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 Partners in Health UpdateSM

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View the latest news and information specific to the AmeriHealth-participating provider community below:
National Drug Code submission guidelines for co-packaged products listed as kits and multi-level packaged products (Billing & Reimbursement) P, A
Enhancements to the NaviNet Open Authorization Log attestation workflow (NaviNet) P, F, A
Required lead time when updating your provider information (Administrative) P, F, A
New Dosage and Frequency Program webpages now available  (Medical) P, F, A
Registered Nurse Health Coaches: Supporting providers and their patients  (Health and Wellness) P
View up-to-date policy activity on our Medical Policy Portal  (Medical) P, F, A
Becoming a credentialed professional provider (Administrative) P
Claim investigation and corrected claim submission procedures (NaviNet) P, F, A
Enhanced claim edits to align with industry standard billing rules for DME and P&O billing providers beginning August 1, 2019 (Billing & Reimbursement) A
Improved access to tele-behavioral health services for AmeriHealth members (Medical) P, F, A
Updated contact information for QIO contractors for Medicare health plan enrollees (Administrative) P, F, A
Updated: New drugs added to the Dosage and Frequency Program  (Medical) P, F, A
Encourage pregnant AmeriHealth members to enroll in Baby FootSteps  (Health and Wellness) P
Now in effect: Precertification requirement for non-emergent inpatient transfers, including ambulance transport, for AmeriHealth Pennsylvania members (Administrative) F
Enhanced claim edits to align with industry standard billing rules for injectable drugs and biological agents  (Billing & Reimbursement) P, F, A
Updates to the list of specialty drugs that will require precertification for AmeriHealth Pennsylvania members  (Medical) P, F, A
Now in effect: Accreditation requirement for office-based varicose vein procedures (Quality Management) P
AmeriHealth to offer drug rebates upfront, at the point of sale (Pharmacy) P
Tysabri added to the Most Cost-Effective Setting Program (Medical) P, F
Bridging medical and behavioral health care  (Quality Management) P
Required lead time when updating your provider information  (Administrative) P, F, A
Professional Injectable and Vaccine Fee Schedule updates effective July 1, 2019  (Billing & Reimbursement) P, F, A
AmeriHealth drug program formulary updates (Pharmacy) P, F, A

NaviNet® Open 

To help you navigate our secure, online provider portal and various transactions, we have created a central location for a variety of NaviNet web portal (NaviNet Open) resources, including user guides, webinars, and a communications archive.

NaviNet Open


Opioid Awareness

We have created a repository of tools and resources to assist you in managing your patients who are prescribed opioid medications.

Opioid Awareness Resources


Utilization Management

Certain utilization review activities are delegated to different entities. Here you will find detailed information on our utilization management programs and common resources used among them.

Utilization Management


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