We previously communicated that the changes detailed below would be made to the list of services and drugs that require precertification for most commercial AmeriHealth New Jersey members effective for dates of service on or after June 1, 2012.* Please note that these changes will now go into effect for dates of service on or after July 1, 2012.

The following precertification requirements are being added in all settings effective for dates of service on or after July 1, 2012:

• potentially cosmetic procedures (please refer to the complete list below);
• pain management procedures (paravertebral facet joint injections, transforaminal epidural injections, epidural injections);
• additional medical infusion/injectable drugs (please refer to the complete list below);
• cataract surgery;
• cochlear implant surgery;
• hyperbaric oxygen;
• uvulopalatopharyngoplasty (UPPP or UP3).

The following precertification requirements are being removed in all settings effective for dates of service on or after July 1, 2012:

• sleep studies
• cardiac rehabilitation
• pulmonary rehabilitation

Cardiac radiology services

We also communicated that we will require precertification for cardiac radiology services (stress echocardiography, resting transthoracic echocardiography, and transesophageal echocardiography) for most commercial AmeriHealth New Jersey members effective for dates of service on or after June 1, 2012.*

Please note that we will allow a 30-day grace period for enforcement of these new precertification requirements, and providers will be required to observe these updated precertification requirements for dates of service on or after July 1, 2012. However, providers can begin to submit precertification requests for these services as of June 1, 2012.

It is very important that providers verify member-specific requirements using the NaviNet? web portal or by referring to the most current precertification requirement lists on our website. Failure to obtain precertification for any of the services or drugs that require it for dates of service on or after July 1, 2012, may result in a reduction in payment or nonpayment for the services not precertified.

Please call Customer Service at 1-800-275-2583 if you have any questions about these changes to precertification requirements.

*Comprehensive Major Medical [CMM] members are excluded. This change is pending approval from the New Jersey Department of Banking and Insurance for Small Employer Health (SEH) members.

**This drug is pending approval from the U.S. Food and Drug Administration.

NaviNet^® is a registered trademark of NaviNet, Inc.