As previously communicated, several new transactions and enhancements were introduced on the NaviNet web portal in September:
- Eligibility and Benefits Inquiry. A new Eligibility and Benefits Inquiry transaction was introduced in September to some providers; in October the new transaction will be deployed to all remaining offices. The member search criteria will be modified, and the presentation of the eligibility and benefits information will change. The Eligibility and Benefits screen will continue to include links to the member's capitated site information (where applicable), ID card, and product-wide provisions associated with the member's benefits plan. For more detailed information about this updated transaction, refer to the new Eligibility and Benefits Inquiry Guide available in the NaviNet Resources section of our Provider News Center.
- Provider File Management. This new transaction has replaced the Provider Change Form transaction. Provider File Management allows professional providers to modify practice information, add hospital affiliations, and add participating providers.
- ICD-10. Portal transactions that reference or leverage diagnosis codes were updated to include ICD-10 codes only. As a reminder, providers must now use ICD-10 codes when submitting referrals, encounters, and authorization requests or when searching for a diagnosis on NaviNet (for dates of service or dates of discharge [for facility inpatient claims] on or after October 1, 2015).
- COB Questionnaire. A new transaction was introduced with a new Coordination of Benefits (COB) Questionnaire. This electronic form allows providers to report and submit Other Party Liability coverage for members. Reporting COB information at the time of service helps claims process correctly.
If you have any questions about these changes, please call the eBusiness Hotline at 215-640-7410.
Submitting authorizations with ICD codes
When submitting an authorization request through NaviNet, do not include the decimal point when entering diagnosis codes. Use the ICD-9 code (for dates of service prior to October 1, 2015) or ICD-10 code (for dates of service on or after October 1, 2015).
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