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This section includes drug formulary updates, medical policy notifications, precertification changes, and other medical- and pharmacy-related topics.

Communications

2023 Updates

Medi
2022 Updates
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  Changes to medical policy on insertion of implantable infusion pumps Posted: 12/22/2022
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  November policy updates include automatic external cardioverter defibrillators Posted: 12/19/2022
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  Changes to the Most Cost-Effective Setting Program Posted: 12/14/2022
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  Changes to medical policy on percutaneous coronary intervention, coronary angiography, and arterial ultrasound Posted: 11/23/2022
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  Changes to medical policy on high-technology radiology services Posted: 11/23/2022
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  Changes to medical policy on musculoskeletal services Posted: 11/23/2022
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  Important alert about Labcorp in-home screenings Posted: 11/22/2022
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  Temporary suspension of precertification extended for nutritional formulas and enteral nutrition Posted: 11/17/2022
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  October policy updates Posted: 11/10/2022
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  Upcoming: Updates to the medical benefit specialty drug cost-share list Posted: 11/7/2022
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  Changes to medical policy on ostomy supplies Posted: 11/4/2022
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  Update to medical policy on maintenance treatment of opioid or alcohol use disorder Posted: 11/1/2022
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  Notifications of policies going into effect January 1, 2023 Posted: 11/1/2022
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  Updated InterQual^® Criteria for 2022 Posted: 10/25/2022
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  Ordering Synagis^® (palivizumab) for the 2022-2023 RSV season Posted: 10/20/2022
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  Clarification on Updated 2022 InterQual^® Criteria Posted: 10/19/2022
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  Upcoming: Updates to the list of specialty drugs that will require precertification Posted: 10/18/2022
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  Changes to medical policy on radiation therapy services Posted: 10/17/2022
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  Expanded coverage of pneumococcal 15-valent conjugate vaccine Posted: 10/12/2022
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  September policy updates Posted: 10/10/2022
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  Changes to medical policy on Pemetrexed (Alimta^®), Pemetrexed (Pemfexy™) Posted: 10/7/2022
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  Changes to medical policy on pneumatic compression therapy devices Posted: 9/23/2022
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  Changes to medical policy on Eculizumab (Soliris^®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris^®) Posted: 9/19/2022
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  Updated InterQual^® Criteria for 2022 Posted: 9/13/2022
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  Monkeypox: Member coverage for laboratory testing, vaccination, and treatment Posted: 9/13/2022
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  Changes to policy on musculoskeletal services Posted: 9/12/2022
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  Changes to policy on sleep disorder testing and positive airway pressure therapy services and supplies Posted: 9/12/2022
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  Update to policy on high-technology radiology services Posted: 9/12/2022
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  August policy updates Posted: 9/6/2022
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  Change to medical policy on Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend^®), Granisetron (Sustol^®), and Rolapitant (Varubi^®) Posted: 8/30/2022
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  Changes to medical policy on outpatient physical medicine, rehabilitation, and habilitation services Posted: 8/29/2022
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  Change to medical policy on home health care services Posted: 8/29/2022
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  Reminder: CRNP and PA credentialing and reimbursement Posted: 8/16/2022
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  Changes to medical policy on wheelchair cushions and seating Posted: 8/16/2022
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  Changes to medical policy on home prothrombin time monitoring Posted: 8/16/2022
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  Changes to medical policy on hospital beds and accessories Posted: 8/12/2022
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  AmeriHealth New Jersey and Thyme Care collaborate to support members with cancer Posted: 8/11/2022
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  July policy updates Posted: 8/5/2022
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  New policy on Aducanumab (Aduhelm^TM) for Alzheimer disease Posted: 7/26/2022
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  Now in effect: Updated telemedicine and telehealth services policy Posted: 7/19/2022
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  Updates to medical policy on obstructive sleep apnea and primary snoring Posted: 7/19/2022
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  Now in effect: Updated policy on power wheelchairs, vehicles, and devices Posted: 7/18/2022
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  Precertification requests for enhanced utilization management services for AmeriHealth Administrators Posted: 7/12/2022
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  Preventive Coverage of Colonoscopies Posted: 7/7/2022
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  Now in effect: Updates to the list of specialty drugs that will require precertification Posted: 7/6/2022
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  Now in effect: Updated proton beam radiation therapy policy Posted: 7/5/2022
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  June policy updates Posted: 7/5/2022
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  New update on medical policy regarding power wheelchairs, vehicles, and devices Posted: 6/23/2022
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  Upcoming changes to policy for wheelchair options and accessories Posted: 6/21/2022
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  Changes to the Direct Ship Drug Program Posted: 6/20/2022
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  Updates made to coverage regarding specific techniques for Uterine Fibroid Myolysis Posted: 6/6/2022
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  May policy updates Posted: 6/2/2022
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  New telemedicine reimbursement rate effective June 1, 2022 Posted: 6/1/2022
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  Revised guidelines: High-Technology Radiology Services Posted: 5/26/2022
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  Precertification process for respiratory assist devices Posted: 5/26/2022
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  Announcing new medical policy! Psychiatric collaborative care management (CoCM) Posted: 5/17/2022
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  Changes to medical policy regarding Stem-Cell Therapy Posted: 5/9/2022
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  April policy updates include Intravenous Ketamine Posted: 5/3/2022
