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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:
Sepsis: Criteria for documenting, coding, and billing  (Medical) P, F, A
View up-to-date policy activity on our Medical Policy Portal  (Medical) P, F, A
Required lead time when updating your provider information  (Administrative) P, F, A
Now in effect: New policy criteria for treatment of osteoarthritis of the knee (Medical) P
Changes to reimbursement of consultation codes for commercial members  (Medical) P
Improved method to contact the AmeriHealth Pennsylvania Provider Network Services team (Administrative) P, F, A
Register now! Use our PEAR portal to manage clinical and financial activities  (PEAR portal) P
AmeriHealth New Jersey Value Formulary now in effect (Pharmacy) P, F, A
Enhanced claim edits to support correct coding principles and important information about professional reporting of observation care (Billing & Reimbursement) P, F, A
Updated payer ID grids now available  (Billing & Reimbursement) P, F, A
New 2020 AmeriHealth New Jersey Medigap plans (Products) P, F, A
Updated list of specialty drugs that require precertification for AmeriHealth New Jersey members now in effect (Medical) P, F, A
Updated list of specialty drugs that require precertification for AmeriHealth Pennsylvania members now in effect (Medical) P, F, A
Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing list for 2020 (Medical) P, F, A
Now in effect: Changes to precertification requirements for intravitreal VEGF products effective January 1, 2020 (Medical) P
Seven drugs to be added to the Most Cost-Effective Setting Program  (Medical) P, F
Updates to Magellan Care Guidelines for transcranial magnetic stimulation treatment (Medical) P

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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