An AmeriHealth participating provider should refer members only to participating providers for covered services. This includes, but is not limited to, ancillary services such as laboratory and radiology, unless the provider has obtained preapproval from AmeriHealth for the use of a non-participating laboratory.
When applicable under the terms of your AmeriHealth Provider Agreement, if a provider continues to direct members and/or their lab specimens to a non-participating laboratory and does not obtain preapproval from AmeriHealth, the ordering provider is required to hold the member harmless.
The ordering provider will be responsible for all costs to the member and shall reimburse the member for such costs or be subject to claims offset by AmeriHealth for such costs. In addition, further non-compliance may result in a corrective action plan or immediate termination of your AmeriHealth Provider Agreement.
To learn more about compliance and what is required by your Provider Agreement, please visit our in-network laboratory services resource