As you are aware, we have migrated AmeriHealth Pennsylvania commercial
members and AmeriHealth New Jersey Medicare Advantage members to our new
operating platform. In addition, we will migrate all AmeriHealth New Jersey
commercial members between September 1, 2015, and October 1, 2015. This new
platform has requirements that differ from our previous claims processing
system, including for anesthesia claims.
The new platform requires anesthesiologists to report the surgery or service
performed that relates to the anesthesia service being provided. When
submitting anesthesia claims electronically, there are three fields in which
providers can report the related surgery/service performed:
- Anesthesia Surg Proc CD
- Claim Note Note
- NOC Desc
Any claims that are submitted using ASA (American Society of
Anesthesiologists) codes that do not indicate the
related surgery or service performed in one of the aforementioned fields will
deny with the following rejection code:
- E5488: The description of the surgery or service reported
that relates to the anesthesia service performed is not valid or is not
reported.
If you have any questions about this billing requirement, please contact
your Network Coordinator or Provider Partnership Associate.