Effective January 1, 2014, AmeriHealth will use a single precertification requirement list across all managed care products. This change is being made as we continue to look for ways to improve and simplify the precertification process:Significant changes will be made to the precertification requirements for the following two categories effective January 1, 2014:

• Outpatient surgical procedures. For standard HMO products, not all outpatient surgical procedures will require precertification. Only select outpatient surgical procedures will be included on the precertification requirement list.
• Durable medical equipment (DME) and prosthetic items. Currently, precertification is required for all rentals and purchases of DME and prosthetic items that cost more than $500. Effective January 1, 2014, the precertification requirement list will be updated to specify only certain DME and prosthetic items that will require precertification, regardless of the cost of these items.

These changes will be reflected in an updated precertification requirement list, which will be posted on the Preapproval/Precertification for Services web page on our website in December, prior to these changes going into effect. Look for more information about the availability of this new precertification requirement list in future editions of Partners in Health Update^SM. If you have any questions, please contact Cheryl McGurk, manager of precertification, at 215-241-4542.