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As a reminder, during the third quarter of 2017, Independence will
transition to a new medical management system for processing requests for
authorization. Please read this communication in its entirety. This transition
will require changes to several administrative procedures, as noted below.
NaviNet®
The Authorizations transaction on the NaviNet web portal will be upgraded.
Enhancements will include the following:
- Streamlined workflow. The new transaction will streamline
the various authorization submission types into one workflow.
- Authorization status. The new transaction will allow
providers to search for a list of their submitted authorization requests based
on a user-defined date range. Providers will no longer be required to limit
their search to a specific member. This new feature will be especially helpful
for providers submitting a significant number of authorization requests. If you
do not have a NaviNet username and password and you anticipate a need to
utilize this function, please see your designated NaviNet Security Officer to
obtain a logon to the web portal. Note: Denial notices will continue
to be sent via mail.
- SNF and non-emergency ambulance transportation. Requests
for coverage for placement in a skilled nursing facility (SNF) and for
non-emergency ambulance transportation will be accepted through the new
Authorizations transaction.
Video now
available
A brief instructional video on the new Authorizations transaction is now
available. More information on this new transaction and video can be found in
the article, New NaviNet Authorizations transaction.
Look for more detailed information in the coming months. New user guides
will be made available prior to the release of the new transaction to help your
office understand these enhancements.
Browser requirements
Once the new system is implemented, providers must use Internet
Explorer 11 to submit authorization requests through NaviNet.
Providers who use a browser other than Internet Explorer 11 will encounter an
error message and will be prevented from completing the request.
If your office currently submits authorization requests using another web
browser (e.g., Microsoft Edge, Google Chrome, Safari, Mozilla Firefox, or an
earlier version of Internet Explorer) and you are unable to switch to Internet
Explorer 11, please have a representative from your organization contact the
eBusiness Hotline at 215-640-7410.
Emergency (unscheduled) admissions
Cases that initially present to the emergency department but are
subsequently determined by the treating physician to require hospital
confinement will require further review when payment is being requested for
inpatient admission. Once notification of the admission is submitted via
NaviNet, clinical information allowing for utilization review must be provided
within 72 hours. In the event such information is not
submitted within 72 hours, the case will be reviewed and a utilization review
determination will be based on whatever information was included in the initial
notification, which will most likely be insufficient to satisfy the applicable
clinical criteria.
Note: There are no changes to denial procedures; hospitals will
continue to be notified verbally and via mail.
New administrative procedures for
hospitals
Independence will no longer identify a specific utilization review nurse to
service a given network hospital. Instead, cases will be handled by a team of
nurses on a rotating basis.
Utilization review and the issuance of determinations will be conducted
primarily via fax. Therefore, 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. New fax cover sheets will be
provided as we get closer to the transition.
Note: Hospitals will continue to use the existing fax numbers for
utilization review requests. New fax numbers will not
be issued as previously communicated.
Placement requests
The review of requests for placement in SNFs, inpatient rehabilitation, and
long-term acute care facilities will also be handled by a team of nurses on a
rotating basis. Hospitals and/or the receiving facilities will request
placement by contacting Independence at 1-800-TO-ADMIT and
selecting the Authorizations option, or by fax.
SNF placements may also be initiated through NaviNet. It will be very
important to provide updated clinical information at the time of the request to
allow for a prompt coverage decision.
Stay informed
It will be 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.
Additional information regarding this transition will be communicated
through Partners in Health UpdateSM and on Independence
NaviNet Plan Central. If you have any questions, please call our eBusiness
Hotline at 215-640-7410.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.
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