As we have previously communicated, during the third quarter of 2017,
AmeriHealth will transition to a new medical management system for processing
requests for authorization. As a result, the Authorizations transaction on the
NaviNet web portal will be upgraded. The new transaction will streamline the
various authorization submission types (ER Notification, Medical/Surgical,
Chemotherapy Infusion, Home Health, DME, and Home Infusion) into one
workflow.
Note: We will deploy the new transaction to a subset of providers
prior to a full network release. We are currently in the process of notifying
this group of providers.
Upcoming changes
Outlined below are some additional changes you will see when using the new
Authorizations transaction.
Authorization numbers
The structure of the authorization number may vary depending upon how and
where the original authorization request is submitted. The following chart
shows the variety of authorization number formats you may see:
| Origin of authorization | Sample
authorization number |
|---|
| NaviNet | EXT – 12345 |
| Telephone | Case – 7890 |
| AIM authorization* | #12345678 |
| eviCore authorization† | A#123456789 |
New authorization log
A new authorization log will be released when we transition to the new
workflow, which will allow providers to search for a list of their submitted
authorization requests based on a user-defined date range.
Providers will be able to perform a variety of functions through the new
log. More details on the functions will be shared in the coming weeks.
Note: The current legacy authorization log and authorization report
for AmeriHealth will be eliminated when we transition to the new Authorizations
transaction. We recommend you review the authorization log in advance of the
release to ensure all incomplete requests are completed.
New authorization submission
types
Requests for coverage for placement in a skilled nursing facility (SNF) and
for non-emergency ambulance transportation will be accepted through the new
transaction.
SNF requests will be made available to all providers. When the transaction
is first released, the placement request function will not include survey
questions; however, the questions will be incorporated into the workflow in a
future release.
Non-emergency Ambulance Land requests (e.g., A0140, A0426, A0428, A0430,
A0434) will be available only to providers credentialed to perform this type of
service. Ambulance providers will be prompted to provide responses to the
following:
- The member?s level of mobility.
- Is the member able to get up from a bed without assistance?
- Is the member able to walk?
- Is the member able to sit in a chair or wheelchair?
- Does the member?s condition permit transport in any other vehicle other
than an ambulance?
- Origin of transportation.
- Full name of the destination.
- Why is the ambulance transport required?
- Is additional ambulance crew required?
Authorization submission
timelines
The grid below provides you with the allowable date ranges by service
type:
| 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 |
| Durable Medical Equipment (DME) Purchase/Rental | 183 days after
current date | 2 days prior to current date |
| Emergency room/department (ER) Admission | 2 days after 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 |
| Skilled Nursing Facility (SNF) | 30 days after current
date | 2 days prior to current date |
For more information
We encourage you to view a brief instructional video that
previews the new transaction to become more familiar with the upcoming changes.
Note: The video does not represent the final product, and we
anticipate screen changes as development efforts continue.
It will be important for providers who submit authorization requests to stay
current with ongoing announcements related to this system transition to ensure
your organization is prepared when the changes are implemented.
Additional information regarding this transition will be communicated
through Partners in Health UpdateSM and on AmeriHealth
NaviNet Plan Central. If you have any questions, please call our eBusiness
Hotline at 609-662-2565 for AmeriHealth New Jersey or at
215-640-7410 for AmeriHealth Pennsylvania.
*Precertification performed by AIM Specialty
Health® (AIM).
†Precertification review is provided by
CareCore National, LLC d/b/a eviCore healthcare (eviCore).
NaviNet is a registered trademark of NaviNet, Inc.