This article was revised on July 23, 2020, to update the suspension criteria and effective timeline.
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.
Temporary suspension of prior authorization during COVID-19 crisis
Effective March 31, 2020, through July 31, 2020, AmeriHealth temporarily suspended prior authorization for acute in-network inpatient admissions from the emergency department; transfers from acute in-network inpatient facilities to in-network post-acute facilities and other inpatient facilities; in-network transportation from acute inpatient facilities to subacute facilities; and in-network ambulance transport for any diagnoses.
Beginning August 1, 2020, AmeriHealth is modifying the policy to temporarily suspend prior authorization for:
- Acute in-network inpatient admissions from the emergency department for only COVID-19 diagnoses.
- Transfers from acute in-network inpatient facilities to in-network post-acute facilities (long-term acute care hospitals, inpatient rehabilitation, skilled nursing facilities) for only COVID-19 diagnoses.
- Transfers from acute in-network inpatient facilities to other in-network inpatient facilities and in-network ambulance transportation for only COVID-19 diagnoses.
The suspension will last until December 31, 2020. AmeriHealth will continue to assess the situation based on COVID-19 activity and share updates with our provider community.
Facilities must continue to 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.
AmeriHealth retains the right to audit medical records, as warranted.
For more information about the AmeriHealth position on COVID-19, please review the following resources: