As announced last month, we will implement important changes to the list of
services and drugs that require precertification effective for dates of service
on or after September 1, 2011 for Pennsylvania and Delaware members. The
updated precertification requirement
lists will be available in July at www.amerihealth.com/providers/preapproval.
The following precertification requirements will be added for all commercial
products in all settings:
-
potentially cosmetic procedures (please refer to the June edition of
Partners in Health Update for the complete list);
-
pain management procedures (paravertebral facet joint injections,
transforaminal epidural injections, epidural injections);
-
hyperbaric oxygen treatments;
-
additional medical infusion/injectable drugs (please refer to the June edition
of Partners in Health UpdateSMfor the complete list);
-
cataract surgery;
-
cochlear implant surgery;
- uvulopalatopharyngoplasty (UPPP or UP3).
The following precertification requirements will be removed for all
commercial products in all settings:
-
sleep studies
-
cardiac rehabilitation
-
pulmonary rehabilitation
As we proceed through this transition, it is very important for providers to
continue to refer to the most current precertification requirements list or to
use the NaviNet® web portal to verify member-specific requirements. Failure
to obtain precertification for any of the services or drugs that require it may
result in a reduction in payment or nonpayment for the services not
precertified.
Please call 1-800-275-2583 if you have any questions about these
upcoming changes.