As previously communicated, beginning October 15, 2018,
all participating AmeriHealth providers will be required to
submit their initial authorization requests through the Authorizations
transaction on NaviNet for services supported by the web portal. Our
Clinical Services team has been trained on the types of requests that can be
submitted through NaviNet for initial submissions beginning October 15, 2018.
In some instances, Clinical Services may have the eBusiness team outreach to a
provider directly if they are experiencing issues using NaviNet or require
training.
The following services must be requested through NaviNet:
- Ambulance (Land) – non-emergent ambulance transportation
(Note: Except for ambulance land requests from a facility as part
of discharge planning.)
- Chemotherapy
- Durable medical equipment (DME) – purchase and rental
- ER admission
- Home health
- Home infusion
- Infusion therapy
- Medical Surgical
The grid below provides the allowable date ranges for each authorization
service type. For example, medical/surgical authorization requests can be
submitted up to 183 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, not all services can be submitted through NaviNet for all
members. While not an all-inclusive list, here are some key exceptions:
- Prior authorization requests where the servicing facility or servicing
provider office does not participate with the member’s plan cannot be
submitted through NaviNet.
- Ambulance authorization requests from a facility
- ER Admission requests from anyone other than the admitting facility through
NaviNet
- Out of capitation requests
- 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.
- This requirement does not apply to providers contracted with Magellan
Healthcare, Inc. (Magellan). Magellan-contracted providers should contact their
Magellan Network Coordinator at 1-800-866-4108 for
authorizations.
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. Please review our detailed user guides and
instructional videos, which are available under the Authorizations 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
215-640-7410 for AmeriHealth Pennsylvania.
NaviNet is a registered trademark of NaviNet, Inc.
Magellan Healthcare, Inc. manages mental health and
substance abuse benefits for most AmeriHealth members.