This article was revised on October 28, 2021, to update the effective timeline for testing and treatment coverage.

Coverage of member cost-share

As previously communicated, AmeriHealth is waiving member cost-sharing (i.e., copayment, deductible, and coinsurance) for the following services:

• Testing. AmeriHealth will waive member cost-sharing for certain COVID-19 diagnostic and antibody tests in accordance with federal guidelines and company medical policy for the duration of the COVID-19 pandemic. For complete details, please review the policy News Article, Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for AmeriHealth Pennsylvania Members (Updated October 6, 2021).
  

• Inpatient treatment (see table for effective dates).

  • AmeriHealth will waive member cost-sharing for in-network, inpatient, acute care treatment of members diagnosed with COVID-19.
    

  • AmeriHealth will waive member cost-sharing for emergency room/department (ED) visits associated with admissions for in-network, inpatient, acute care treatment of COVID-19 whether for medical or behavioral health.

       Note: Cost-sharing is not waived for outpatient services provided in the ED for COVID-19 related services.​

We also communicated that self-funded customers can opt-out of waiving cost-sharing for the treatment of COVID-19; therefore, some members may still be required to pay their applicable cost-share. For High Deductible Health Plans, in-network cost-sharing waivers for COVID-19 related services detailed above will remain in effect through December 31, 2021, unless prohibited by law.​

Claims processing

Processes have been implemented to ensure provider payments are accurate and claims are processed in a timely fashion and in accordance with applicable law and regulatory guidance.

The following chart outlines how claims will be processed for the various services provided to AmeriHealth Pennsylvania members – specifically regarding member cost-sharing:

​​For information on how we are processing claims for PCP telemedicine services, please read this arti​cle.

Payment adjustments

If cost-sharing was inadvertently applied to the claim and it should have been removed, the claim will be adjusted to pay the provider the correct amount. We ask that providers wait until after the claim has been processed, and adjusted, to bill the member for any applicable cost-share noted on the Provider Explanation of Benefits.

As a result of the processes we have implemented, you will not need to contact the call center or submit a claim investigation via PEAR Practice Management on the Provider Engagement, Analytics & Reporting (PEAR) portal to request an adjustment.​

Learn more

Read more about our coverage of services during the COVID-19 public health emergency in our News Articles on our Medical and Claim Payment Policy Portal​.