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  AmeriHealth New Jersey telemedicine changes Posted: 4/21/2022
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  Selective photothermolysis using pulsed-dye lasers Posted: 4/20/2022
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  Anesthesia services for spinal pain management Posted: 4/12/2022
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  AmeriHealth Administrators to offer enhanced utilization management solutions through AIM and eviCore Posted: 4/7/2022
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  Bronchial valve placement changes Posted: 4/7/2022
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  Updates to the Proton Beam Radiation Therapy medical policy Posted: 4/6/2022
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  Now in effect: Updated preferred products for select oncology and oncology adjunct therapies Posted: 4/5/2022
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  Clinical Guidelines for cardiology updated Posted: 4/4/2022
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  March policy updates include EMG, Nerve Conduction Studies Posted: 4/4/2022
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  COVID-19 (Coronavirus): Prior authorizations for acute care resume Posted: 3/31/2022
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  Updates to the list of specialty drugs that will require precertification Posted: 3/31/2022
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  Updates to the medical benefit specialty drug cost-share list effective July 1, 2022 Posted: 3/31/2022
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  Clinical Guidelines for radiology revised Posted: 3/31/2022
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  Reimbursement of long-acting reversible contraceptives supplied after an obstetrical delivery Posted: 3/28/2022
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  Tezspire™ eligible for coverage under the medical benefit Posted: 3/24/2022
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  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 3/2/2022
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  Telemedicine reimbursement rate update Posted: 3/1/2022
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  Changes to the Most Cost-Effective Setting Program Posted: 2/15/2022
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  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 2/1/2022
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  Preferred products for infliximab Posted: 1/12/2022
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  New Implant Reimbursement Request Form for AmeriHealth New Jersey Posted: 1/10/2022
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  Non-Remote and Remote Intraoperative Neurophysiological Monitoring (INM) coverage clarification Posted: 1/6/2022
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  Needle Electromyography (EMG) and Nerve Conduction Studies (NCS) coverage criteria changes Posted: 1/6/2022
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  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 1/5/2022
Medi
2021 Updates
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  Updated preferred products for select oncology and oncology adjunct therapies Posted: 12/29/2021
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  Hepatoma screening initiative for AmeriHealth New Jersey Posted: 12/28/2021
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  COVID-19 (Coronavirus): Urgent Care providers cost-share waiver Posted: 12/28/2021
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  Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo^®) coverage criteria changes Posted: 12/22/2021
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  Quartet is expanding behavioral services for patients Posted: 12/20/2021
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  Changes to the Most Cost-Effective Setting Program Posted: 12/8/2021
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  Elzonris^® and Trogarzo^™ policies to be archivedPosted: 12/6/2021
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  Important changes to Pepaxto^® coverage Posted: 12/6/2021
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  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 12/1/2021
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  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 11/22/2021
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  Updates to the list of specialty drugs that will require precertification Posted: 11/22/2021
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  COVID-19 (Coronavirus): Vaccine information Posted: 11/11/2021
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  COVID-19 (Coronavirus): Vaccine coverage and reimbursement Posted: 11/11/2021
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  Pegfilgrastim (Neulasta^®) and related biosimilars coverage criteria changes Posted: 11/10/2021
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  Assistant-at-Surgery Services reimbursement policy update Posted: 11/5/2021
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  Now in effect! Preferred product for injectable treprostinil Posted: 11/3/2021
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  COVID-19 (Coronavirus): Infusion drug treatment Posted: 10/29/2021
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  COVID-19 (Coronavirus): Member coverage for treatment Posted: 10/29/2021
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  COVID-19 (Coronavirus): Member coverage for testing Posted: 10/29/2021
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  COVID-19 (Coronavirus): Telemedicine services for AmeriHealth New Jersey members Posted: 10/29/2021
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  COVID-19 (Coronavirus): Member cost-share claims processing for AmeriHealth New Jersey members Posted: 10/28/2021
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  COVID-19 (Coronavirus): Member cost-share claims processing for testing and treatment for AmeriHealth Pennsylvania members Posted: 10/28/2021
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  Help monitor COVID-19 patients at home with pulse oximeters Posted: 10/27/2021
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  COVID-19 (Coronavirus): Billing and coding for testing Posted: 10/27/2021
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  Ordering Synagis^® (palivizumab) for 2021-2022 RSV season Posted: 10/26/2021
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  Updates to the medical benefit specialty drug cost-share list effective January 1, 2022 Posted: 10/21/2021
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  Important updates to AmeriHealth Pennsylvania telemedicine policy for commercial members Posted: 10/12/2021
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  An innovative approach to behavioral health Posted: 10/8/2021
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  CRNP and PA credentialing and reimbursement Posted: 10/7/2021
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  Reminder: Changes to reimbursement of consultation codes for commercial members Posted: 10/4/2021
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  COVID-19 (Coronavirus): Telemedicine services for AmeriHealth Pennsylvania members Posted: 10/1/2021
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  Annual Synagis^® (palivizumab) distribution programPosted: 9/30/2021
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  Radiation Therapy Clinical Guidelines – effective October 1, 2021 Posted: 9/28/2021
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  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 9/27/2021
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  Coverage for preventive PrEP services Posted: 9/20/2021
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  Two drugs added to the Most Cost-Effective Setting Program Posted: 9/15/2021
