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As previously communicated, we will be introducing a new Claim Status
Inquiry transaction on the NaviNet web portal. However, access to the new
transaction will be delayed until January 2017. Check for updates regarding the
release of this transaction and new user guides on the Provider News Center
.
Claim Review
As a reminder, all participating providers (including third-party supporting
agents) are required to be enabled with NaviNet. As part of our self-service
requirements, participating providers are required to use NaviNet when checking
for claim status. Additionally, providers who are looking to request a claim
review must submit those requests through the Claim Investigation transaction.
We will continue to redirect those providers who submit paper claim review
requests to the NaviNet provider portal to initiate the claim review. Please be
specific when describing the reason for the claim review.
Note: A number of providers are submitting claim review requests for
lack of referral or authorization. If a claim is denied for lack of referral or
authorization and one was required, you must submit a valid referral or
authorization number in order for the claim to be reconsidered. The submission
of medical records as a replacement for a required authorization or referral is
not valid.
If, however, you are experiencing an issue that affects a significant number
of claims, we recommend that you contact your Network Coordinator for
assistance rather than submit an adjustment request through NaviNet.
For more information
If you have any questions, please call the eBusiness Hotline at
215-640-7410.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.