This article was revised on December 14, 2020, to change the program's launch date.
Beginning April 1, 2021, AmeriHealth Administrators will delegate precertification for certain services to eviCore healthcare (eviCore).
Providers should seek precertification from eviCore for:
- certain genetic/genomic tests (i.e., nucleic acid testing) and certain molecular analyses;
- radiation therapy.
Certain genetic/genomic tests and molecular analyses
Precertification for certain genetic/genomic tests (i.e., nucleic acid testing) and molecular analyses is required through eviCore.
The ordering provider is responsible for submitting precertification requests for the applicable tests. Failure to adhere to the precertification process may result in a bill to your patient.
When a request for genetic/genomic testing is received, laboratories must ensure a precertification is on file before rendering services. If precertification is not on file for the member, it is the laboratory’s responsibility to submit a request to eviCore.
Precertification for nonemergent outpatient radiation therapy services is required through eviCore. Precertification is not required when radiation therapy is rendered in the inpatient hospital setting.
Consistent with the updated NCCN Guidelines, eviCore has updated their Guidelines to consider hypofractionation medically necessary for specific populations. The Guidelines will no longer consider conventional fractionation medically necessary for these indications.
A request for precertification for conventional fractionation may require a peer-to-peer call with an eviCore Radiation Oncologist.
Additional information will be shared as it becomes available.