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  Expanded coverage of Shingrix for AmeriHealth members Posted: 9/13/2021
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  Check medical policies before processing claims Posted: 9/3/2021
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  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 8/31/2021
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  Preferred product for the generic injectable treprostinil Posted: 8/10/2021
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  Have you visited the Medical & Claim Payment Policy portal lately? Posted: 8/2/2021
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  Updated Colorectal Cancer Screening Preventive Coverage Posted: 7/27/2021
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  COVID-19 (Coronavirus): Pharmacologic nuclear stress testing Posted: 7/15/2021
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  Updated InterQual^® guidelines for 2021 Posted: 7/13/2021
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  Aduhelm™ for treatment of Alzheimer’s disease considered experimental/investigational Posted: 7/8/2021
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  Now in effect! Updates to the list of specialty drugs that require precertification Posted: 7/1/2021
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  Now in effect! Updates to the medical benefit specialty drug cost-share list effective July 1, 2021Posted: 7/1/2021
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  COVID-19 (Coronavirus): DME requirements reinstated Posted: 7/1/2021
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  Have you visited the Medical & Claim Payment Policy portal lately?Posted: 7/1/2021
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  COVID-19 (Coronavirus): Coverage for respiratory equipment and related supplies Posted: 7/1/2021
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  COVID-19 (Coronavirus): Well visits for adult and pediatric members Posted: 7/1/2021
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  Update to AmeriHealth Pennsylvania commercial telemedicine policy Posted: 6/30/2021
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  Updated Radiation Therapy Clinical GuidelinesPosted: 6/29/2021
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  Updates to the list of specialty drugs that will require precertification Posted: 6/29/2021
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  Updates to the medical benefit specialty drug cost-share list effective July 1, 2021Posted: 6/29/2021
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  AmeriHealth Medical and Claim Payment Policy portalPosted: 6/28/2021
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  COVID-19 (Coronavirus): Certain DME requirements waived Posted: 4/27/2021
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  Now in effect: Changes to the Direct Ship Drug ProgramPosted: 4/15/2021
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  Now in effect: Two drugs added to the Most Cost-Effective Setting Program Posted: 4/8/2021
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  Now in effect: Preferred products for long- and short-acting colony-stimulating factorsPosted: 4/1/2021
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  AmeriHealth New Jersey physical therapy and occupational therapy network expansionPosted: 4/1/2021
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  COVID-19 (Coronavirus): Member coverage for testing and treatment Posted: 3/31/2021
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  COVID-19 (Coronavirus): How to become a vaccinator Posted: 3/30/2021
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  Changes to the Direct Ship Drug ProgramPosted: 3/25/2021
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  Two drugs added to the Most Cost-Effective Setting Program Posted: 3/25/2021
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  COVID-19 (Coronavirus): Vaccine reporting requirements Posted: 3/10/2021
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  COVID-19 (Coronavirus): Non-traditional providers Posted: 3/10/2021
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  New LTAC precertification form Posted: 3/8/2021
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  AmeriHealth Administrators to delegate some precertification to eviCore Posted: 1/28/2021
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  COVID-19 (Coronavirus): Specimen collection by medical professionals Posted: 1/8/2021
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  Now in effect: Updates to the medical benefit specialty drug cost-share list as of January 1, 2021Posted: 1/4/2021
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  Now in effect: Coverage changes for select injectable asthma drugsPosted: 1/4/2021
Medi
2020 Updates
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  Updated list of specialty drugs that require precertification now in effect Posted: 12/30/2020
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  Preferred products for long- and short-acting colony-stimulating factors Posted: 12/30/2020
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  Medical policy changes for polyarticular juvenile idiopathic arthritis drugs Posted: 12/8/2020
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  Reminder: The annual Synagis^®(palivizumab) distribution programPosted: 12/7/2020
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  COVID-19 (Coronavirus): Update to AIM guidelines to allow CT for diagnosis of COVID-19 pneumoniaPosted: 12/2/2020
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  Archival of several medical policiesPosted: 12/2/2020
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  Updated Lab Management Clinical GuidelinesPosted: 12/1/2020
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  ACT 81: Medical coverage for newborns for AmeriHealth Pennsylvania membersPosted: 11/23/2020
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  New code added as a benefit exclusion for correcting an intraocular lensPosted: 11/5/2020
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  View up-to-date policy activity on our Medical and Claim Payment Policy PortalPosted: 10/27/2020
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  Upcoming changes to billing requirements for deep brain stimulation Posted: 10/26/2020
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  Avastin^®is the preferred product for treatment of vascular endothelial growth factorPosted: 10/26/2020
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  Reminder: The annual Synagis^® (palivizumab) distribution programPosted: 10/14/2020
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  Updated policies on musculoskeletal services: AIM guidelines for select interventional pain management and spinal and joint surgical proceduresPosted: 10/14/2020
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  AmeriHealth to update telemedicine coverage in 2021 Posted: 10/2/2020
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  Updates to the list of specialty drugs that will require precertification Posted: 10/2/2020
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  Medical necessity criteria for skilled and subacute care in a Skilled Nursing FacilityPosted: 10/1/2020
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  Updates to the medical benefit specialty drug cost-share list effective January 1, 2021Posted: 10/1/2020
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  Now in effect! Updated Radiation Therapy Clinical GuidelinesPosted: 10/1/2020
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  Now in effect: Three drugs added to the Most Cost-Effective Setting Program Posted: 10/1/2020
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  Coverage changes for select injectable asthma drugs Posted: 10/1/2020
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  Encourage flu vaccinationsPosted: 9/25/2020
