COVID-19 (Coronavirus): Temporary suspension of certain prior authorizations

March 2, 2021

This article was revised on March 2, 2021, to update the effective dates.

AmeriHealth will suspend prior authorizations requirements for patients without a COVID-19 diagnosis from December 4, 2020, through March 31, 2021, for:

To quickly get your patients the care they need, there is no need to call AmeriHealth prior to transferring patients. Facilities must notify the UM department within contractual timeframes, but no longer than 2 business days from admission to acute or post-acute facility.

  • Transfers from acute in-network inpatient facilities to in-network post-acute facilities (long-term acute care hospitals, inpatient rehabilitation, skilled nursing facilities).

  • Transfers from acute in-network inpatient facilities to other in-network inpatient facilities and in-network ambulance transport.

We will continue to require and apply prior authorization for acute inpatient admissions from the emergency department at in- and out-of-network facilities for patients without a COVID-19 diagnosis.

AmeriHealth will suspend prior authorizations requirements for patients with a COVID-19 diagnosis from March 31, 2020, through March 31, 2021, for:

  • Acute in-network inpatient admissions from the emergency department

  • Transfers from acute in-network inpatient facilities to in-network post-acute facilities (long-term acute care hospitals, inpatient rehabilitation, skilled nursing facilities).

  • Transfers from acute in-network inpatient facilities to other in-network inpatient facilities and in-network ambulance transport.

Effective March 21, 2020, until 90 days after the end of both the Public Health Emergency and State of Emergency declared by the State of New Jersey in response to COVID-19, prior authorization will be waived for services delivered to AmeriHealth New Jersey members via telehealth/telemedicine regardless of diagnosis.

AmeriHealth is committed to providing our members with access to the care they need during the COVID-19 pandemic. We encourage all AmeriHealth members and providers to visit our dedicated AmeriHealth New Jersey and AmeriHealth Pennsylvania COVID-19 webpages regularly for the latest news and updates. We will continue to evaluate member needs as the situation changes.

AmeriHealth will continue to assess the situation based on COVID-19 activity and share updates with our provider community.

Utilization management

Facilities must continue to notify the AmeriHealth Utilization Management (UM) department within contractual time frames, but no longer than two business days from admission to an acute or post-acute facility.

The UM and Care Management departments will collaborate with facilities to gather clinical information and to assist in the coordination of transitions of care for members.

AmeriHealth retains the right to audit medical records, as warranted.