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Over the past several years, Independence has instituted a number of
provider self-service requirements under
which providers must use the NaviNet web portal to obtain certain information.
All participating providers, facilities,
Magellan-contracted providers, and billing agencies that support provider
organizations are required to use
self-service options for the following:
- Eligibility and claims status information. All participating
providers and facilities are required to use NaviNet
to verify member eligibility and obtain Independence claims status information.
The claim detail provided through
NaviNet includes specific information, such as check date, check number,
service codes, paid amount, and
member responsibility.
- Claim adjustments. All participating providers and facilities must
submit claim adjustment requests using the
Claim Investigation Inquiry transaction on NaviNet. Providers must supply the
necessary information to support an
adjustment request. For example, if a provider is requesting a claim adjustment
related to the payment amount,
the provider must supply the member's benefit product for the date of service
at issue and the relevant terms in the
provider's contract in order for a review and adjustment consideration to
occur.
- Authorizations.* All participating providers and facilities must use
NaviNet to initiate the following authorization
types:
- –medical/surgical procedures
- –chemotherapy/infusion therapy
- –durable medical equipment
- –emergency hospital admission notification
- –home health (dietitian, home health aide, occupational therapy,
physical therapy, skilled nursing, social work, speech therapy)
- –home infusion
Any provider who contacts Provider Services to obtain eligibility and claims
status information, question a
claim payment, submit a claim adjustment, or request an authorization will be
directed to use the self-service
options on NaviNet.
Resources available
Detailed user guides and webinars for many NaviNet transactions are
available in the NaviNet Resources section of
the Provider News Center.
All office locations are required to have NaviNet access. If you are not yet
NaviNet-enabled, go to the NaviNet website, to sign up. If your office is
NaviNet-enabled but would like training on any of the self-service
transactions, call the eBusiness Hotline at 215-640-7410.
*This information does not apply to providers contracted
with Magellan Healthcare, Inc. (Magellan). Magellan-contracted providers should
contact their Magellan Network Coordinator at 1-800-866-4108 for
authorizations.
Magellan Healthcare, Inc., an independent company, manages mental health and
substance abuse benefits for most Independence members.
NaviNet is a registered trademark of NaviNet, Inc., an independent company.
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