[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-288623-105":3,"detail-sidebar-cat-1-en-105":80,"doc-detail-288623-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","navitus-tx-medicaid-prior-authorization-faqs","Navitus TX Medicaid Prior Authorization FAQs","","Navitus provides pharmacy prior authorization for Texas Medicaid and related STAR/STAR Kids and CHIP requests through a toll-free Pharmacy Provider Hotline. The document details contact hours, voicemail and return timing, faxing of determinations, and decision timelines based on request completeness and approval criteria. It explains 24/7 clinical support access, emergency 72-hour supply dispensing when response is not possible, and processes for denials, reconsideration, and appeals, including MCO accreditation differences.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/navitus-tx-medicaid-prior-authorization-faqs/288623/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/navitus-tx-medicaid-prior-authorization-faqs/288623.png","ImageObject",442,249,{"name":42,"@type":43},"Noah","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-09-23","2026-09-17",true,{"@type":52,"interactionType":53,"userInteractionCount":30},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"How do prescribers contact Navitus to request a Medicaid prior authorization?","Question",{"text":62,"@type":63},"Prescribers call the toll-free Pharmacy Provider Hotline at 877.908.6023 to request prior authorization for non-preferred drugs or drugs subject to Clinical Edits. Collect calls are also accepted.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"What decision timing applies for STAR/STAR Kids Medicaid prior authorization requests?",{"text":67,"@type":63},"Navitus reviews available medical and prescription drug claim history and completes reviews within 24 hours from receipt, with notifications sent within that timeframe.",{"name":69,"@type":60,"acceptedAnswer":70},"What happens if Navitus cannot respond within 24 hours or the situation is an emergency?",{"text":71,"@type":63},"Navitus allows the pharmacy to dispense a 72-hour emergency supply when it cannot provide a response within 24 hours after receipt and/or the prescriber cannot submit the PA because it is after office hours and the dispensing pharmacist determines it is an emergency.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},288623,1789633714,{"code":4,"msg":81,"data":82},"success",[83,88,93,98,103,108,112,117,122],{"id":84,"doc_module":22,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},11,"Presentations",90,"presentations",{"id":89,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},12,"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":110,"slug":111},17,40,"forms",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},18,"Letters",30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":81,"data":127},{"doc_id":78,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":109,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":30,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":79,"read_time":26},8796095462418,"https://ap-avatar.wpscdn.com/avatar/80000253c1241d02b47?x-image-process=image/resize,m_fixed,w_180,h_180&k=1778826106357471780","Contacting Navitus and Hours of Operations:  \nNavitus’ Pharmacy Prior Authorization is accessed via the same toll-free Pharmacy Provider Hotline for prescribers to call and request a prior authorization for non-preferred drugs or drugs that are subject to Clinical Edits. The phone number is: 877.908.6023. Collect calls will also be accepted.  \nNavitus’ Prior Authorization Department will be staffed with live agents knowledgeable in the Texas Medicaid pharmacy benefit no less than 6:00am to 6:00pm Monday-Friday and 8:00am to 12:00pm Saturday and Sunday Central time excluding state approved holidays.  \nDuring hours when the Pharmacy Prior Authorization department is closed, providers will have the option to leave a voicemail message, which will be returned the next business day. Navitus’ telephone system is capable of providing instructions to callers during closed hours, which can include normal hours of operation, emergency procedures, and other relevant information.  \nPrior authorization determinations are faxed to the prescriber immediately upon completion. Generally, prior authorization determination letters are processed the same day as the request.  \nClinical staff is available 24 hours a day, 7 days a week via Navitus Customer Care.  \nPrior Authorization Timelines:  \nNavitus will provide a decision at the time of the call, when the caller is requesting a Medicaid prior authorization and has all the necessary information required to complete the prior authorization review.  \nFor all other STAR/STAR Kids Medicaid prior authorization requests, Navitus will notify the prescriber’s office of a prior authorization denial or approval no later than 24 hours after receipt.  \nIf Navitus cannot provide a response to the prior authorization request within 24 hours after receipt orthe prescriber is not available to make a PA request because it is after the prescriber’s office hours and the dispensing pharmacist determines it is an emergency situation, Navitus will allow the pharmacy to dispense a 72-hour emergency supply of the drug. This requirement applies to drugs which can be filled as a 72-hour emergency supply.  \nFor CHIP prior authorization request, Navitus will provide a favorable determination when all information provided meets criteria for approval, no later than the second working day after the date of the request for utilization review and the receipt of all information necessary to complete the review.  \nFor CHIP prior authorization requests, when not all information provided meets criteria, Navitus will a denial within three days. If Navitus questions the medical necessity or appropriateness, or the experimental or investigational nature of health care services prior to the issuance of a denial, provider of record will be given a reasonable opportunity to discuss the plan of treatment for the enrollee with a physician.  \nIf the information provided meets criteria for approval, Navitus will issue the favorable determination no later than the second working day after the date of the request for utilization review and the receipt of all information necessary to complete the review.  \nSTAR/STAR Kids:  \nAll PA requests will be processed per the HHSC/Texas Medicaid (STAR) prior authorization requirements. Navitus will review the available medical and prescription drug claim history to determine whether the information shows that the member's condition meets the established criteria and if the request is considered a medical necessity decision. Reviews will be completed and notifications sent within 24 hours from receipt.  \na. If the information provided meets the prior authorization criteria or medical necessity criteria for approval, Navitus will approve the prior authorization, the prescriber will be notified, the member will be notified, and the patient can return to their pharmacy to obtain the prescription. The drug claim will be paid and no further action will be required. Approved requests for prior authorization will","cbCaiguiiIJBhlzv","https://ap.wps.com/l/cbCaiguiiIJBhlzv","pdf",504615,"English","# Contacting Navitus and Hours of Operations\n## Prior Authorization Timelines\n## STAR/STAR Kids\n## CHip Prior Authorization Processes","[{\"question\":\"How do prescribers contact Navitus to request a Medicaid prior authorization?\",\"answer\":\"Prescribers call the toll-free Pharmacy Provider Hotline at 877.908.6023 to request prior authorization for non-preferred drugs or drugs subject to Clinical Edits. Collect calls are also accepted.\"},{\"question\":\"What decision timing applies for STAR/STAR Kids Medicaid prior authorization requests?\",\"answer\":\"Navitus reviews available medical and prescription drug claim history and completes reviews within 24 hours from receipt, with notifications sent within that timeframe.\"},{\"question\":\"What happens if Navitus cannot respond within 24 hours or the situation is an emergency?\",\"answer\":\"Navitus allows the pharmacy to dispense a 72-hour emergency supply when it cannot provide a response within 24 hours after receipt and/or the prescriber cannot submit the PA because it is after office hours and the dispensing pharmacist determines it is an emergency.\"}]","Navitus TX Medicaid Prior Authorization FAQs | PDF"]