We appreciate your continued patience during our transition to a new
utilization management system and upgrades to functionality on the NaviNet web
portal. As we prepare to release additional system enhancements in the coming
months, we will continue to look for new opportunities to improve your
experience.
With the new system in place, we will begin to reinforce our self-service
requirements.
Beginning October 15, 2018, all participating providers will
be required to submit their initial authorization requests through the
Authorizations transaction on NaviNet.
The following services must be requested through NaviNet:
- Ambulance (Land) ? non-emergency ambulance transportation
- Chemotherapy
- Durable medical equipment (DME) ? purchase and rental
- ER admission
- Home health
- Home infusion
- Infusion therapy
- Medical surgical
We encourage you to review the grid below prior to October 15, 2018. The
grid provides you with allowable date ranges for each authorization service
type. For example, non-emergency Ambulance Land authorization requests can be
submitted up to 30 days in advance of the current date or retroactively up to 2
days prior to the current date.
| Service Type | Future Date
Maximum | Retroactive Date Maximum |
|---|
| Ambulance Land | 30 days
after current date | 2 days prior to current date |
| Chemotherapy | 183 days
after current date | 2 days prior to current date |
| DME Purchase/Rental | 183
days after current date | 2 days prior to current
date |
| ER Admission | current
date | 365 days prior to current date |
| Home Health | 30 days after
current date | 2 days prior to current date |
| Home Infusion | 183 days
after current date | 2 days prior to current date |
| Infusion Therapy | 183 days
after current date | 2 days prior to current date |
| Medical Surgical | 183 days
after current date | 2 days prior to current date |
Please note:
- Ambulance authorization requests may only be submitted by ambulance service
providers.
- Providers will continue to submit authorization requests to AIM Specialty
Health? (AIM) and CareCore National, LLC d/b/a eviCore healthcare
(eviCore) through the current AIM and eviCore transactions.
For more information
In preparation for reinforcement of this self-service requirement, we will
offer virtual refresher training sessions beginning in September 2018. Look for
registration details on AmeriHealth NaviNet Plan Central in the near
future.
We encourage providers to review the authorization submission practices
within their office and begin adhering to this NaviNet self-service requirement
in advance of October 15, 2018. Review our detailed user guides and
instructional videos, which are available under the Authorization transaction
resources in the NaviNet Resources section.
If you have any questions, please contact the eBusiness Hotline at
609-662-2565 for AmeriHealth New Jersey or at 215-640-7410 for
AmeriHealth Pennsylvania.
NaviNet is a registered trademark of NaviNet, Inc.