In certain instances, AmeriHealth delegates utilization review activities to entities with expertise in medical management of a certain membership population or type of benefits. AmeriHealth has delegated specific review activities to:

• AIM Specialty Health^® (AIM)
• CareCore National, LLC d/b/a eviCore healthcare (eviCore), a specialty benefit management company

As an important reminder, you may check the status of finalized AIM and eviCore authorization requests through the Authorizations transaction on the NaviNet web portal (NaviNet Open).

Authorization numbers

The structure of the authorization number may vary depending upon how and where the original authorization request is submitted. For example, if the original request is submitted through NaviNet Open, the authorization number will display with a prefix of EXT. However, if the original request is submitted via phone, the authorization number will display a prefix of CASE.

You cannot search for a finalized request using a REQ number.

Searching for an authorization

To perform an Authorization Inquiry, select Authorizations from the Workflows menu, and then select Authorization from the fly-out menu.

You are then presented with the Authorizations screen. The following fields are required to be completed:

• Requesting or Servicing Provider name (this field has the type-ahead feature) or select from the drop-down list.
• Date Range of the authorization(s) for which you are searching.

Click inside the Requesting/Servicing Provider field and select your organization. The drop-down menu display includes the group/facility name and NPI, address, tax ID, and internal provider number (Payer ID) to assist with your selection.

The Date Range field defaults to the most current 30-day period. To modify the date, click inside the field. You have the option to select a pre-defined date range (e.g., last seven days) or to define a custom range using the calendar tool. If using the calendar tool, you will need to select a begin date using the calendar on the left. To select an end date, use the calendar on the right.

In the Optional Details section, there are additional fields that can be used to further narrow the number of authorizations returned. Data may be keyed in either Member ID or Authorization Number or both fields. If the Optional Details fields are left blank, then all authorization requests for the identified provider are returned regardless if your organization is the requesting or servicing provider.

Select Search to view the list of authorizations that meet your search criteria.

Checking the status of pended authorizations

To check the status of pended authorizations for AIM or eviCore:

• AIM. To check the status for AIM pended authorizations, please use the AIM option under the Authorizations transaction. For more information, call AIM Support at 1-800-275-2583 and follow the prompts for AIM.
• eviCore. To check the status for eviCore pended authorizations, please use the eviCore option under the Authorizations transaction. For more information, call eviCore Support at 1-866-686-2649.

More information

If you have questions on how to use the Authorizations transaction, we encourage you to review our detailed Authorization Submission and Inquiry Guide, which is available under Authorizations transaction resources in the NaviNet Open section.

For more information on our utilization management programs, please visit our Utilization management programs webpage.

If you have any questions after reviewing these resources, please contact the eBusiness Hotline at 609-662-2565 for AmeriHealth New Jersey or at 215-640-7410 for AmeriHealth Pennsylvania.

NaviNet^® is a registered trademark of NantHealth.