Navitus Customer Service — Expert Guide for Members, Pharmacies, and Plan Sponsors

Overview: who Navitus is and what customer service covers

Navitus Health Solutions is a pharmacy benefit manager (PBM) that supports payers, employers, and health plans with claims adjudication, formulary management, clinical programs, and cost-management strategies. For members and pharmacies, “customer service” at a PBM like Navitus covers benefits verification, prior authorization (PA) processing, claim remits/reversals, coordination with pharmacies, and clinical inquiries (drug interactions, dosing, specialty drug coordination).

When you contact Navitus customer service you are engaging with a multi-channel operation that must tie member identity (member ID and DOB), benefit parameters (BIN/PCN/Group), clinical rules (formulary and step therapy), and claim adjudication history. Knowing how those components fit together reduces friction: successful resolutions often depend on having the exact fields available from the member ID card and the pharmacy claim.

Primary contact channels and what to expect

Official contact points are posted on Navitus’ website (https://www.navitus.com) and on plan/member ID cards. For members, customer service typically offers a phone line for benefit verification and claims, an email or secure portal for documentation uploads, and a separate clinical or pharmacist line for medication questions. Pharmacies use an electronic claims path (real-time claims through the pharmacy management system), but they will also call the PBM help desk for rejects and reversals; the RxBIN and PCN from the member card route those calls internally.

Typical channel expectations in a modern PBM operation: phone-based inquiries resolve live issues (benefits, formulary status, PA requirements) immediately or within the call; PA determinations can be immediate for standard clinical submissions or require 24–72 hours if clinical review or external documentation is needed; complex appeals or administrative reconciliations may take up to 10 business days. Always verify hours of operation and the phone number on navitus.com or the back of the member ID card before calling.

Essential information to have before calling (high-value checklist)

• Member information: full name as on the ID, date of birth, member ID number, group number.
• Card routing data: BIN (6 digits), PCN (alphanumeric), and Rx Group from the ID card — these determine the claim pathway and the correct pharmacy queue.
• Prescription-level data: NDC (11-digit or 10-digit split as required), prescription number, date filled, prescriber name and NPI, pharmacy NPI and NCPDP number, quantity and days supply.
• Claim/transaction info: claim rejection message, error code, transaction reference number (if provided), and the POS (point-of-sale) adjudication response.
• Supporting clinical documents for PAs and appeals: chart notes, lab results with dates, prior therapy information with start/stop dates, and any step-therapy documentation.

Common issues and practical resolutions

Rejects due to eligibility or incorrect BIN/PCN are among the top problems. Resolution: confirm that the ID card data matches what was entered at the pharmacy; if the member has active coverage but the system shows ineligibility, escalate to eligibility support with proof of coverage (effective date and group) from the employer or plan sponsor.

Prior authorization denials are second-most frequent. To resolve efficiently, collect the required clinical documentation referenced in the denial, check the formulary alternatives (generic or therapeutic alternatives), and submit an expedited appeal if the drug is critical. For urgent medications, request a temporary override or emergency supply while the PA is processed; many PBMs (including Navitus clients) allow a 72-hour emergency supply in urgent cases.

Prior authorization workflow, appeals, and timelines

A best-practice PA workflow: (1) front-line pharmacy or prescriber checks formulary and PA rules via the clinical edit message returned on real-time adjudication; (2) prescriber submits PA with clinical documentation electronically or by fax; (3) clinical pharmacist or physician reviewer adjudicates the PA, typically within 24–72 business hours; (4) if denied, an appeal can be submitted with additional clinical evidence and should include dates, outcomes, and a proposed alternative therapy plan.

Expect turnaround targets: many PBMs aim for 72-hour standard reviews and 24–48-hour expedited reviews for urgent requests. If timeliness is critical (oncology, transplant, severe infection), request an expedited review and document the potential harm from delay in the submission.

Escalation, plan sponsor coordination, and dispute resolution

• Step 1 — Front-line resolution: call the member or pharmacy line and provide claim/session reference. Ask for immediate remediation (reprocess, override, or temporary supply) if possible.
• Step 2 — Clinical escalation: if the issue is a clinical edit or PA denial, escalate to the clinical review team with supporting medical records and a specific clinical question (e.g., “request step-therapy override due to documented intolerance to alternatives, see chart dated MM/DD/YYYY”). Expect a clinical review response within 24–72 hours.
• Step 3 — Plan sponsor/legal escalation: unresolved billing disputes, reconciliation issues, or systemic errors should be elevated to the plan sponsor/benefits administrator. Provide a written summary with claim IDs, dates of service, and financial impact. For formal appeals or external review rights, follow the contract and state/regulatory timelines noted in the plan document.

