Benefits information.
  • Drug authorizations.

NaviNet helps speed up the provider-health plan connection and can often replace paper transactions. If you're not a NaviNet user, learn more about NaviNet.

Using NaviNet

The following resources will help you use or get started with NaviNet:

Jiva

AmeriHealth Caritas Delaware offers our providers access to the Jiva Provider Portal for electronic submission of requests for services, prior authorization and case management activities. The Jiva Provider Portal is accessed through NaviNet using single sign on functionality. Once in NaviNet, our providers may select the Pre-Authorization Management link, and this will launch the Jiva Provider Portal.

amerihealth caritas next provider portal

Provider Tools and Services

Our user-friendly tools and resources are designed to support AmeriHealth Caritas Next's providers and staff in giving our members excellent and efficient health care.

Working with AmeriHealth Caritas Next

We offer the monitoring resources to assist you and your staff:

  • Provider manual (PDF)
    This manual will help you and your office staff provide services to our members.
  • Provider reference manual (PDF)
    Print and use this document to have important arrange contact information right at your fingertips.
  • Reimbursement policies
    Reimbursement policies secure providers are aware of guidelines governing claims submission and payment.
  • Claims, billing, and payment
    Electronic claims submission and electronic payment options.
  • Member benefits
    This section includes information on the 10 essential benefits, metal-level benefits, and summaries of coverage.
  • Fraud, waste, and abuse
    Learn how you can help report fraud, waste, and abuse.
  • Online Medical Authorizations
    AmeriHealth Caritas Next has worked with NantHealth | NaviNet to bring you Medical Authorizations — a robust, intuitive, and streamlined online authorizations workflow.
  • Let Us Realize

    NaviNet

    What is NaviNet?

    NaviNet is an easy-to-use, no-cost, web-based platform that links providers to AmeriHealth Caritas Ohio. Through NaviNet, you can access and submit:

    • Real-time clinical Healthcare Effectiveness Data and Information Set (HEDIS) alerts

    • Eligibility information
    • Claims information and updates
    • Benefits information
    • Drug authorizations
    • Prior authorizations

    NaviNet helps speed up the provider-health plan connection and can often replace paper transactions. If you're not a NaviNet user, learn more about how to sign up for NaviNet. 

    Register for NaviNet

    NaviNet provides a quick and streamlined registration process using our digital documentation system for automated identity and business verification. When registering for NaviNet, please have the following information ready to be entered into the online registration form:

    • Office name
    • Address
    • Phone number
    • TIN

    You will also be asked to attach one of the following documents for verification:

    • Certificate of Good Standing
    • Sole Proprietor SS-4
    • IRS 147C Letter

    AmeriHealth Caritas Florida’s contract with the Florida Statewide Medicaid Managed Care program ended on January 31, 2025.

    AmeriHealth Caritas Florida is working together with the Agency for Health Care Administration (AHCA) to provide a smooth transition for our providers.

    AHCA has information on the SMMC program available online at: https://ahca.myflorida.com/medicaid/statewide-medicaid-managed-care. This website provides information about the SMMC program; the plans that are available by region; and information on provider training, upcoming webinars, and plan provider relations contacts.

    Please submit ALL claims as soon as possible. More information and Transition FAQs

    AmeriHealth Caritas Florida has restored connectivity with Optum/Change Healthcare. The restoration of connectivity with Optum/Change Healthcare affords our providers options for claims submissions. 

    Electronic claims

    AmeriHealth Caritas Florida providers will have the option of submitting electronic claims via:

    • Optum/Change Healthcare – Providers with a software vendor or who use another clearinghouse to submit claims to Optum/Change Healthcare must consult their vendor/clearinghouse to confirm

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      Help

      For email support for technical issues, report a problem with the AmeriHealth member site.

      For AmeriHealth PA members, please refer to the customer service telephone number on the back of your identification card. If this number is unavailable, contact Customer Service Monday through Friday from 8 a.m. to 6 p.m. at 1-866-681-7373.

      For AmeriHealth NJ members, please refer to the customer service telephone number on the back of your identification card. If this number is unavailable, contact Customer Service Monday through Friday from 8 a.m. to 6 p.m. at 1-888-YOUR-AH1.

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      AmeriHealth Member Site Overview

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      Welcome, everyone.

      Whether you're a member, employer, provider, or broker, you can easily access the resources and information you need through our online portals.

      Members

      Log in to find a doctor, view and print your ID card, verify coverage, and learn more about your health plan.

      Log in

      New to AmeriHealth? Register.

      Employers

      Manage your group's account safely and conveniently through our secure online portal.

      Learn more

      Providers

      The PEAR portal offers access to multiple digital tools, helping participating providers*