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As outlined in the Provider Manual for Participating Professional
Providers*, when referring an AmeriHealth member for a surgical procedure
or hospital admission, the primary care physician needs to issue only
one referral to the specialist or attending/admitting
physician.
Please note the following:
- The referral will cover all facility-based (i.e., hospital, ambulatory
surgical center) services provided by the specialist or attending/admitting
physician for the treatment of the member?s condition.
- The referral is valid for 90 days from the date it was issued.
- The admitting physician should obtain the required preapproval.
- Any pre-admission testing and hospital-based physician services (e.g.,
anesthesia) will be covered under the hospital or surgical preapproval.
Certain products (e.g., HMO, POS, PPO) have specialized referral and
preapproval requirements and/or benefits exemptions. Please be sure to check
our websites for AmeriHealth New Jersey and
AmeriHealth
Pennsylvania for a list of services requiring preapproval.
*The Hospital Manual for
Participating Hospitals, Ancillary Facilities, and Ancillary Providers
will be updated to reflect this information.
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