This article was revised on March 31, 2022, to update the coverage position.
Effective March 1, 2022, AmeriHealth has resumed prior authorizations requirements for transfers from acute in-network inpatient facilities to post-acute in-network facilities (long-term acute care hospitals, inpatient rehabilitation, skilled nursing facilities) for members with any diagnosis. This includes ambulance transport.
Effective March 21, 2020, prior authorization will be waived for services delivered to AmeriHealth New Jersey members via telehealth/telemedicine regardless of diagnosis.
These steps are intended to facilitate and reduce administrative processes for the placement of COVID-19 patients to the most appropriate care settings. Notification from facilities is still required.
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.
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.