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  New guide for post-acute facility admissionsPosted: 9/23/2020
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  Updated coverage criteria for trigger point injections without medication Posted: 9/14/2020
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  Annual Synagis^® (palivizumab) distribution programPosted: 9/14/2020
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  Three drugs to be added to the Most Cost-Effective Setting ProgramPosted: 9/1/2020
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  Now in effect! Updates to the list of specialty drugs that require precertification Posted: 9/1/2020
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  Clinical criteria and guidelines used for determinations of medically necessary coverage decisions Posted: 8/14/2020
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  Updated sleep study precertification requirementsPosted: 8/7/2020
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  Updates to the list of specialty drugs that will require precertificationPosted: 7/31/2020
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  Updated InterQual^® Criteria for 2020Posted: 7/30/2020
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  Now in effect! Updates to the list of specialty drugs that require precertificationPosted: 7/29/2020
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  Now in effect: Preferred products for select oncology biosimilarsPosted: 7/9/2020
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  Updated Radiation Therapy Clinical GuidelinesPosted: 7/2/2020
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  Now in effect: Two drugs added to the Most Cost-Effective Setting ProgramPosted: 7/1/2020
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  COVID-19 (Coronavirus): Travel recommendations and precautionsPosted: 6/30/2020
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  Preferred products announced for select oncology biosimilars Posted: 6/16/2020
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  Two drugs to be added to the Most Cost-Effective Setting ProgramPosted: 5/28/2020
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  Updates to the list of medical benefit specialty drugs that will require precertification and/or cost-share effective July 1, 2020Posted: 4/3/2020
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  View up-to-date policy activity on our Medical Policy Portal Posted: 3/4/2020
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  Avoid denials and processing delays by submitting necessary information for vendor-based utilization management authorization requestsPosted: 3/3/2020
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  Archival of policy regarding electrical stimulation and electromagnetic stimulation for the treatment of wounds Posted: 2/19/2020
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  Change to reimbursement criteria for office-based dermatological pathology proceduresPosted: 2/18/2020
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  View up-to-date policy activity on our Medical Policy PortalPosted: 2/18/2020
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  Preferred products announced for select oncology biosimilars Posted: 2/13/2020
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  Archival of policy regarding cardiac pacemaker reportingPosted: 2/10/2020
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  Archival of policy regarding myocardial perfusion imaging Posted: 2/3/2020
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  Now in effect: Seven drugs added to the Most Cost-Effective Setting Program Posted: 2/3/2020
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  View up-to-date policy activity on our Medical Policy Portal Posted: 1/23/2020
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  Sepsis: Criteria for documenting, coding, and billing Posted: 1/23/2020
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  Now in effect: New policy criteria for treatment of osteoarthritis of the kneePosted: 1/16/2020
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  Changes to reimbursement of consultation codes for commercial members Posted: 1/15/2020
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  Updated list of specialty drugs that require precertification for AmeriHealth Pennsylvania members now in effectPosted: 1/2/2020
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  Updated list of specialty drugs that require precertification for AmeriHealth New Jersey members now in effectPosted: 1/2/2020
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  Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing list for 2020Posted: 1/2/2020
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  Now in effect: Changes to precertification requirements for intravitreal VEGF products effective January 1, 2020Posted: 1/2/2020
Medi
2019 Updates
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  Seven drugs to be added to the Most Cost-Effective Setting Program Posted: 12/30/2019
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  Updates to Magellan Care Guidelines for transcranial magnetic stimulation treatmentPosted: 12/30/2019
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  View up-to-date policy activity on our Medical Policy Portal Posted: 12/18/2019
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  Clinical Appropriateness Guidelines for Radiology to be updatedPosted: 12/17/2019
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  Self-funded groups must elect to participate in vendor-based utilization management programsPosted: 12/16/2019
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  Updates to the specialty drugs covered under the pharmacy benefitPosted: 12/12/2019
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  Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing list for 2020Posted: 12/3/2019
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  Updates to the list of specialty drugs that will require precertification for AmeriHealth Pennsylvania membersPosted: 12/2/2019
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  Updates to the list of specialty drugs that will require precertification for AmeriHealth New Jersey membersPosted: 12/2/2019
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  View up-to-date policy activity on our Medical Policy Portal Posted: 11/21/2019
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  Eleven new drugs added to the Dosage and Frequency ProgramPosted: 11/15/2019
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  Vaccinations recommended for adult AmeriHealth membersPosted: 11/5/2019
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  Changes to precertification requirements for intravitreal VEGF products effective January 1, 2020Posted: 11/1/2019
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  View up-to-date policy activity on our Medical Policy PortalPosted: 10/24/2019
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  Scheduling annual well-care visitsPosted: 10/21/2019
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  Reminder: Coverage criteria for the annual Synagis^® (palivizumab) distribution program Posted: 10/17/2019
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  Act now! Encourage adults to get flu vaccinationsPosted: 10/10/2019
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  Introducing the new PEAR portal for managing clinical and financial activitiesPosted: 10/4/2019
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  New policy criteria for treatment of osteoarthritis of the kneePosted: 10/3/2019
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  Updated policy for Direct Access to OB/GYN servicesPosted: 10/2/2019
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  Updates to the list of specialty drugs that will require precertification for AmeriHealth New Jersey membersPosted: 10/2/2019
