Each year, the medical directors at AmeriHealth Administrators (AHA) review
the list of medical services and drugs that require precertification under AHA
plan members? medical plans. They consider provider practices, evidence-based
medicine, current standards of care, technology changes, and utilization
trends. On April 1, 2016, the updated list of services and medications
that require precertification will take effect for AHA plans. This list will be
available on the
AmeriHealth Administrators website under "Procedures and
medications that require precertification."
Coordination of precertification
requests
Some of the services or supplies on the precertification list may not be
covered by a particular AHA plan member?s medical benefits. When you request
precertification, AHA applies the benefits as defined in the AHA plan member?s
medical plan documents.
It is important that you request required precertification on your AHA plan
member?s behalf. You can request precertification through AHA in one of the
following ways:
- Submit the request electronically through iEXCHANGE®
- Call the number on the AHA plan member?s ID card.
AHA will apply the specified benefit reduction as described in the medical
plan if an AHA plan member receives a covered service or supply without the
required precertification. AHA will not precertify or authorize items that
the AHA plan member?s plan does not cover. For precertification of
behavioral health services, please contact Magellan HealthCare, Inc. at the
phone number on the plan member?s ID card.
How this may affect prescription drug
benefits
AHA uses this list solely to administer medical benefits. If an AHA plan
member has a prescription drug program through FutureScripts®, the drugs on the medical precertification list are not covered
under their prescription plan. However, some medications on AHA?s medical
precertification list may be covered through other pharmacy benefit managers?
programs.
If you have questions about this update to AHA?s Health Utilization
Management program or the updated precertification list, please contact AHA
Provider Relations.
Magellan Healthcare, Inc. manages mental health and
substance abuse benefits for most AmeriHealth members.