As more of your patients move onto the Highmark system, understanding key preauthorization differences for your Legacy and Highmark system patients will help ensure faster processing times while reducing administrative burdens.
For patients on Highmark’s system, preauthorization requests must be submitted through NaviNet. We will be following Highmark’s list of procedures/DME requiring authorization.
You can access this list any time by going to the Provider Resource Center and clicking the “Requiring Authorization” tab at the top of the PRC homepage.
High-end imaging, cardiac imaging, and cardiac implantable devices will need to be submitted to NaviNet for Highmark system patients.
Requests for high-end imaging and radiation therapy services will continue to be sent to NIA Magellan for your Legacy system patients through the remainder of 2022.
You can submit preauthorization requests and view pending requests by logging into your NaviNet account and clicking “Authorization Submission” or “Auth Inquiry and Reports” on the side menu of Plan Central under “Workflows for This Plan.”
For additional guidance on how to navigate through NaviNet, please review the user guide here.
Beginning September 1, 2022, the New York State Office of Mental Health will implement new preauthorization criteria for inpatient behavioral health services for adults and children. This change will be effective for BOTH your Highmark system and Legacy system patients.
Under the new criteria, only your adult and pediatric patients with the following complexity triggers will require preauthorization for behavioral health admissions:
For additional information about preauthorization, please go here.