Data privacy, documentation, and recordkeeping

When you contact Navitus customer service, protected health information (PHI) will be exchanged; PHI handling must comply with HIPAA. Recordkeeping best practice: retain call reference numbers, names of representatives, and copies of any faxed clinical documents. For plan sponsors, reconcile remittance advices and explain any adjustments within 30–60 days based on contract terms.

For pharmacies, ensure fax confirmations and electronic submissions are archived for at least the period required by state board of pharmacy (commonly two to five years) and by payer contract (commonly three to seven years). This documentation is critical for audits, appeals, and downstream audits by employers or regulators.

Final practical tips

Always verify contact details on navitus.com and on the member ID card before initiating a call. Prepare the high-value checklist items (member ID, BIN/PCN, NDC, prescriber NPI) to reduce hold time and number of transfers. When possible, use the secure portal or electronic PA submission to speed clinical reviews and maintain an audit trail.

For plan sponsors needing account-level service (reporting, reconciliation, special pricing inquiries), request a dedicated client service manager and set quarterly review meetings. Regular reporting metrics to track: claims accuracy, PA turnaround time, generic fill rate, specialty spend as a percentage of total pharmacy spend, and audit findings — these KPIs drive continuous improvement and reduce customer-service volume over time.

How do I contact Navitus Customer Care?

844-268-9789
We’re here to help! Just call the Customer Care number listed on your pharmacy benefit member ID card, or call Navitus Customer Care at 844-268-9789.

Is Navitus owned by Costco?

Navitus is owned by nonprofit health system SSM Health and Costco Wholesale, managing Costco’s employees and dependents since 2019.

What insurance company is Navitus?

Navitus Health Solutions, LLC, owned by SSM Health and Costco Wholesale Corporation, was founded in 2003 as an alternative to traditional pharmacy benefit manager (PBM) models.

Why did I get a check from Navitus?

An AI Overview is not available for this searchCan’t generate an AI overview right now. Try again later.AI Overview You received a check from Navitus for one of several possible reasons related to your pharmacy benefits or adoption assistance. It could be a refund for a past overpayment, or a benefit related to the Adoption Assistance Program, according to Navitus. Alternatively, it could be a scam, so it’s crucial to verify the check’s legitimacy.  Here’s a more detailed breakdown: Possible Reasons for Receiving a Check from Navitus:

• Refund for Overpayment: . Opens in new tabIf you or your pharmacy overpaid for a prescription, Navitus may be sending a refund check. This is common if there was a discrepancy between the amount you paid and the amount your insurance plan covered. 
• Adoption Assistance Benefit: . Opens in new tabNavitus offers an Adoption Assistance Benefit that provides financial support for eligible associates adopting children. If you are enrolled in this benefit, the check could be related to reimbursement for eligible adoption expenses. 
• Other Reimbursements or Credits: . Opens in new tabNavitus may also issue checks for other reasons, such as incorrect claim processing or other credits related to your pharmacy benefits. 

Important Steps to Take:

1. 1. Verify the Check: . Opens in new tabIf you’re unsure why you received the check, contact Navitus directly to inquire about the reason for the payment. You can find their contact information on their website or your insurance card. 
2. 2. Check for Scams: . Opens in new tabUnfortunately, there are scams that involve fake checks. If you have any doubts about the legitimacy of the check, contact Navitus to verify its authenticity and avoid depositing it if you suspect fraud. 
3. 3. Contact the Bank: . Opens in new tabIf you decide to deposit the check, contact your bank to confirm that it’s valid and that there are no issues with the account information. 
4. 4. Review your Explanation of Benefits (EOB): . Opens in new tabYour EOB will detail the claims processed by Navitus for your prescriptions and any payments or adjustments made. 

By taking these steps, you can determine the reason for the check and ensure it is legitimate, protecting yourself from potential scams or errors. 

AI responses may include mistakes. Learn moreMember Rights and ResponsibilitiesReview and understand the information you receive about your prescription drug benefit and how to use Navitus services. Please vis…NavitusBenefits Overview – NavitusNavitus offers the Adoption Assistance Benefit. This provides eligible associates with up to $5,000 per adopted child for adoption…Navitus(function(){
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Does Navitus cover Wegovy for weight loss?

Certain weight loss medications are not required to be covered and Wegovy is not currently covered. What conditions / drugs commonly required prior authorization or step therapy? Call Navitus at 1.866.

Who owns Navitus?

SSM Health
Navitus Health Solutions is owned by SSM Health and Costco Wholesale and serves almost 18 million lives across 800 clients, including employers, unions, government plans, payors and health systems.