NaviNet Customer Care 888-482-8057

Health care professionals associated with OHP can submit medical Aetna precertification transactions through NaviNet®:

• Access https://connect.navinet.net (or click Prospective Review)
• Select Aetna Health Plan from NaviNet Plan Central.
• Choose "Precertifications" from the transaction menu

While visiting our website, be sure to review the "Resources" section on Aetna Plan Central for quick and easy access to:

• Clinical Policy Bulletins
• Precertification Code Search Tool
• Precertification List

For a Medical contact or to complete an update to a previously submitted request please dial the appropriate Aetna provider service center and select the "precertification" option:

1-888-632-3862 for traditional (non-HMO) plans
1-800-624-0756 for HMO plans

1-800-462-5680

Customer Service Phone#:
1-800-261-6232

Health care professionals can access CIGNA Online Precertification using one of the following methods:

 - Via OHP

• From OHP Home page, click CIGNA under Health Plan Sites. OHP User ID and password required
• Select View and Submit Precertification Requests from the eServices page. This directs health care professionals to NaviNet. Select Precertifications from the transaction menu to access CIGNA Precertification transactions. Review CIGNA's Precertification Guidelines and Services Requiring Precertification by going to the Resources page>Clinical Reimbursement Policies and Payment Policies>Precertification Guidelines

• Select View and Submit Precertification Requests from the eServices page. This directs health care professionals to NaviNet. Select Precertifications from the transaction menu to access CIGNA Precertification transactions. Review CIGNA's Precertification Guidelines and Services Requiring Precertification by going to the Resources page>Clinical Reimbursement Policies and Payment Policies>Precertification Guidelines

  - Directly through NaviNet (www.NaviNet.net): NaviNet ID & Password Required

• Log into NaviNet. Select CIGNA HealthCare from your list of Health Plans. Select Precertifications from the transaction menu to access CIGNA Precertification transactions.

For more information on how to load Precertification through NaviNet go to www.cignaforhcp.com    Education and Help >Online Precertification

Process for requesting changes to a submitted request:

Health Care Professionals needing to update an existing precertification request (level of care change, continued stay review), should discuss the situation with the CIGNA Inpatient Case Manager (if located at the facility) or call the CIGNA Health Facilitation Center at 1.800.88CIGNA (1.800.882.4462).

Updates made to a precertification request will be viewable via the Precertification Inquiry function on NaviNet after the update is finalized.

Customer Service Phone:
1-800-440-1561

• Submit new pre-certification requests or search for existing pre-certifications (to which you are assigned as a provider).
• For more information on how to load and search for pre-certification requests in the Care Management Provider Portal, go to http://www.chpw.org/for-providers/provider-training/.

• Select Community Health Plan in the Health Plan Sites column on the home page.
• Click the Health Information Portal (HIP) link. Sign into the HIP portal.
• In the left navigation menu, select Provider Services > Authorizations > Request. This directs health care professionals to the login page of the Care Management Provider Portal.
• Submit new pre-certification requests or search for existing pre-certifications (to which you are assigned as a provider).
• For more information on how to load and search for pre-certification requests in the Care Management Provider Portal, go to http://www.chpw.org/for-providers/provider-training/

All types of impatient admissions and precertifications can be handled through this common pre-authorization online process.

1. Select the link provided or www.fchn.com and select Providers.

2. Select the pre-authorization and online forms link.

3. Select the appropriate member group from the Group Search drop down list. If the member's plan is not listed here, we do not provide medical management for that group. Please re-check the patient's ID card.

4. Once your group is selected, you may view that groups precertification list to determine if precertification is required.

5. Click on the Pre-authorization Request form and -complete form as directed.

6. Submit the required documentation by:

a. Fax to 1-888-272-3289
b. Secure email to preauthorization@fchn.com
c. The online form can be submitted:

i. Electronically via the web
ii. Printed and sent via fax or email with the required documentation.

Provider Assistance:
1-888-767-4670 option #2

Referred services are limited to those identified in the written authorization form. To request prior authorization for services not included on the authorization form, non-participating providers and facilities must contact the Referral Center at 503-813-4560, 8 a.m.-5 p.m., Mon-Fri.

Our Added Choice (point of service) plan is not a closed panel plan. Services requiring prior authorization are explained in the member's Evidence of Coverage. To request prior authorization, contact Permanente Advantage at 1-800-822-3399.

For general information, please contact Membership Services: 503-813-2000 or 1-800-813-2000, 8 a.m.-6 p.m., Mon-Fri.

For Medicare members, call 1-877-221-8221, 8 a.m.-8 p.m., seven days a week.

Physician and Provider Relations
Phone: 1-877-342-5258

Authorizations:
1-800-869-7175

Physician and Provider Relations
Phone: 1-877-342-5258

Physician and Provider Relations
Phone: 1-800-722-4714

1-800-322-1737 (Ask for help with using the web site)

For assistance with using
the website call our
Web Help Desk at 866-842-3278, option 2.

Prior Authorizations/Advance Notifications are required at least 5 days prior to the planned service date. Prior Authorization for home health services is required within 48 hours after the physician’s order.

For more information about services requiring a Prior Authorization or Advance Notification, please see the current Administrative Guide on UnitedHealthcareOnline.com at Tools & Resources > Policies, Protocols and Guides.

Prior Authorizations and Advance Notifications can be submitted or verified in any of the following ways:

1.Online: Log into UnitedHealthcareOnline.com and go to Notifications/Prior Authorizations > Notification/Prior Authorization Submission and follow the prompts. User ID & Password Required.

• Not registered on UnitedHealthcareOnline.com? Click on the New User link on the upper right hand corner of the home page and follow the prompts.

• For assistance entering or verifying a Prior Authorization, click on Help > Step-by-Step Help > Notification/Prior Authorization Status.

2.Electronically: Transmit Prior Authorizations/Advance Notifications and Referrals via the Health Care Services Review & Referral 278 (005010x217) transaction. More information

3.Fax:


• For commercial patients, use 866-756-9733
  
• For Medicare Complete members, use 800-676-4798
  
• For MedicareAdvantage Special Needs Plans members, use 800-538-1339.

4.Phone: Please refer to the number on the back of the member's ID card.

Registration/Login/Password Issues 1-800-693-8322

 For prior authorization requests, referral/authorization information and inpatient admission notification. User ID & Password Required

• Select iExchange under the "Services and Tools" section.
• Tracking number assigned upon submission of a notification can be used to track the case status.
• Alerts from UHC West are sent when a notification is reviewed and updated by the Medical Management Department.
• Ability to provide clinical notes to UHC West in the comments section
• Use the Library/Resource Center to access Provider Policy and Procedure Manuals and Medical Management guidelines
• If not already granted access to iEXCHANGE^TM, please request it by sending an e-mail to iexchange@uhc.com

To Request Prior Authorization contact (800) 762-8456

If there are no network specialties or ancillary providers identified within the service area for a necessary service, the physician must submit a completed United HealthcareWest Referral/Treatment Authorization Form to UHC West customer service/delegated Medical Group for approval.

Call 1-800-541-2894