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Enhancements to NaviNet Prior Authorization Experience

Date:
November 29, 2022

Beginning January 1, 2023, we will begin to roll out enhancements to our utilization management (UM) tool through NaviNet. These enhancements are intended to streamline your experience by enabling faster reviews and greater transparency around the status of your authorization requests.

While you will still submit authorization requests via NaviNet, your requests will be routed to the enhanced UM tool. You will log into NaviNet as usual, choose the authorization type and complete the Selection Form as you do currently. Authorization request screens may appear differently than they did previously.

After you submit the Selection Form, you will proceed to the clinical platform where all data entered will transfer to the enhanced UM tool.

Tips for NaviNet Authorization Submissions on the New Platform

  • Place of Service: This new field will need to be entered with your place of service; options include “office”; (patient’s) “home”; “outpatient hospital”; “independent clinic”; “ambulatory surgical center” and “comprehensive outpatient rehabilitation facility”
  • Diagnosis code: Must contain a decimal place (e.g., E34.4)
  • Attachments: You may attach clinical (or any supporting) documentation by clicking the “+” sign on the right side of your screen
  • Validation: Before you submit your request, validate your information on the Review Screen; if needed, click the “back” button to make any edits

Click here to view the updated NaviNet Provider Portal Authorization Submission Guide. The guide can also be accessed on the Highmark Provider Resource Center > Authorizations tab on the left side of the main page.

If you need assistance with the new clinical platform, please email us at ElecAuthSubmit@highmark.com.

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