Pre-service review for out-of-area members will be made available through NaviNet®

July 31, 2014

Starting in mid-August, IBC will offer the ability to useElectronic Provider Access (EPA) through the NaviNetweb portal to access the provider portal of an out-of-areamember?s Home Plan and conduct electronic pre-servicereviews.

With this added function on NaviNet, you may no longerbe required to call the out-of-area member?s healthplan line to request preapproval. Users may still needto call the member?s Home Plan to request preapprovalif the Home Plan does not offer the pre-service reviewelectronically. The new transaction, Pre-Service Reviewfor Out-of-Area Members, will be available underthe Blue Exchange® Out of Area option in the PlanTransactions menu.

The benefits of EPA include:

  • more efficient pre-service review process;
  • reduced administrative costs and fewer phone calls;
  • improved provider and member satisfaction.

For more information

A new user guide that describes this transaction ingreater detail is available in the NaviNet TransactionChanges section of our Business Transformationsite.We encourage you to review the guide prior to thetransaction becoming available in mid-August.

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

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