This article details changes that are scheduled to be made in February to the NaviNet web portal. Please review this information to understand how these changes may affect how you do business with Independence.

NaviNet office conversion

We are converting all NaviNet offices to the new platform in February as part of our ongoing transition to the new operating platform. Most providers will see a difference in their provider group drop-down menus within many individual transactions on NaviNet.

Some of the more significant changes that providers will see on the new platform include:

• expanded drop-down lists for all office locations associated to a group record;
• elimination of PPO/HMO lines of business designators;
• elimination of customized provider group name descriptions.

As there may be significant impacts to your NaviNet office, we strongly encourage you to review the NaviNet Office Conversion Guide.

Allowance Inquiry transaction

A new Allowance Inquiry transaction will be added as an option in the transactions menu, replacing the retired Fee Schedule Inquiry transaction. This new transaction will return fees for professional providers only and will indicate where primary care physician (PCP) capitation is generally applicable. The fees returned via Allowance Inquiry will be associated with migrated members only and will not include results for Traditional or Comprehensive Major Medical members. A detailed user guide will be posted to the NaviNet Transaction Changes section of our Business Transformation site.

Tiering information enhancements

In order to better serve our Keystone HMO Proactive members and self-funded customers in tiered network programs, we are introducing NaviNet enhancements in February that will:

• assist providers in identifying appropriate member cost-sharing (e.g., copayment);
• help providers with the referral and preapproval submission processes.

The following NaviNet transactions will be enhanced with tiering information:

• Eligibility and Benefits Inquiry. A Billing Provider drop-down menu will be added to the search screen. Whensearching for member eligibility and benefits information, you will need to select the appropriate provider group or facility before entering the member search criteria. The combination of provider and member information entered will assist in identifying the appropriate member cost-sharing. The Eligibility and Benefits Details screen offers several links to benefit provisions (e.g., professional services, outpatient facility services). When selecting a benefitprovision link, the member's tier benefit cost-sharing will be highlighted based on the provider group or facility you selected.
  
  Note: Selecting an incorrect provider group or facility on the Eligibility and Benefits Search screen may result in incorrect member cost-sharing being highlighted.
• Authorization Submission. Where applicable, you will see an additional column in the search results screen whenlooking for a physician or facility while submitting an Emergency Room Admission Notification or an authorization request for one of the following:
      –medical/surgical procedures
      –chemotherapy/infusion services
      –home health
      –home infusion
      –durable medical equipment
  
  This new column will identify the benefit tier placement associated with that physician or facility. Members with tieredprograms pay the lowest cost-sharing when they use providers on the lowest tier.
• Referral Submission. Where applicable, PCPs will see an additional column in the search results screen when looking for a physician or facility while submitting a referral. This new column will identify the benefit tier placement associated with that physician or facility.
  Reminder: As of January 1, 2015, some Independence small group and individual commercial members have the new Preventive Plus benefit for colon cancer preventive screening colonoscopies. When performed at a freestanding ambulatory surgery center (ASC), the Preventive Plus benefit fully covers a colon cancer preventive screening colonoscopy with no member cost-sharing (i.e., no copayment, deductible, or coinsurance). When the services are performed at a hospital outpatient facility or hospital-based ASC, the member will incur cost-sharing of up to $750.
• Network Facility Inquiry and Network Provider Inquiry. When searching for a physician or facility through thesetransactions, the Network drop-down menu will include options for Keystone HMO Proactive and other self-funded customer tiered network programs. Once you?ve selected one of these options and entered the appropriate search criteria, your results will include a new column that displays the applicable tier information.

For more information

To help you better understand these changes, we will publish more details in future editions of Partners in HealthUpdate^SM. In addition, we strongly encourage you to review the NaviNet Transaction Changes section of our Business Transformation site. If you have any questions about upcoming changes to NaviNet, call the eBusiness Hotline at 215-640-7410.

NaviNet^® is a registered trademark of NaviNet, Inc., an independent company.