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Updates made to the NaviNet Chemotherapy/Infusion and Home Infusion Authorizations Guide

October 3, 2011

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In January 2011, AmeriHealth published the NaviNet Chemotherapy/Infusion and Home Infusion Authorizations Guide, an online resource to educate providers and their office staff about obtaining authorizations for certain chemotherapy and home infusion therapies.

This guide included the clinical question sets that providers must answer when requesting precertification for the following drugs:

  • bevacizumab (Avastin?)*
  • cetuximab (Erbitux?)
  • infliximab (Remicade?)
  • intravenous immune globulin (IVIG)
  • oxaliplatin (Eloxatin?)
  • rituximab (Rituxan?)
  • trastuzumab (Herceptin?)
  • As of September 2011, these clinical question sets will no longer be included in the user guide. However, they will continue to be available online as an attachment within the medical policy for each drug, making the medical policy a comprehensive resource for all medical necessity criteria, dosing and frequency requirements, coding guidelines, and clinical question sets.

    To view medical policies through the NaviNet web portal, select Reference Materials and Reports from the Plan Transactions menu and then Medical Policy. Then type the drug name into the Search box on the Medical Policy homepage. You can also go to www.amerihealth.com/medpolicy and type the drug name into the Search box.

    The revised guide is still available in the Administrative Tools & Resources section of NaviNet Plan Central.

    If your office has any questions or requires training for NaviNet, please call the eBusiness Help Desk at 215-241-2305.

    *Requests for intravitreal injection of bevacizumab (Avastin?) to treat the ophthalmologic conditions listed in this drug's medical policy do not require precertification. The clinical questions associated with bevacizumab (Avastin?) only apply to oncologic requests for the drug.

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