In January 2011, AmeriHealth published the
NaviNet Chemotherapy/Infusion and
Home Infusion Authorizations Guide, an online resource to educate providers
and their office staff about obtaining authorizations for certain chemotherapy
and home infusion therapies.
This guide included the clinical question sets that providers must answer when
requesting precertification
for the following drugs:
bevacizumab (Avastin?)*
cetuximab (Erbitux?)
infliximab (Remicade?)
intravenous immune globulin (IVIG)
oxaliplatin (Eloxatin?)
rituximab (Rituxan?)
trastuzumab (Herceptin?)
As of September 2011, these clinical question sets will no longer be included
in the user guide. However, they will continue to be available online as an
attachment within the medical policy for each drug, making the medical policy a
comprehensive resource for all medical necessity criteria, dosing and frequency
requirements, coding guidelines, and clinical question sets.
To view medical policies through the NaviNet web portal, select Reference
Materials and Reports from the Plan Transactions menu and then Medical
Policy. Then type the drug name into the Search box on the Medical Policy
homepage. You can also go to www.amerihealth.com/medpolicy and type the drug
name into the Search box.
The revised guide is still available in the Administrative Tools &
Resources section of NaviNet Plan Central.
If your office has any questions or requires training for NaviNet, please call
the eBusiness Help Desk at 215-241-2305.