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AmeriHealth 65® HMO members are required to use their
primary care physician's (PCP) capitated (designated) site for certain
services, such as laboratory. This article is a reminder that PCPs must refer
AmeriHealth 65 HMO members to their capitated site for these services. In order
for a member to receive these services at a location other than the PCP's
capitated site, Clinical Services must provide preapproval based on medical
necessity.
To verify what services are capitated for an AmeriHealth 65 HMO member, use
the Eligibility and Benefits Inquiry transaction on the NaviNet®
web portal and select the Capitated Site Information link on the
Eligibility and Benefits Details screen for that member.
For more information about capitated services, please refer to the
Provider Manual for Participating Professional Providers.
NaviNet is a registered trademark of NaviNet, Inc.
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