Effective October 25, 2013, further changes will be made to several transactions on the NaviNet^® web portal during the month of October:

• authorization submission transactions
• referral submission and inquiry transactions

Note: When conducting transactions from AmeriHealth NaviNet Plan Central, search results will include information only for members covered under AmeriHealth plans.

Authorization submission transactions

Effective October 25, 2013, the following changes will be made to authorization submission transactions:

• Under the Authorizations option in the Plan Transactions menu, the Cardiac Rehab and Pulmonary Rehab transactions will be removed. As previously communicated, cardiac rehab and pulmonary rehab services no longer require precertification.
  
  Note: The Sleep Studies transaction was also recently removed, as AmeriHealth has delegated precertification of sleep studies and CPAP titration studies in a facility setting to AIM Specialty Health^SM. Please see the article published in the June 2013 edition of Partners in Health Update^SM for more details.
• When initiating a request, you will be required to enter the patient's full member ID number. You will no longer be able to search using only the patient's name and date of birth.
• The Patient Search Results screen will:
• only display members with active coverage;
• not display the product name of the member's coverage;
• no longer offer a link to the member's eligibility and benefits information.
Please use the Eligibility and Benefits Inquiry transaction to obtain this information.
• When requesting services in an inpatient or outpatient setting, you will only be able to select physicians and facilities that are participating in the member's plan network, where applicable.
• New submission date criteria will go into effect:

Transaction Current search date setup NEW search date setup Current date - 7 days Current date - 2 daysDME Current date + 30 days Current date + 30 days Current date - 7 days Current date - 2 daysHome Health Current date + 30 days Current date + 30 days Current date - 7 days Current date - 2 daysHome Infusion Current date + 30 days Current date + 30 days Current date - 2 daysMedical/Surgical Current date + 180 days Current date + 180 days

Referral submission and inquiry transactions

Effective October 25, 2013, the following changes will be made to the referral submission transactions:

• Providers will be able to submit and query all medical and OB/GYN referrals using a single transaction on NaviNet.
• Primary care physician and OB/GYN offices submitting referrals will no longer be able to fax them to specialists or facility providers. All referral submissions should be made using NaviNet.
• Referrals will no longer be tracked in the Referral/Authorization log. Instead, providers will need to use the Referral Inquiry transaction to look for submitted or completed referrals. NaviNet will purge all incomplete and complete referrals from the Referral/Authorization log.
• The comments field on the Referral Submission form will be removed.
• Your existing list of providers to whom you frequently refer members will be removed; however, as you begin submitting referrals through the new Referral Submission transaction, NaviNet will automatically track and save your most frequently referred to providers.

For more information

New user guides for these transactions will be available on our Upcoming System and Process Changes web page in the coming weeks. If you have any questions regarding upcoming NaviNet transaction changes, 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. Note: The changes to the Claim INFO Adjustment Submission transaction that were scheduled to be implemented on September 27, 2013, have been delayed until later in 2013. Please continue to submit your adjustment requests through the current transaction. We will notify you with more information about this change as soon as it's available.

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