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This article details more changes to the NaviNet web portal that are scheduled for release in December 2014 and February 2015.
Coming in December 2014
CareCore (for Pennsylvania members only)
As previously communicated, for dates of service on or after January 1, 2015, precertification will be required for non-emergent outpatient radiation therapy for all commercial members in Pennsylvania. AmeriHealth is working with CareCore National, LLC (CareCore) to manage precertification requests for non-emergent outpatient radiation therapy services. Precertification is not required for radiation therapy in the inpatient hospital setting.
To initiate precertification for non-emergent outpatient radiation therapy, a new CareCore option will be added to 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 precertification requests by calling CareCore directly at 1-866-686-2649.This precertification requirement does not apply to commercial or Medicare Advantage AmeriHealth New Jersey members.
Authorization submission
To help expedite prior authorization requests, we will update several clinical questions related to specific chemotherapy/infusion services, medical/surgical procedures, home health, and durable medical equipment services.
Coming in February 2015
NaviNet office conversion
We will be converting all NaviNet offices to the new platform in February as part of our ongoing transition to a new operating platform. Most providers will see a difference in their provider group drop-down menus within many individual transactions on NaviNet.
Some of the more significant changes that providers will see on the new platform include:
- consolidated drop-down lists, as there will no longer be a need for duplicate records to differentiate between HMO and PPO lines of business;
- elimination of customized provider group name descriptions.
Allowance Inquiry transaction
The new Allowance Inquiry transaction will be added as an option in the menu of plan transactions, replacing the retired Fee Schedule Inquiry transaction. This new transaction will return fees for professional providers only and will indicate where primary care physician capitation is generally applicable. The fees returned via Allowance Inquiry will be associated with migrated members only and will not include results for Traditional or Comprehensive Major Medical members.
Note: Provider payment allowance information will be for informational purposes only and will not be a guarantee of payment for the amount displayed.
Tiering information enhancements
We will introduce enhancements in February that will assist providers when rendering services to members covered through one of our tiered products (e.g., Tier 1 Advantage, Community Advantage). The enhancements will allow providers to better identify appropriate member cost-sharing (e.g., copayment) and complete the referral and preapproval submission processes more easily for these members.
We will publish more information about these tiering information enhancements in future editions of Partners in Health UpdateSM.
For more information
To help you better understand all of these changes, we encourage you to stay tuned to upcoming editions of Partners in Health UpdateSM and to review the NaviNet Transaction Changes section of our System and Process Changes site.
If you have any questions about NaviNet updates, please call the eBusiness Hotline at 215-640-7410 for providers in Pennsylvania and Delaware and at 609-662-2565 for providers in New Jersey.
NaviNet® is a registered trademark of NaviNet, Inc.
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