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Identifying services that require preapproval/precertification

August 1, 2013

AmeriHealth requires preapproval/precertification for all elective inpatient admissions and certain outpatient or office-based services prior to being performed. We would like to remind you that all precertification requirements and guidelines can be accessed on the Preapproval/Precertification for Services page of our website. Note: These requirements vary by benefits plan and are subject to change. If your patient needs a medical service that requires preapproval/precertification, please contact AmeriHealth at least five business days prior to the scheduled date of the procedure to ensure documentation of timely preapproval/precertification. Preapproval/precertification can be requested through the NaviNet® web portal or by calling the Provider Automated System* at 1-800-275-2583. Note: This information does not apply to providers contracted with Magellan. Magellan-contracted providers should contact their Magellan Network Coordinator at 1-800-866-4108 for preapproval/precertification requests.

*The Provider Automated System will be phased out for AmeriHealth Pennsylvania members as they are migrated to our new operating platform.

NaviNet® is a registered trademark of NaviNet, Inc.


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