Care Gaps
NaviNet care gap alerts
NaviNet provides care gap alerts in addition to eligibility and claims status information. These alerts allow you to find missing recommended services (care gaps) before a member comes in for a visit.
When you check a member's eligibility and benefits, an alert box will appear if the member has a care gap.
You can view and print your patients' care gap reports, which list services your patients are missing. Place the care gap report in the member's chart for services to consider during the visit.
You can also view and print a comprehensive care gap report for your practice. You can choose reports based on a specific measure (e.g., preventive health screening) or all measures. To access this information, choose the Report Inquiry option from the transaction menu and then select Clinical Reports.
Resolve care gaps electronically via a Care Gap Response Form for services provided
This solution will reduce paperwork and enable more frequent status updates of care gaps. You no longer need to print and complete a worksheet and fax it back to us to resolve care gaps. Instead, the new Care Gap Response Form allows you to close care gaps by entering information in the response form.
Use the new Patient Clinical Documents workflow to navigate to the Care Gap Response Form. Here you can enter information on services you have provided.
In conjunction with this upgraded functionality release, faxed submissions of the Care Gap Worksheet will no longer be accepted.
Step-by-step instructions on accessing and completing the response form can be found in the Care Gap Response Form Provider Guide (PDF) as well as by viewing the training video above.
Care gap names have changed to align with HEDIS® measures. Please use this chart (PDF) to cross-reference the updated names to the former names.
If you have any questions or feedback about this NaviNet feature, call AmeriHealth Caritas VIP Care Plus Provider Services at 1-888-667-0318 or NaviNet Customer Support at 1-888-482-8057.
Gaps in care specification documents
The medical and pharmacy specification documents in the links below provide a high-level explanation of each measure's purpose. The member and provider data is used to determine whether the member has a gap in care. At the bottom of each specification document, there is a link to the companion document that details the coding criteria for each measure.
Asthma
Cardiovascular
- ACE Inhibitor/ARB Therapy (CAD) (PDF)
- ACE Inhibitor/ARB Therapy (HF) (PDF)
- Anti-Coagulant Therapy (HF) (PDF)
- Antiplatelet Therapy (CAD) (PDF)
- Beta-Blocker Therapy (CAD) (PDF)
- Beta-Blocker Therapy (HF) (PDF)
- Controlling High Blood Pressure (PDF)
- Controlling High Blood Pressure - Medication Adherence (PDF)
- Event Cholesterol Test (CAD) (PDF)
- LDL-Lowering Drug Therapy (CAD) (PDF)
- Lipid Test (CMC) - for Coronary Artery Disease (CAD) (PDF)
- LVF Assessment (HF) (PDF)
Diabetes
- Diabetes Eye Exam (PDF)
- Diabetes HbA1C Test (PDF)
- Diabetes Lipid Test (PDF)
Preventive Care
- Adults' Access to Care (PDF)
- Anti-Rheumatic Drug Therapy (PDF)
- Breast Cancer Screening (PDF)
- Colorectal Cancer Screening (PDF)
- Glaucoma Screening in Older Adults (GSO) (PDF)
- Hepatitis A Vaccination (PDF)
- Hepatitis B Vaccination (HBV) for adults (PDF)
- Hepatitis C SVR-12 (PDF)
- Osteoporosis Management in Women Who Had a Fracture (OMW) (PDF)
- Pneumococcal Vaccination (PDF)