As previously communicated, during the third quarter of 2017, AmeriHealth will transition to a new medical management system for processing authorization requests. This transition will require changes to several administrative procedures for the following, as was also noted in the article, Update: Transition to a new medical management system:

• NaviNet^® web portal
• emergency (unscheduled) admissions
• hospitals

Note: The Authorizations transaction on NaviNet will be upgraded as a result of this transition. For more details, read the complete article, Update: New NaviNet^® Authorizations transaction.

New resources available

To make this transition as seamless as possible, we have created a Transition to a new medical management system: Frequently Asked Questions (FAQ) document to help answer any questions you may have about this change. This FAQ can be found in the Frequently Asked Questions section of AmeriHealth NaviNet Plan Central under Administrative Tools & Resources. Note: The FAQ will be updated as more information becomes available.

Because utilization review and the issuance of determinations will be conducted primarily via fax, we created new fax cover sheets for admission reviews and discharge planning requests. We strongly suggest using these cover sheets to ensure the requests are directed to the appropriate AmeriHealth staff. These fax cover sheets can be found in the Miscellaneous Resources section of AmeriHealth NaviNet Plan Central under Administrative Tools & Resources.

Note: It is imperative that we have your most current fax number on file. You can update your fax number as outlined in the Administrative section of the Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers.

Stay informed

It is 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.

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