Ways to Avoid Common Errors in Electronic Prior Authorization Submissions
Submitting your electronic prior authorization requests thoroughly and accurately in NaviNet will help in processing your requests more quickly, help minimize claims errors, and help you get paid on time. Outlined below are ways to avoid the most common errors when submitting your prior authorization requests.
Do not duplicate authorizations.
- Amend existing authorizations via NaviNet.
- Update/amend existing approved inpatient planned admission via NaviNet.
You can verify if your authorization is a duplicate via NaviNet. As part of the authorization workflow, NaviNet will use the information you enter to determine if the request is a duplicate of an existing request even if the request was not submitted via NaviNet. If the authorization appears to be a duplicate, you will receive a message informing you that a duplicate may exist. You will also receive the reference number of the duplicate authorization along with a link to view that duplicate authorization. Please see our NaviNet Medical Authorizations Participant Guide (PDF) for full instructions on how to amend an authorization request.
Initiate amendments if more services/days are requested. Do not attach documents as a “request.”
Amending a request is the process of extending existing services or requesting another service on the same authorization. Amending is only available to requests that have been approved or partially approved by First Choice by Select Health of South Carolina. Submitting an attached document alone will not initiate a request without the authorization being amended. Please view our NaviNet Medical Authorizations Participant Guide (PDF) for full instructions on how to amend an authorization request.
Reference the Prior Authorization Lookup Tool before submitting authorization requests.
Please use the Prior Authorization Lookup Tool available on Select Health of South Carolina’s website to find out if a service requires prior authorization. In addition, the NaviNet new authorization prescreening questions contain links to the Prior Authorization Lookup Tool on the plan website. The Prior Authorization Lookup Tool allows you to enter the CPT or HCPCS code to help determine if the service requires prior authorization.
Enter all codes and units requested during initial submission or amendment.
Failure to enter complete data, including all relevant diagnosis codes, procedure codes, modifiers, and units, may delay the processing of your prior authorization request.
Do not add newborns who are not yet in the system under the mother’s record.
If the newborn’s record is not currently available in NaviNet, authorization requests for the newborn must be faxed to First Choice by Select Health of South Carolina at 1-866-368-4562. You cannot submit the authorization request under the mother’s record.
Understand the difference between urgent and emergent.
Outpatient urgent
An unexpected illness or injury that needs prompt medical attention but is not an immediate threat to the patient’s health.
Inpatient urgent
Potential admission for illness/injury that can be treated in a 24-hour period and if left untreated could rapidly become a crisis or emergency; member not currently admitted.
Inpatient emergent
Concurrent review; member is currently admitted.
Ensure HIPAA three points of verification are located on all pages of clinical documentation submitted.
The HIPAA three points of verification are:
- Member name
- Date of birth
- Member ID (either First Choice ID or Medicaid ID)
Submit delivery notifications correctly.
Please view our NaviNet Medical Authorizations Participant Guide (PDF) for full instructions on submitting a delivery notification. Accurately submitting a delivery notification via the NaviNet portal will provide a real-time response to the provider (no need for further follow-up or faxes).
Understand provider type differences between inpatient and outpatient requests.
For outpatient requests:
- The requesting provider is the referring provider — the provider who is requesting the member have the service.
- The servicing provider is the treating provider — the provider who is completing the service.
- These could be the same provider or different in an outpatient request.
For inpatient requests:
- The requesting provider is the referring provider — the provider who is requesting the member have the service.
- The servicing provider is the provider completing the service — also known as the attending provider.
- The servicing facility is the facility where the services are performed.
Include a phone and fax number under the contact information so the Utilization Management department can reach the provider.
Failure to provide complete contact information may delay the processing of your prior authorization request. When entering your contact information into NaviNet, there is a checkbox option that allows you to save your default contact information. Checking this option helps save time when entering future authorizations.
Ensure the admission date for an inpatient request is the date the member was admitted.
The admission date is not the date of the authorization request but needs to be verified as the date the member was admitted to the hospital or facility.
Do not use NaviNet to request a reconsideration or a peer-to-peer review (P2P).
NaviNet does not have the capability at this time to initiate these types of requests. For a reconsideration or P2P request, contact our Utilization Management department at 1-888-559-1010 or fax your request to 1-866-368-4562.