Skip to main content

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: New field to be populated (choose “home” or “outpatient hospital”)
  • 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.

Recent Articles

  • Introducing Highmark’s Provider News
    As part of our affiliation with Highmark, we want to create a more seamless and enhanced provider experience. To support this, we will transition our monthly provider communication from “Blue Bulletin” to “Provider News.” Beginning in January, you’ll receive Highmark’s monthly Provider News emails at the end of each month replacing Blue Bulletin. Provider News will deliver local information to help you work with us, including reimbursement, coding, preauthorization, and policy updates. In this article, you can find more information and view the Provider News webpage on the Highmark Provider Resource Center (PRC).
  • Reminder: Highmark Commercial and Medicare Advantage Reimbursement Policies
    As a reminder, on January 1 after all your Highmark Blue Cross Blue Shield of Western New York patients are on Highmark’s systems, we will be following Highmark’s reimbursement policies for commercial and Medicare Advantage lines of business. Here, you can find out how to access Reimbursement Policies on the Highmark Provider Resource Center (PRC).
  • Population Health University - Clinical Pharmacy Resources Available Online
    Before discussing, prescribing, and deprescribing certain medications with your Highmark Blue Cross Blue Shield of Western New York patients, Highmark’s Population Health University offers clinical pharmacy resources to assist you. In this article, you can learn how to access the toolkits that provide useful pharmacy guidance.
  • Provider Tools and Resources Remaining on the Legacy Website
    Our legacy provider website will be decommissioned on February 1, 2023, at which point you will be redirected to the Highmark Provider Resource Center (PRC). Despite this change, you will still be able to access several tools and pages on the legacy website. Here, you can find out which content will be remaining and where to find it.
  • Credentialing and Enumeration for Nurse Practitioners and Certified Registered Nurse Anesthetists
    Beginning January 1, nurse practitioners will have the option to be fully credentialed as a primary care provider (PCP), specialist, or enumerated in either role. Certified registered nurse anesthetists will have to option to credential as a specialist or be enumerated in the reimbursement system only. In this article, you can find information on how to credential and enumerate.