Referral and Authorization Management

Offered as an add-on product to Provider Communication Management, Referral and Authorization Management helps expand the communication exchange between health plans and provider networks. Providing automation for costly referral and authorization transactions, Referral and Authorization Management allows users to manage referrals and authorizations in real-time. The process can be submitted, tracked and managed by all constituents relevant to the specific submission, whether primary care physicians’ office staff or specialists. Functionality includes:

• Referral Status Inquiry
• Referral Submission
• Referral and Authorization Tracking and Management
• Pre-Certification Inquiry
• Pre-Certification Submission
• Pre-Certification Updates
• Notification of Pre-Certification Adjustment Results
• Requests for Additional Information
• Pre-Certification Requirements Look-up
• Drug Pre-Authorization
• Formulary Override or Appeal

For more information on NaviNet Referral and Authorization Management, please contact us.