Care Gaps

NaviNet care gap alerts

• NaviNet Care Gap Timing and Status (PDF)
• NaviNet Provider Guide: Care Gaps Response Form (PDF)

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 screen) or all measures. To access this information, choose the Report Inquiry option from the transaction menu and then select Clinical Reports.

If you have any questions or feedback about this NaviNet feature, call AmeriHealth Caritas VIP Care Provider Services at 1-800-521-6007 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, there is a link to the companion document that details the coding criteria for each measure.

Asthma

• Asthma Medication Adherence (PDF)
• Asthma Medication Management (PDF)

Cardiovascular

• ACEI/ARB Therapy (CAD) (PDF)
• ACEI/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)
• Lipid Test (CDC) - for Diabetes (PDF)

Preventive Care

• Adult 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) (PDF)
• Hepatitis C SCR-12 Gaps in Care (PDF)
• Osteoporosis Management in Women Who Had a Fracture (OMW) (PDF)
• Pneumococcal Vaccination (PDF)