As previously communicated, providers
must use the NaviNet? web portal in order to
initiate the following authorization types:
- medical/surgical procedures
- chemotherapy/infusion therapy
- durable medical equipment
- emergency hospital admission
notification
- home health (dietitian, home health aide,
occupational therapy, physical therapy, skilled nursing, social work, speech
therapy)
- home infusion
- outpatient speech therapy
Please note that the representatives at
the Health Resource Center are no longer able to initiate the authorizations
listed above.
Tips for submitting
authorizations
NaviNet submissions that result in a
pended status can take up to two business days to be completed. These may
include requests for additional clinical information as well as requests that
may result in a duplication of services. If the authorization remains pended
beyond two business days, or if the authorization request is urgent, providers
should call 1-800-275-2583 for assistance.
Requests for medical/surgical
procedures can be made up to six months in advance on NaviNet, and in most
cases, requests for medically necessary care are authorized immediately.
In some instances, providers can modify
the date of service previously approved by selecting Authorizations from
the Plan Transactions menu, and then Authorization Status Inquiry.
About NaviNet
For your convenience, NaviNet is
available to all participating providers Monday through Saturday, 5 a.m. to 10
p.m., and Sunday, 9 a.m. to 9 p.m. If your office location has not yet
registered for NaviNet, you must do so by April 1, 2013. To register, please
visit NaviNet and select Sign Up
from the top right. If your office is currently NaviNet-enabled and would like
training on how to submit authorizations, please call the eBusiness Provider
Hotline at 215-640-7410 for providers in
Pennsylvania and Delaware or at 609-662-2565 for
providers in New Jersey.
Note: This information does not apply to
providers contracted with Magellan Behavioral Health, Inc. Magellan-contracted
providers should contact their Magellan Network Coordinator at 1-800-866-4108 for authorizations.
Magellan Behavioral Health, Inc. manages mental
health and substance abuse benefits for most AmeriHealth members.
NaviNet® is a registered trademark
of NaviNet, Inc.