As previously communicated, beginning October 15, 2018, all participating 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 will be trained on the types of requests that can be submitted through the Authorizations transaction and will be advising providers to use NaviNet for initial submissions beginning October 15, 2018. In some instances, providers may be redirected to the eBusiness Hotline if they are experiencing issues using NaviNet or require additional training.
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
Attention
In the coming weeks, select providers may begin to experience redirection to utilize NaviNet or be redirected to the eBusiness Hotline, when appropriate, as we work with our Clinical Services team on the implementation of this enforcement.
The grid below provides the 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, 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.
Upcoming training sessions
In preparation for the reinforcement of this self-service requirement, we will offer virtual refresher training sessions later this month. If your office or department would benefit from this instruction, please contact the eBusiness Hotline number at 609-662-2565 for AmeriHealth New Jersey or 215-640-7410 AmeriHealth Pennsylvania.
For more information
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 AmeriHealth Pennsylvania.
NaviNet is a registered trademark of NaviNet, Inc.
Magellan Healthcare, Inc. manages mental health and substance abuse benefits for most AmeriHealth members.