After submitting an authorization request through the NaviNet web portal, the Pre-Authorization Submission Confirmation Screen will appear. This screen displays the status of the authorization as either ?Certified? or ?Pended,? as shown in the sample screen shot below. For purposes of NaviNet, the term Certified means that the authorization request is approved.

In most cases, authorization requests submitted through NaviNet are authorized immediately; however, in some cases authorization requests may result in a Pended status.

Note: The information on the confirmation screen may vary depending on the service for which you are requesting authorization, but the Transaction Status will always be listed, along with the Transaction Number (i.e., authorization number).

Requests with a Pended status

Authorization requests may result in a Pended status in certain situations, for example when additional clinical information is needed or when requests may result in a duplication of services. A request that has a Pended status can vary in the time it takes for completion.

If the authorization is in a Pended status, it is not yet approved. During this time, providers should not submit any claims or claim inquiry requests that relate to the Pended authorization until it has an approved status of Certified. If claims are submitted prior to the authorization being approved, they may be rejected.

If an urgent request (i.e., procedure or admission for the same or next day) results in a Pended status, please call 1-888-YOUR-AH1 (1-888-968-7241) for AmeriHealth New Jersey or 1-800-275-2583 for AmeriHealth Pennsylvania for assistance.

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