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  Updates to the list of specialty drugs that will require precertification for AmeriHealth Pennsylvania membersPosted: 10/2/2019
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  Changes to precertification requirements for intravitreal VEGF products effective January 1, 2020Posted: 10/2/2019
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  Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing list for 2020Posted: 9/30/2019
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  Expanding preventive coverage of HPV vaccinePosted: 9/27/2019
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  Coverage update for surgical and minimally invasive treatments for urinary outlet obstruction due to BPHPosted: 9/27/2019
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  View up-to-date policy activity on our Medical Policy PortalPosted: 9/24/2019
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  Save the date! Pennsylvania will host Medication-Assisted Treatment Regional Summits this fallPosted: 9/19/2019
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  Important information! CRNP contracting and credentialingPosted: 9/17/2019
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  Coverage criteria for the annual Synagis^® (palivizumab) distribution program Posted: 9/9/2019
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  AIM to allow pre-service review for arterial ultrasounds Posted: 9/4/2019
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  Reminder: Tysabri^® added to the Most Cost-Effective Setting Program Posted: 9/3/2019
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  Now in effect: New claim payment policy for multiple therapies Posted: 9/3/2019
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  Clinical Appropriateness Guidelines for Radiology to be updatedPosted: 9/3/2019
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  Changes to the Most Cost-Effective Setting Program: Pediatric exceptionPosted: 8/27/2019
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  Skilled nursing, subacute, and inpatient rehabilitation facility admission guidelinesPosted: 8/23/2019
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  View up-to-date policy activity on our Medical Policy PortalPosted: 8/21/2019
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  Changes to the annual Synagis^® (palivizumab) distribution program Posted: 8/9/2019
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  New claim payment policy for multiple therapies Posted: 8/1/2019
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  View up-to-date policy activity on our Medical Policy PortalPosted: 7/22/2019
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  Updated InterQual^® Criteria for 2019Posted: 7/15/2019
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  Claim reprocessing for multiple procedure payment reductions on certain diagnostic services for AmeriHealth New Jersey membersPosted: 7/3/2019
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  Specialty drugs that require precertification for AmeriHealth Pennsylvania members as of July 1, 2019Posted: 7/1/2019
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  Radiation Therapy Clinical Guidelines updated as of July 1, 2019Posted: 7/1/2019
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  The AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing list updated as of July 1, 2019Posted: 7/1/2019
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  Clinical Appropriateness Guidelines for Radiology updated as of July 1, 2019Posted: 7/1/2019
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  Clinical Appropriateness Guidelines for Arterial Ultrasound updated as of July 1, 2019Posted: 7/1/2019
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  Clinical Appropriateness Guidelines for Advanced Imaging of the Heart updated as of July 1, 2019Posted: 7/1/2019
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  New Dosage and Frequency Program webpages now available Posted: 6/21/2019
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  View up-to-date policy activity on our Medical Policy Portal Posted: 6/20/2019
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  Updated: New drugs added to the Dosage and Frequency Program Posted: 6/5/2019
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  Updates to the list of specialty drugs that will require precertification for AmeriHealth Pennsylvania members Posted: 6/3/2019
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  Tysabri^® added to the Most Cost-Effective Setting ProgramPosted: 5/30/2019
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  Preventive coverage of exercise interventions for the prevention of falls for commercial membersPosted: 5/22/2019
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  View up-to-date policy activity on our Medical Policy Portal Posted: 5/20/2019
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  Measles disease outbreak and vaccine coverage for AmeriHealth commercial membersPosted: 5/20/2019
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  Cost-sharing and billing requirements for preventive colonoscopy and flexible sigmoidoscopy services provided to AmeriHealth New Jersey membersPosted: 5/6/2019
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  Cost-sharing and billing requirements for preventive colonoscopy and flexible sigmoidoscopy services provided to AmeriHealth Pennsylvania membersPosted: 5/6/2019
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  Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing listPosted: 5/1/2019
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  Clinical Appropriateness Guidelines for Arterial Ultrasound to be updatedPosted: 5/1/2019
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  Clinical Appropriateness Guidelines for Radiology to be updatedPosted: 5/1/2019
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  Clinical Appropriateness Guidelines for Advanced Imaging of the Heart to be updatedPosted: 5/1/2019
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  View up-to-date policy activity on our Medical Policy Portal Posted: 4/22/2019
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  Updated Radiation Therapy Clinical GuidelinesPosted: 4/22/2019
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  FDA releases statement on the efficacy of Lartruvo^®Posted: 4/12/2019
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  Self-funded groups must elect to participate in vendor-based utilization management programsPosted: 4/8/2019
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  Mumps disease outbreak and vaccine coverage for AmeriHealth members Posted: 4/5/2019
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  Updates to Direct Ship Drug Program listPosted: 4/4/2019
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  Reminder: Updated reimbursement policy for CRNPs and PAs Posted: 4/3/2019
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  Claim reprocessing for multiple procedure payment reductions on certain diagnostic services for AmeriHealth Pennsylvania membersPosted: 3/28/2019
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  View up-to-date policy activity on our Medical Policy Portal Posted: 3/25/2019
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  Preventive coverage of spinal muscular atrophy screening for AmeriHealth Pennsylvania membersPosted: 3/18/2019
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  Suspected meningococcal disease outbreak and vaccine coverage for AmeriHealth New Jersey membersPosted: 3/15/2019
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  Updated reimbursement policy for CRNPs and PAs Posted: 3/1/2019
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  View up-to-date policy activity on our Medical Policy Portal Posted: 2/22/2019
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  Updates to the list of specialty drugs that require precertification for AmeriHealth New Jersey membersPosted: 2/20/2019
