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Update: New NaviNet® Authorizations transaction

June 2, 2017

As we have previously communicated, during the third quarter of 2017, AmeriHealth will transition to a new medical management system for processing requests for authorization. As a result, the Authorizations transaction on the NaviNet web portal will be upgraded. The new transaction will streamline the various authorization submission types (ER Notification, Medical/Surgical, Chemotherapy Infusion, Home Health, DME, and Home Infusion) into one workflow.

Note: We will deploy the new transaction to a subset of providers prior to a full network release. We are currently in the process of notifying this group of providers.

Upcoming changes

Outlined below are some additional changes you will see when using the new Authorizations transaction.

Authorization numbers

The structure of the authorization number may vary depending upon how and where the original authorization request is submitted. The following chart shows the variety of authorization number formats you may see:

Origin of authorizationSample authorization number
NaviNetEXT – 12345
TelephoneCase – 7890
AIM authorization*#12345678
eviCore authorizationA#123456789
New authorization log

A new authorization log will be released when we transition to the new workflow, which will allow providers to search for a list of their submitted authorization requests based on a user-defined date range.

Providers will be able to perform a variety of functions through the new log. More details on the functions will be shared in the coming weeks.

Note: The current legacy authorization log and authorization report for AmeriHealth will be eliminated when we transition to the new Authorizations transaction. We recommend you review the authorization log in advance of the release to ensure all incomplete requests are completed.

New authorization submission types

Requests for coverage for placement in a skilled nursing facility (SNF) and for non-emergency ambulance transportation will be accepted through the new transaction.

SNF requests will be made available to all providers. When the transaction is first released, the placement request function will not include survey questions; however, the questions will be incorporated into the workflow in a future release.

Non-emergency Ambulance Land requests (e.g., A0140, A0426, A0428, A0430, A0434) will be available only to providers credentialed to perform this type of service. Ambulance providers will be prompted to provide responses to the following:

  • The member?s level of mobility.
  • Is the member able to get up from a bed without assistance?
  • Is the member able to walk?
  • Is the member able to sit in a chair or wheelchair?
  • Does the member?s condition permit transport in any other vehicle other than an ambulance?
  • Origin of transportation.
  • Full name of the destination.
  • Why is the ambulance transport required?
  • Is additional ambulance crew required?
Authorization submission timelines

The grid below provides you with the allowable date ranges by service type:

Service typeFuture date maximumRetroactive date maximum
Ambulance Land30 days after current date2 days prior to current date
Chemotherapy183 days after current date2 days prior to current date
Durable Medical Equipment (DME) Purchase/Rental183 days after current date2 days prior to current date
Emergency room/department (ER) Admission2 days after current date365 days prior to current date
Home Health30 days after current date2 days prior to current date
Home Infusion183 days after current date2 days prior to current date
Infusion Therapy183 days after current date2 days prior to current date
Medical Surgical183 days after current date2 days prior to current date
Skilled Nursing Facility (SNF)30 days after current date2 days prior to current date

For more information

We encourage you to view a brief instructional video that previews the new transaction to become more familiar with the upcoming changes. Note: The video does not represent the final product, and we anticipate screen changes as development efforts continue.

It will be important for providers who submit authorization requests to stay current with ongoing announcements related to this system transition to ensure your organization is prepared when the changes are implemented.

Additional information regarding this transition will be communicated through Partners in Health UpdateSM and on AmeriHealth NaviNet Plan Central. If you have any questions, please call our eBusiness Hotline at 609-662-2565 for AmeriHealth New Jersey or at 215-640-7410 for AmeriHealth Pennsylvania.

*Precertification performed by AIM Specialty Health® (AIM).

Precertification review is provided by CareCore National, LLC d/b/a eviCore healthcare (eviCore).

NaviNet is a registered trademark of NaviNet, Inc.


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