This article details more changes to the NaviNet webportal that are scheduled for release in December 2014and February 2015.

Coming in December 2014

CareCore

As previously communicated, for dates of service on orafter January 1, 2015, precertification will be requiredfor non-emergent outpatient radiation therapy forcommercial and Medicare Advantage HMO and PPOmembers. Independence is working with CareCoreNational, LLC (CareCore), an independent company,to manage precertification requests for non-emergentoutpatient radiation therapy services. Precertification isnot required for the inpatient hospital setting.

To initiate precertification for non-emergent outpatientradiation therapy, a new CareCore option will be addedto the Authorizations menu in the list of plan transactions.This option will link to the CareCore provider portal,where providers can complete precertification requests.

Note: Providers will also be able to initiate precertificationrequests by calling CareCore directly at 1-866-686-2649.This precertification requirement does not apply toFederal Employee Program or Comprehensive MajorMedical members.

Authorization submission

To help expedite prior authorization requests, we willupdate several clinical questions related to specificchemotherapy/infusion services, medical/surgicalprocedures, home health, and durable medicalequipment services.

Coming in February 2015

NaviNet office conversion

We will be converting all NaviNet offices to the newplatform in February as part of our ongoing transitionto a new operating platform. Most providers will seea difference in their provider group drop-down menuswithin many individual transactions on NaviNet.

Some of the more significant changes that providers willsee on the new platform include:

• consolidated drop-down lists, as there will no longer bea need for duplicate records to differentiate betweenHMO and PPO lines of business;
• elimination of customized provider group namedescriptions.

Allowance Inquiry transaction

The new Allowance Inquiry transaction will be added asan option in the menu of plan transactions, replacingthe retired Fee Schedule Inquiry transaction. This newtransaction will return fees for professional providersonly and will indicate where primary care physiciancapitation is generally applicable. The fees returnedvia Allowance Inquiry will be associated with migratedmembers only and will not include results for Traditionalor Comprehensive Major Medical members.

Note: Provider payment allowance information will be forinformational purposes only and will not be a guaranteeof payment for the amount displayed.

Tiering information enhancements

In order to better serve our Keystone HMO Proactivemembers and self-funded customers in tiered networkprograms, we are introducing NaviNet enhancementsin February that will:

• assist providers in identifying appropriate membercost-sharing (e.g., copayment);
• help providers with the referral and preapprovalsubmission processes.

We will publish more information about these tieringinformation enhancements in future editions ofPartners in Health Update^SM.

For more information

To help you better understand these changes, weencourage you to stay tuned to upcoming editionsof Partners in Health Update^SM and to review theNaviNet Transaction Changes section of ourBusiness Transformation site.

If you have any questions about NaviNet updates,call the eBusiness Hotline at 215-640-7410.

NaviNet^® is a registered trademark of NaviNet, Inc., an independent company.