Does Highmark require prior authorization?

Highmark now requires authorization numbers to ensure appropriate reimbursement. reimbursement. Denials of coverage of services may be issued based on medical necessity and/or appropriateness determinations.

How do you do prior authorization on NaviNet?

Providers that are not able to submit requests for precertification/prior authorization through our online utilization management request tool on NaviNet may call our Prior Authorization team at 1-800-664-2583, Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time.

Does Highmark use NaviNet?

NaviNet gives users real-time access to Highmark’s membership, claims and provider and payment systems, making your job easier.

Does Highmark use eviCore?

Effective Jan. 1, 2019, eviCore will manage advanced imaging and cardiology services for Highmark Delaware members.

How do I use NaviNet?

Use NaviNet to get answers to common questions, 24/7. Simply sign in to NaviNet.net, select Help and then select Horizon BCBSNJ. The tool provides: • The ability to search for prior authorization information for up to five CPT® or HCPCS codes.

How do I check my NaviNet eligibility?

From the Plan Central Page Select Eligibility and Benefits Inquiry from the left navigation bar. The Eligibility and Benefits function within NaviNet allows you to access real-time eligibility and benefit information including deductible, co-pay, and coinsurance amounts for local members.

What payers are on NaviNet?

“NaviNet has a tremendous, long-term customer base of more than 40 health plans – Blue Cross Blue Shield payers, Aetna, Cigna, and many others – a nationwide network of more than 450,000 active end-users across all 50 states, and an All-Payer Access provider portal to 450+ commercial and government plans nationally …

What is Evicore phone number?

800-646-0418
You can also email us at [email protected], or reach us by phone at 800-646-0418, option 2.

Is NaviNet a clearinghouse?

Navinet is one of the best clearinghouse for medical facility.

How do I get an eviCore authorization?

What is the most effective way to get authorization for urgent requests? Urgent requests can be requested on the web portal at www.priorityhealth.com/provider or by calling eviCore healthcare directly at 844-303-8456 indicating the request is urgent.

What is eviCore used for?

eviCore is a medical benefits management company which helps patients avoid unnecessary care that can be expensive and potentially unsafe.

What is the difference between precertification and prior authorization?

Prior authorization—sometimes called precertification or prior approval—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.