COVID-19 (Coronavirus): Suspending prior authorization for acute care

May 12, 2020

This article was revised on May 12, 2020, to update the suspension timeline and to remove a reference to fully insured customers.

AmeriHealth is committed to providing our members with access to the care they need. As COVID-19 has escalated into a pandemic, we are working to make sure that our members can receive appropriate testing and treatment for the virus causing COVID-19 if needed.

We encourage all AmeriHealth members 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.

Temporary suspension of prior authorization during COVID-19 crisis

Effective immediately, AmeriHealth is temporarily suspending prior authorization for:

  • Acute in-network inpatient admissions from the emergency department for all diagnoses, including COVID-19.
  • Transfers from acute in-network inpatient facilities to in-network post-acute facilities (long-term acute care hospitals, inpatient rehabilitation, skilled nursing facilities) for any diagnoses.
    • This includes in-network transportation prior authorization requirements from the acute inpatient facility to a subacute facility.
  • Transfers from acute in-network inpatient facilities to other in-network inpatient facilities and in-network ambulance transportation for any diagnoses.

The suspension will last until June 30, 2020. At that time, we will reassess the situation based on COVID-19 activity.

Utilization management

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

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

Medical records

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

Learn more

For more information about the AmeriHealth position on COVID-19, please review the following resources: