Requests for precertification with all supporting documentation should be submitted immediately upon identifying the inpatient request or at least 72 hours prior to the scheduled admission. This will allow IntegraNet to verify benefits and process the precertification request. For services that require prior authorization, IntegraNet makes case-by-case determinations that consider an individual’s health care needs and medical history, in conjunction with nationally recognized standards of care.

Physician Portal

The IntegraNet physician portal is the preferred method for the submission of preauthorization requests for providers requesting inpatient and outpatient medical services for members. Additionally, providers can use this tool to make inquiries on previously submitted requests regardless of how they were sent (phone, fax, or online portal).

Initiate preauthorization requests online, eliminating the need to fax. The portal allows detailed text, photo images and attachments to be submitted along with your request.

Make inquiries on previously submitted requests via phone, fax, or portal.

Instant accessibility from almost anywhere including after business hours.

Use the dashboard to provide a complete view of all UM requests with real-time status updates including alerts, faxes and email if requested using a valid email address.

Real-time results for some common procedures with immediate decisions.

Access a link to the portal through our website at https://www.IntegraNetHealth.com/ or the portal directly at www.InetDr.com.

To register for the portal, visit https://www.integranethealth.com/provider-registration

For an optimal experience with the portal Google Chrome is recommended. It is also recommended to clear the cache on a regular basis (browsing history).

For the below services, contact Amerivantage directly:

Transplant services

Behavioral Health

Our website will be updated as additional functionality and lines of business are added throughout the year.

Hospitals can confirm a precertification is on file using the portal or by calling Utilization Services at 281-591-5289 or 888-292-1923.

IntegraNet Health accepts electronic notifications of admission 24 hours a day, 7 days a week. The preferred method of electronic submission is through the IntegraNet Health Provider Portal at www.InetDr.com. Providers should contact the health plan directly for all inquiries regarding eligibility and benefits to accept precertification requests through the portal.

The precertification nurse will review the coverage request and the supporting medical documentation to determine the medical appropriateness of diagnostic and therapeutic procedures. When appropriate, the precertification nurse will assist the physician in identifying alternatives for health care delivery as supported by the medical director.

When the clinical information received is in accordance with the definition of medical necessity and in conjunction with nationally recognized standards of care, an IntegraNet reference number will be issued to the referring physician. All utilization guidelines must be supported by an individualized determination of medical necessity based on the member’s needs and medical history.

If medical necessity criteria for the admission are not met on the initial review, the Medical Director will contact the requesting physician to discuss the case.

If the precertification documentation is incomplete or inadequate, the precertification nurse will notify the referring provider to submit the additional necessary documentation.

If the Medical Director denies coverage of the request, the appropriate denial letter, including the appropriate appeal rights, will be mailed to the member and provider.

Member liability for inpatient admissions will be assigned only:

When the denial is issued prior to the services being rendered

When the important message from Medicare is delivered in accordance with CMS guidelines

When inpatient services were rendered by a nonparticipating facility, were not precertified and are not considered       services covered under the plan

Participating providers will be held liable for all other inpatient denials issued. Any subsequent appeals should follow the correct process as outlined in the denial letter.