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Reminder! Authorization submission requirements through NaviNet®

October 11, 2018

As previously communicated, beginning October 15, 2018, all participating Independence providers will be required to submit their initial authorization requests through the Authorizations transaction on NaviNet for services supported by the web portal. Our Clinical Services team has been trained on the types of requests that can be submitted through NaviNet for initial submissions beginning October 15, 2018. In some instances, Clinical Services may have the eBusiness team outreach to a provider directly if they are experiencing issues using NaviNet or require training.   

The following services must be requested through NaviNet:

  • Ambulance (Land) – non-emergent ambulance transportation (Note: Except for ambulance land requests from a facility as part of discharge planning.)
  • Chemotherapy
  • Durable medical equipment (DME) – purchase and rental
  • ER admission
  • Home health
  • Home infusion
  • Infusion therapy
  • Medical Surgical

The grid below provides the allowable date ranges for each authorization service type. For example, medical/surgical authorization requests can be submitted up to 183 days in advance of the current date or retroactively up to 2 days prior to the current date.

Service TypeFuture Date MaximumRetroactive Date Maximum
Ambulance Land30 days after current date2 days prior to current date
Chemotherapy183 days after current date2 days prior to current date
DME Purchase/Rental183 days after current date2 days prior to current date
ER Admissioncurrent date365 days prior to current date
Home Health30 days after current date2 days prior to current date
Home Infusion183 days after current date2 days prior to current date
Infusion Therapy183 days after current date2 days prior to current date
Medical Surgical183 days after current date2 days prior to current date

Please note, not all services can be submitted through NaviNet for all members. While not an all-inclusive list, here are some key exceptions:

  • Prior authorization requests for Federal Employee Program members
  • Prior authorization requests where the servicing facility or servicing provider office does not participate with the member’s plan cannot be submitted through NaviNet.
  • Ambulance authorization requests from a facility
  • ER Admission requests from anyone other than the admitting facility through NaviNet
  • Out of capitation requests
  • Providers will continue to submit authorization requests to AIM Specialty Health® (AIM) and CareCore National, LLC d/b/a eviCore healthcare (eviCore), independent companies, through the current AIM and eviCore transactions.
  • This requirement does not apply to providers contracted with Magellan Healthcare, Inc. (Magellan), an independent company. Magellan-contracted providers should contact their Magellan Network Coordinator at 1-800-866-4108 for authorizations.

We encourage providers to review the authorization submission practices within their office and begin adhering to this NaviNet self-service requirement in advance of October 15, 2018. Please review our detailed user guides and instructional videos, which are available under the Authorizations transaction resources in the NaviNet Resources section.

If you have any questions, please contact the eBusiness Hotline at 215-640-7410. 

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

Magellan Healthcare, Inc. manages mental health and substance abuse benefits for most Independence members.


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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