Provider and Pharmacy Directory

This directory provides a list of the NaviCare network plan providers, including physicians, specialists, hospitals, pharmacies, and other providers. If you would like a Provider and Pharmacy Directory mailed to you, please complete our online form.

Use our Find a Doctor tool to find a NaviCare provider
(This link will take you away from NaviCare's website.) To find NaviCare providers, go to the "Advanced Search" section, pick "Search a specific plan's network," and then choose "NaviCare" as your plan.

Download the 2025 NaviCare SCO and NaviCare HMO SNP Provider and Pharmacy Directory (pdf, last updated 11/13/2024)
This directory is current as of 11/13/2024. Some plan providers may have been added or removed from the list after this directory was created. 

Download the 2024 NaviCare SCO and NaviCare HMO SNP Provider and Pharmacy Directory (pdf, last updated 11/13/2024)
This directory is current as of 11/13/2024. Some plan providers may have been added or removed from the list after this directory was created. 

To get the most up-to-date information about NaviCare plan providers in your area:

  • Current members call:
    1-877-700-6996 (TRS 711), 8 a.m.–8 p.m., Monday–Friday
    (7 days a week, October 1–March 31) 
  • Prospective members call: 
    1-877-790-4971 (TRS 711), 8 a.m.–8 p.m., Monday–Friday
    (7 days a week, October 1–March 31)

You are entitled to ask for information on physician incentive payments from your plan. To obtain this information, call Enrollee Services at 1-877-700-6996 (TRS 711), 8 a.m.–8 p.m., Monday–Friday, (7 days a week, October 1–March 31).

We make sure you get the care you need

When you first enroll with NaviCare, we'll work with you to develop an Individualized Plan of Care to address your needs. If you have providers that you currently see who are not in our network, you may continue to see them for the first 90 days of your membership, or until you're assessed by your Care Team and your plan of care is implemented, whichever comes first.

Getting care from out-of-network providers as a NaviCare member

As a NaviCare member, you may get services from out-of-network providers when providers of specialized services aren't available in our network. For services to be covered from an out-of-network provider, your in-network provider (usually your PCP) must request prior authorization (approval in advance) from NaviCare. Fallon Health’s Utilization Management staff review the prior authorization request. This team is trained to understand the specialist’s area of expertise and will determine if that service is available within NaviCare’s network of specialists.

If the service isn't available within your plan’s network, your request will be approved. There may be certain limitations to the approval, such as whether you are approved for just one initial consultation visit or a specified type or amount of services.

If the specialist’s services are available within your plan’s network, the request for services outside of the network may be denied as “services available in network.” As with any denial, you'll have the option to appeal the determination.

The plan covers emergency care or urgently needed services that you get from an out-of-network provider. For more information about this, and to see what emergency or urgently needed services means, see your Chapter 3 in your Evidence of Coverage.

 

 

To view the PDF files above, you may need to download a free copy of Adobe® Acrobat Reader software on your computer. (This link takes you away from the NaviCare website.) Adobe® is a registered trademark of Adobe Systems Incorporated.

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The information on this page was last updated on 10/1/2024.