As previously communicated, provider groups must use the NaviNet? web portal in order to initiate the following authorization types:

• medical/surgical procedures
• cardiac rehabilitation*
• chemotherapy/infusion
• 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
• pulmonary rehabilitation*
• sleep studies*

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, go to NaviNet and select Sign up from the top right. If your office is currently NaviNet-enabled but 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 856-638-2701 for providers in New Jersey.

*These services do not require authorization for Pennsylvania and Delaware members and Medicare Advantage HMO members. Authorization is still required for New Jersey commercial members through May 31, 2012.

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.