Navitus Health Solutions Letter of Medical Necessity Guide
How to write an LMN and overturn a prior authorization denial with Navitus Health Solutions. Includes denial reasons, turnaround times, appeals address, and clinician tips.
Quick Facts
- Avg Turnaround: 72h standard, 24h expedited
- Appeals Address: Navitus Appeals, PO Box 1039, Appleton, WI 54912
- Provider Portal: https://www.navitus.com/
Why Navitus Denies Prior Authorizations
- 1. Non-formulary
- 2. Step therapy
- 3. PA required
- 4. Quantity limit
Clinician Tips for Navitus
- ✓ Pass-through pricing PBM owned by SSM Health and Costco
- ✓ Submit PA via CoverMyMeds or the Navitus portal
- ✓ Lumicera is the specialty pharmacy arm
100% pass-through PBM model — popular with self-insured employers and labor unions.
Navitus Prior Authorization FAQ
Why does Navitus deny prior authorizations?
The most common Navitus denial reasons are: Non-formulary; Step therapy; PA required; Quantity limit.
How long does Navitus take to review a prior authorization?
Navitus typically responds in 72h standard, 24h expedited.
What should a Letter of Medical Necessity for Navitus include?
An LMN for Navitus Health Solutions should reference the specific medical policy or coverage bulletin, document failed first-line therapies with dates, include current labs and ICD-10 codes, and cite supporting clinical guidelines. 100% pass-through PBM model — popular with self-insured employers and labor unions.