Navitus Health Solutions Exception To Coverage Request Form

Navitus Health Solutions Exception To Coverage Request Form - Exception to Coverage Request Processing Timeframe Allow 72 hours for Exchange and Medicare Plans and 2 business days for Commercial Plans and 24 hours for Expedited Quantity Limit Increase Dose prescribed exceeds allowed quantity limits Indicate diagnosis clinical rationale why the covered quantity and or dosing are insufficient

Your prescriber may use the attached Supporting Information for an Exception Request or Prior Authorization form to support your request Provide additional information we should consider below or fax any supporting documents to the fax number above

Navitus Health Solutions Exception To Coverage Request Form

Navitus Health Solutions Exception To Coverage Request Form

Access Formularies via our Provider Portal navitus > Providers> Prescribers Login Exception to Coverage Request Complete Legibly to Expedite Processing Navitus Health Solutions PO BOX 999 Appleton, WI 54912-0999 Customer Care: 1-866-333-2757 Fax: 1-855-668-8551 COMPLETE REQUIRED CRITERIA AND FAX TO: NAVITUS …

The Exception to Coverage ETC process allows members to request coverage of medications that show formulary restrictions The five criteria that would justify an ETC form are 1 Not Covered NC 2 New Not Reviewed Drug ND NR 3 Quantity Limit QL 4 Gender Specific 5 High Dose HD The ETC form cannot be used to request copay

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A prescriber can submit a Prior Authorization Form to Navitus via U S Mail or fax or they can contact our call center to speak to a Prior Authorization Specialist The request processes as quickly as possible once all required information is together

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How to file a Manual Claim Select the proper claim form below OTC COVID 19 At Home Test Claim Form PDF Direct Member Reimbursement Claim Form PDF Compound Claim Form PDF Foreign Claim Form PDF Complete all the information on the form

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A coverage exception request is made prior to a formal denial process such as grievance or appeal Benefit limitations for which exceptions to coverage are requested include coverage for drugs not normally covered due to Non covered formulary status Plan exclusions established by the client

Navitus Health Solutions has partnered with CoverMyMeds to offer electronic prior authorization (ePA) services. Select the appropriate Navitus Health Solutions form to get started. CoverMyMeds is Navitus Health Solutions Prior Authorization Forms’s Preferred Method for Receiving ePA Requests.

PO BOX 999 Exception To Coverage Request

Navitus believes that effective and efficient communication is the key to ensuring a strong working relationship with our prescribers The Prescriber Portal offers 24 7 access to plan specifications formulary and prior authorization forms everything you need to manage your business and provide your patients the best possible care

Navitus Health Solutions Exception To Coverage Request Form

A coverage exception request is made prior to a formal denial process such as grievance or appeal Benefit limitations for which exceptions to coverage are requested include coverage for drugs not normally covered due to Non covered formulary status Plan exclusions established by the client

Your prescriber may use the attached Supporting Information for an Exception Request or Prior Authorization form to support your request Provide additional information we should consider below or fax any supporting documents to the fax number above

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