AmeriHealth has identified an increase in claims for follow-up care provided in an emergency room (ER) setting. Generally, follow-up care after an ER visit is considered routine care. Members should not be referred back to the ER for follow-up services when they can be referred to their primary physician or specialty care physician without medically harmful consequences. For commercial members, routine (nonemergent) follow-up care provided in the ER setting by a participating provider is not a covered service. Examples of routine follow-up care in the ER include the following: patient returns to have a prescription extended that was written in the ER; patient returns to the ER for reapplication of bandages, splints, or wraps; patient who had a laceration repaired with sutures returns to the ER to have the sutures removed. When follow-up care provided in the ER setting is denied as a noncovered service, commercial members may be billed for such noncovered services subject to the terms of your participating provider agreement. This requires, in relevant part, that you provide the member with prior written notice indicating that follow-up care in the ER setting is not covered and the member will be financially responsible.