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  New drugs to be added to the Dosage and Frequency ProgramPosted: 2/18/2019
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  Updates to the list of specialty drugs that require precertification for AmeriHealth Pennsylvania membersPosted: 2/15/2019
- •
  Four drugs added to the Dosage and Frequency ProgramPosted: 1/25/2019
- •
  Three drugs added to Most Cost-Effective Setting Program for AmeriHealth New Jersey membersPosted: 1/25/2019
- •
  Four drugs added to Most Cost-Effective Setting Program for AmeriHealth Pennsylvania membersPosted: 1/25/2019
- •
  Reminder: Updated credentialing requirements for CRNPs and PAsPosted: 1/24/2019
- •
  Acupuncture benefits and new network now in effectPosted: 1/22/2019
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 1/22/2019
- •
  Changes coming to application of Modifier 59 in 2019Posted: 1/11/2019
- •
  Changes to the management of CAPS drugs now in effectPosted: 1/7/2019
- •
  Updated list of specialty drugs that require precertification for AmeriHealth Pennsylvania members now in effectPosted: 1/3/2019
- •
  Updated list of specialty drugs that require precertification for AmeriHealth New Jersey members now in effectPosted: 1/3/2019
- •
  Frequency limit established for trigger point injections for myofascial pain syndromePosted: 1/3/2019
- •
  Updated AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing list now in effectPosted: 1/3/2019
Medi
2018 Updates
- •
  New policy on pediatric intensive day feeding programPosted: 12/28/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 12/19/2018
- •
  Outbreak of life-threatening coagulopathy associated with synthetic cannabinoids usePosted: 12/14/2018
- •
  Updated credentialing requirements for CRNPs and PAsPosted: 12/12/2018
- •
  Reminder: New acupuncture benefit and networkPosted: 12/6/2018
- •
  Reminder: Updates to the list of specialty drugs that will require precertification for AmeriHealth Pennsylvania membersPosted: 12/5/2018
- •
  Reminder: Updates to the list of specialty drugs that will require precertification for AmeriHealth New Jersey membersPosted: 12/5/2018
- •
  Reminder: Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing listPosted: 12/5/2018
- •
  Updated policy for facility reporting of observation servicesPosted: 11/30/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 11/26/2018
- •
  Four drugs added to Most Cost-Effective Setting Program for AmeriHealth Pennsylvania membersPosted: 11/5/2018
- •
  Four drugs to be added to Most Cost-Effective Setting Program for AmeriHealth New Jersey membersPosted: 11/5/2018
- •
  Updates to the list of specialty drugs that will require precertification for AmeriHealth New Jersey membersPosted: 11/1/2018
- •
  Updates to the list of specialty drugs that will require precertification for AmeriHealth Pennsylvania membersPosted: 11/1/2018
- •
  Three drugs to be added to the Dosage and Frequency ProgramPosted: 11/1/2018
- •
  Reminder: Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing listPosted: 11/1/2018
- •
  Updated Clinical Appropriateness Guidelines for Radiology now availablePosted: 10/29/2018
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 10/18/2018
- •
  Important news about the annual Synagis^® (palivizumab) distribution program Posted: 10/17/2018
- •
  Changes to the seasonal influenza vaccine recommendations for 2017 – 2018 Posted: 10/9/2018
- •
  Acupuncture benefits and new network Posted: 10/3/2018
- •
  New Most Cost-Effective Setting Program webpages Posted: 10/3/2018
- •
  Updated Radiation Therapy Clinical Guidelines now availablePosted: 10/1/2018
- •
  Changes to the management of CAPS drugsPosted: 10/1/2018
- •
  Changes to reimbursement of anesthesia physical status modifiersPosted: 10/1/2018
- •
  Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing listPosted: 9/28/2018
- •
  Updates to the list of specialty drugs that will require precertification for AmeriHealth New Jersey membersPosted: 9/25/2018
- •
  Updates to the list of specialty drugs that will require precertification for AmeriHealth Pennsylvania membersPosted: 9/25/2018
- •
  Updated policy on proton beam radiation therapyPosted: 9/19/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 9/18/2018
- •
  Update to multiple procedure payment reductions on certain diagnostic servicesPosted: 9/14/2018
- •
  Annual Synagis^® (palivizumab) distribution program approaching Posted: 9/13/2018
- •
  Four drugs to be added to the Dosage and Frequency ProgramPosted: 9/11/2018
- •
  Reimbursement for observation services with an ER visitPosted: 9/6/2018
- •
  Updated policy on aqueous shunts, microstents, viscocanalostomy, and canaloplasty for the treatment of glaucoma Posted: 9/5/2018
- •
  Upcoming change to the clinical review of Home Health servicesPosted: 8/31/2018
- •
  New precertification requirement for Onpattro^TM (patisiran) for AmeriHealth Pennsylvania membersPosted: 8/17/2018
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 8/16/2018
- •
  Revised guidelines for colorectal cancer screening for average-risk-level AmeriHealth Pennsylvania adult membersPosted: 8/9/2018
- •
  Revised guidelines for colorectal cancer screening for average-risk-level AmeriHealth New Jersey adult membersPosted: 8/9/2018
- •
  Updated Radiation Therapy Clinical GuidelinesPosted: 8/8/2018
- •
  Updated Clinical Appropriateness Guidelines for RadiologyPosted: 8/8/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 7/18/2018
- •
  Updated InterQual^® Criteria for 2018Posted: 7/16/2018
- •
  Three drugs to be added to the Dosage and Frequency ProgramPosted: 7/10/2018
- •
  Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing list now in effectPosted: 7/2/2018
- •
  Four drugs to be added to Most Cost-Effective Setting Program for AmeriHealth Pennsylvania membersPosted: 6/26/2018
- •
  Four drugs to be added to Most Cost-Effective Setting Program for AmeriHealth New Jersey membersPosted: 6/26/2018
- •
  Updated coverage positions on zoster and hepatitis B vaccinesPosted: 6/18/2018
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 6/18/2018
- •
  Reminder: Updates to the list of specialty drugs that require precertification for AmeriHealth Pennsylvania members Posted: 6/15/2018
- •
  Updated policy on SCODIPosted: 6/13/2018
- •
  Updates to Direct Ship Drug Program request formsPosted: 6/11/2018
- •
  Updated information regarding our Cardiology Utilization Management ProgramPosted: 6/11/2018
- •
  Site of service changes and new coverage option for Benlysta^® now in effect Posted: 6/1/2018
- •
  Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing listPosted: 5/31/2018
- •
  Billing of date ranges for DME and specialty pharmacyPosted: 5/24/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 5/18/2018
- •
  Updates to the list of specialty drugs that require precertification for AmeriHealth Pennsylvania membersPosted: 5/10/2018
- •
  Reminder: Site of service changes and new coverage option for Benlysta^® Posted: 5/1/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 4/20/2018
- •
  Code update for home prothrombin time monitoringPosted: 4/13/2018
- •
  Code update for TENS and associated suppliesPosted: 4/6/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 3/14/2018
- •
  Reminder: Home-based sleep testing now requires precertification Posted: 3/2/2018
- •
  Reminder: Updates to the list of specialty drugs that require precertification for AmeriHealth Pennsylvania membersPosted: 3/2/2018
- •
  Reminder: Delegation of precertification for interventional pain management services to AIM now in effectPosted: 3/1/2018
- •
  Site of service changes and new coverage option for Benlysta^® Posted: 3/1/2018
- •
  Updated policy on DME and consumable medical suppliesPosted: 2/23/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 2/15/2018
- •
  Changes for pathologists reporting services in the office settingPosted: 2/13/2018
- •
  Reminder: Delegation of precertification for interventional pain management services to AIMPosted: 2/12/2018
