New Medical Authorizations Log

Health Plans: 

  • Medical Mutual of Ohio

Workflow: 

  • Medical Authorizations Log

Overview

The Authorizations Log lets you view the status of entered authorization requests in NaviNet or on behalf of your office (where your attested provider is listed as the submitting, ordering, or servicing provider). For those records that you have access to, additional actions can be taken. The available actions vary based on the status of the request. 

About This New Features Guide

This New Features guide represents the NaviNet Open Authorizations Log implementation for Medical Mutual of OhioThis new features guide is not meant to be a user guide. For a complete user guide that describes all functionality in detail, see the NaviNet Open Medical Authorizations Log User Guide.

Accessing the Authorizations Log

To access the Authorizations Log:

  1. Sign in to NaviNet. On the Workflows menu, select My Health Plans, and then click your health plan. 
  2. Under Workflows For This Plan, click Medical Authorizations Log

Filtering and Sorting the Authorizations Log

You can filter and sort the authorization log presentation to meet your needs. To filter the authorizations list, select or specify items in the Filter by area of the screen:

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To sort the authorizations list by Date of Service or Date Submitted (descending) select an option from the Sort by drop-down menu:

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Statuses on the Authorizations Log

View the status of each authorization record on the Authorizations Log. Tip: To make sure you're viewing the latest status of the authorization, point to the authorization in the authorizations log  click Refresh Status

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  • Approved: An authorization request has been submitted to the health plan and has been approved. 
  • Auth Not Required: An authorization request has been successfully submitted to the plan but the plan has determined that no authorization is required for the member and criteria submitted.
  • Cancelled: An authorization request has been submitted to the health plan, but the health plan cancelled it. 
  • Complete: An authorization request has been submitted to the health plan, and it has been approved and completed.
  • Contact Payer: An authorization request has been submitted to the health plan, but you must contact the payer before it can be approved.
  • Denied: An authorization request has been submitted to the health plan but has been denied.  
  • Modified: The health plan has updated the status on one or more of the requested services on a previously submitted request.   
  • Partially Approved: An authorization request has been submitted to the health plan, but not all of the services have been approved.
  • Pending: An authorization request has been submitted to the health plan and is pending determination.  

Actions on the Authorizations Log

Point to any record in the Authorizations Log to see the list of available actions. The available actions depend on the status of the authorization and health plan-specific rules. Not all actions are available for all statuses. 

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  • Auth Details: Displays the Authorization Details for the selected record.  Click Back to Authorization Log to return to the log.  
  • Amend: Add, modify, or extend services on a previously submitted authorization. The type of service, status of the request, and health plan's rules determine which actions are available. Note: The Amend workflow does not save the authorization in an interim state. If the user cannot complete the Amend, the original authorization is retained with its original status.
  • Create New:  Create a new authorization for the patient.    
  • Continue: Edit authorizations that have been saved but have not been submitted to the health plan. These authorizations appear with the Incomplete status. When you click Continue, the Create New Authorization screen appears. 
  • Delete: Delete authorization records you no longer need or do not want to submit. You are prompted to confirm the action before a record is deleted. You can only delete authorizations that you created, and you cannot delete authorizations that have already been submitted to the health plan for processing. Note: Your office's security officer can delete any authorization submitted by someone in your office.
  • History: View a chronological list of actions taken on an authorization as it moves through the determination process. History information includes when an authorization was submitted and by whom, as well as when the status was updated.
  • Refresh Status: Retrieves the latest status of the authorization from the health plan. 

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