- •
  Updates to the AmeriHealth Pennsylvania medical benefit specialty drug cost-sharing list for 2018Posted: 2/6/2018
- •
  Updates to the list of specialty drugs that require precertification for AmeriHealth Pennsylvania membersPosted: 1/30/2018
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 1/16/2018
- •
  Coverage position changes for endovenous mechanochemical ablationPosted: 1/4/2018
- •
  Update to the nebulizers policy to include inhalation solutionsPosted: 1/4/2018
- •
  Announcing soft launch period for new Musculoskeletal Utilization Management ProgramPosted: 1/3/2018
- •
  Coverage changes for office-based pathology servicesPosted: 1/3/2018
- •
  Updated policy for Mohs' micrographic surgery Posted: 1/2/2018
Medi
2017 Updates
- •
  Important: Postponement of new AmeriHealth New Jersey policy regarding CPT^® consultation codesPosted: 12/28/2017
- •
  Upcoming changes to billing requirements for neuropsychological testing for neurologically based conditionsPosted: 12/27/2017
- •
  Precertification requirement for fractional flow reserve added to AIM Radiology Guidelines Posted: 12/22/2017
- •
  Updates to the list of specialty drugs that will require precertificationPosted: 12/21/2017
- •
  Reminder: Updates to Most Cost-Effective Setting Program for injectable and infusion therapy drugsPosted: 12/18/2017
- •
  Three drugs to be added to the Dosage and Frequency ProgramPosted: 12/15/2017
- •
  Update regarding InterQual^® guidelines for 2017Posted: 12/15/2017
- •
  Reminder of utilization management programs effective January 2018 and delegation of precertification review to AIM Posted: 12/15/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 12/14/2017
- •
  Precertification of spinal bone growth stimulators Posted: 12/4/2017
- •
  Closing of pathology network for new office-based pathology providersPosted: 12/1/2017
- •
  Announcing the expansion of the AmeriHealth Musculoskeletal Utilization Management Program to include services for interventional pain management Posted: 12/1/2017
- •
  Home-based sleep testing to require precertification Posted: 12/1/2017
- •
  Reminder: New Cardiology Utilization Management Program through AIMPosted: 11/28/2017
- •
  Reminder: New utilization management program for musculoskeletal servicesPosted: 11/28/2017
- •
  Update regarding InterQual^® guidelines for 2017Posted: 11/20/2017
- •
  Reminder: Updates to Most Cost-Effective Setting Program for injectable and infusion therapy drugsPosted: 11/17/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 11/17/2017
- •
  Three drugs to be added to the Dosage and Frequency ProgramPosted: 11/15/2017
- •
  New policy for laboratory-based vestibular function testingPosted: 11/15/2017
- •
  Updates to our policy on presumptive and definitive drug testing in substance abuse and pain management treatmentsPosted: 11/15/2017
- •
  Updates to the list of specialty drugs that will require precertificationPosted: 11/14/2017
- •
  Changes to recent Notification regarding precertification requirements for CINV/antiemetic agentsPosted: 11/14/2017
- •
  Updated policy on the treatment of glaucomaPosted: 11/1/2017
- •
  Now in effect: Preferred product for enzyme replacement to treat Gaucher's disease Posted: 10/26/2017
- •
  Reminder: Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic testsPosted: 10/25/2017
- •
  Important news about the annual Synagis^® (palivizumab) distribution program Posted: 10/23/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 10/18/2017
- •
  Updates to Most Cost-Effective Setting Program for injectable and infusion therapy drugsPosted: 10/16/2017
- •
  Changes to management of subcutaneous immunoglobulin now in effectPosted: 10/5/2017
- •
  New AmeriHealth New Jersey policy regarding CPT^® consultation codesPosted: 10/3/2017
- •
  Announcing Cardiology Utilization Management Program through AIMPosted: 10/3/2017
- •
  Announcing new utilization management program for musculoskeletal servicesPosted: 10/3/2017
- •
  Upcoming changes to specialty drugs requiring precertificationPosted: 10/2/2017
- •
  Select chemotherapy-induced nausea and vomiting drugs to require precertificationPosted: 10/2/2017
- •
  New precertification requirement for CAR T-cell therapyPosted: 9/22/2017
- •
  Updated policy on cast and splint applications and suppliesPosted: 9/21/2017
- •
  Reminder: Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic testsPosted: 9/21/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 9/18/2017
- •
  Updates to our Most Cost-Effective Setting Program now in effectPosted: 9/7/2017
- •
  Annual Synagis^® (palivizumab) distribution program approaching Posted: 9/5/2017
- •
  Reminder: Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic testsPosted: 8/22/2017
- •
  Reminder: Seven drugs to be added to Most Cost-Effective Setting ProgramPosted: 8/17/2017
- •
  Get up-to-date health notifications for your patients Posted: 8/16/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 8/11/2017
- •
  Initiatives to combat opioid misuse and abuse for AmeriHealth Pennsylvania membersPosted: 8/7/2017
- •
  Initiatives to combat opioid misuse and abuse for AmeriHealth New Jersey membersPosted: 8/7/2017
- •
  Upcoming changes to billing requirements for septoplastyPosted: 8/3/2017
- •
  Preferred product designated for enzyme replacement to treat Gaucher's diseasePosted: 7/26/2017
- •
  Updates to the policy on Modifier 25 reporting and reimbursementPosted: 7/24/2017
- •
  Reminder: Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic testsPosted: 7/20/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 7/17/2017
- •
  Updates to presumptive and definitive drug testing in substance abuse and pain management treatments Posted: 7/7/2017
- •
  Reminder: Seven drugs to be added to Most Cost-Effective Setting ProgramPosted: 7/6/2017
- •
  Updated billing requirements for preventive colonoscopy and flexible sigmoidoscopy services provided to AmeriHealth Pennsylvania membersPosted: 7/5/2017
- •
  Updated billing requirements for preventive colonoscopy and flexible sigmoidoscopy services provided to AmeriHealth New Jersey membersPosted: 7/5/2017
- •
  Updated policy on toe nail debridementPosted: 6/29/2017
- •
  Medical codes for services that require precertificationPosted: 6/28/2017
- •
  Updated InterQual^® guidelines for 2017Posted: 6/21/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 6/19/2017
- •
  Precertification requirements for Spinraza™ (nusinersen) and Bavencio^® (avelumab) Posted: 6/15/2017
- •
  Updated Lab Management Clinical GuidelinesPosted: 6/13/2017
- •
  Combined policies for abdominoplasty, panniculectomy, abdominal lipectomy, and other excisions of redundant skin Posted: 6/7/2017
- •
  Update to our Radiation Treatment of Breast Carcinoma guideline Posted: 6/1/2017
- •
  New policy for autonomic nervous system testingPosted: 5/26/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 5/19/2017
- •
  Seven drugs to be added to Most Cost-Effective Setting ProgramPosted: 5/16/2017
- •
  Clear Claim Connection^™ transaction to be removed from NaviNet^®Posted: 5/9/2017
- •
  Reminder: Our policy on inpatient hospital readmissionsPosted: 5/4/2017
- •
  Updated policy on Modifier 25 reporting and reimbursementPosted: 5/1/2017
- •
  Reminder: Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic testsPosted: 5/1/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 4/20/2017
- •
  Medical policy for Frenectomy or Frenotomy for Ankyloglossia (Tongue-Tie)Posted: 4/14/2017
- •
  Four drugs added to the Dosage and Frequency ProgramPosted: 4/13/2017
- •
  New policy for Therapeutic Drug Monitoring for Antidepressants, Antipsychotics, or AntiepilepticsPosted: 3/28/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 3/13/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 2/6/2017
- •
  2016 SOAP Progress Note submission deadline for the ePASS^® incentive programPosted: 2/1/2017
- •
  Neulasta^®: Updates to precertification and setting requirements and coverage options now in effectPosted: 1/11/2017
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 1/10/2017
- •
  Billing guidelines for leuprolide acetate (Lupron Depot^® and Eligard^®)Posted: 1/6/2017
- •
  Reminder: Changes to precertification requirements for 2017Posted: 1/6/2017
Medi
2016 Updates
- •
  Clarification: Billing requirements and cost-sharing for Preventive colorectal cancer screeningPosted: 12/1/2016
- •
  Reminder: Neulasta^®: Updates to precertification requirements, sites of service, and coverage optionsPosted: 12/1/2016
- •
  Reminder: Upcoming changes to precertification requirements for 2017Posted: 12/1/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 12/1/2016
- •
  Reminder: Upcoming changes to AmeriHealth Pennsylvania's medical benefit specialty drug cost-sharing for 2017Posted: 12/1/2016
- •
  Cost-sharing and billing requirements for Preventivecolorectal cancer screeningPosted: 10/31/2016
- •
  Neulasta^®: Updates to precertification requirements, sites of service, and coverage optionsPosted: 10/31/2016
- •
  Coverage for transgender servicesPosted: 10/31/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 10/31/2016
- •
  Updates to Most Cost-Effective Setting Program for injectable and infusion therapy drugsPosted: 10/3/2016
- •
  Updated policy for anesthesia servicesPosted: 10/3/2016
- •
  Upcoming changes to drug precertification requirements for 2017Posted: 10/3/2016
- •
  Coverage position changes for select medical servicesPosted: 10/3/2016
- •
  Changes to our ePASS^® incentive opportunity for professional providersPosted: 10/3/2016
- •
  Important news about the annual Synagis^® (palivizumab) distribution programPosted: 10/3/2016
- •
  Upcoming changes to AmeriHealth Pennsylvania's medical benefit specialty drug cost-sharing for 2017Posted: 10/3/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 10/3/2016
- •
  Upcoming precertification changes for outpatient, non-emergent radiation therapy servicesPosted: 10/3/2016
- •
  Upcoming changes to precertification requirements for Cologuard^™ and NIPT/NIPSPosted: 10/3/2016
- •
  Why health plans partner with vendors for Personal Health Visits (New Jersey only)Posted: 8/31/2016
- •
  Upcoming changes to our ePASS^® incentive opportunity for professional providersPosted: 8/31/2016
- •
  Changes to the seasonal influenza vaccine recommendations for 2016-2017Posted: 8/31/2016
- •
  Annual Synagis^® (palivizumab) distribution program approachingPosted: 8/31/2016
- •
  Injectable hyaluronate acid products removed from the Direct Ship Drug ProgramPosted: 8/31/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 8/31/2016
- •
  Updated Radiation Therapy Clinical GuidelinesPosted: 8/31/2016
- •
  Updated policies for Always Bundled Procedure CodesPosted: 7/29/2016
- •
  New policies for Modifier 53: Discontinued ProcedurePosted: 7/29/2016
- •
  Coverage requirements for applied behavioral analysis for the treatment of autism spectrum disordersPosted: 7/29/2016
- •
  Upcoming changes to 2016 ePASS^® incentive opportunityPosted: 7/29/2016
- •
  Upcoming coverage position changes for certain laboratory testsPosted: 7/29/2016
- •
  Vitamin D testing policies now in effectPosted: 7/29/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 7/29/2016
- •
  Reminder: Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic tests now in effectPosted: 7/29/2016
- •
  Updates to policies pertaining to nerve conduction studies and needle electromyographyPosted: 6/30/2016
- •
  Yervoy^® being added to Dosing and Frequency ProgramPosted: 6/30/2016
- •
  Updated InterQual^® guidelines for 2016Posted: 6/30/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 6/30/2016
- •
  Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic tests now in effect Posted: 6/30/2016
- •
  Recent updates to Direct Ship Drug Program Posted: 6/1/2016
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 6/1/2016
- •
  Upcoming training for precertification of certain genetic/genomic tests through eviCorePosted: 6/1/2016
- •
  Update on appropriate use of vitamin D testingPosted: 4/29/2016
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 4/29/2016
- •
  Utilization management program for genetic/genomic tests, certain molecular analyses, and cytogenetic testsPosted: 4/29/2016
- •
  Precertification for diagnostic imaging servicesPosted: 4/29/2016
- •
  Reminder: Clinical Relationship Logic and Code-to-Code Edits Posted: 3/31/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 3/31/2016
- •
  Precertification approval email notifications to be offered by eviCore Posted: 3/31/2016
- •
  New utilization management program for genetic/genomic testing and certain molecular analyses Posted: 3/31/2016
- •
  Criteria for endometrial ablationPosted: 2/29/2016
- •
  Coverage for Autism Spectrum Disorders for AmeriHealth Pennsylvania membersPosted: 2/29/2016
- •
  2016 ePASS^® incentive opportunity for professional providers Posted: 2/29/2016
- •
  Reminder: New preferred providers for Direct Ship Drug Program and IVIG/SCIG home infusion Posted: 2/29/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 2/29/2016
- •
  Telemedicine solutions for AmeriHealth commercial members Posted: 1/29/2016
- •
  Reminder: AmeriHealth New Jersey medical record requests and ePASS^® submissions now using EFT for paymentsPosted: 1/29/2016
- •
  New preferred providers for Direct Ship Drug Program and IVIG/SCIG home infusionPosted: 1/29/2016
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 1/29/2016
Medi
2015 Updates
- •
  Reminder: Changes to precertification requirements for 2016 Posted: 12/30/2015
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 12/30/2015
- •
  Precertification changes for AmeriHealth Pennsylvania non-emergent outpatient radiation therapy services Posted: 12/30/2015
- •
  AmeriHealth New Jersey non-emergent outpatient radiation therapy precertification requirements now in effect Posted: 12/30/2015
- •
  AmeriHealth New Jersey medical record requests and ePASS^® submissions now using EFT for payments Posted: 12/1/2015
- •
  Upcoming changes to precertification requirements for 2016 Posted: 12/1/2015
- •
  Upcoming changes in coverage for intrauterine devices Posted: 12/1/2015
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 12/1/2015
- •
  Update on coverage for digital breast tomosynthesisPosted: 12/1/2015
- •
  Reminder: Upcoming changes to medical benefit specialty drug cost-sharing for 2016 Posted: 12/1/2015
- •
  Introducing telemedicine primary care for our Pennsylvania commercial membersPosted: 12/1/2015
- •
  Training available for upcoming AmeriHealth New Jersey non-emergent outpatient radiation therapy precertification requirements Posted: 12/1/2015
- •
  Reminder: Upcoming changes to drug precertification requirements for 2016 Posted: 10/30/2015
- •
  Appropriate use of vitamin D testing Posted: 10/30/2015
- •
  View up-to-date policy activity on our Medical Policy PortalPosted: 10/30/2015
- •
  Upcoming changes to drug precertification requirements for 2016Posted: 10/1/2015
- •
  Direct Ship Drug Program updates Posted: 10/1/2015
- •
  Important news about the annual Synagis^® (palivizumab) distribution program Posted: 10/1/2015
- •
  Upcoming changes to medical benefit specialty drug cost-sharing for 2016Posted: 10/1/2015
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 10/1/2015
- •
  AmeriHealth New Jersey introduces non-emergent outpatient radiation therapy precertification requirements Posted: 10/1/2015
- •
  Annual Synagis^® (palivizumab) distribution program approaches Posted: 9/1/2015
- •
  Chiropractic services policy updatePosted: 9/1/2015
- •
  Reminder: Coverage for injectable drugs that reduce the risk of preterm birthPosted: 9/1/2015
- •
  View up-to-date policy activity on our Medical Policy Portal Posted: 9/1/2015
- •
  View up-to-date medical and claim payment policy activity on the Medical Policy Portal Posted: 7/31/2015
- •
  Reminder: Upcoming changes to the medical and claim payment policy for AmeriHealth New Jersey members Posted: 7/2/2015
- •
  Reminder: Use –X{EPSU} modifiers to report separate, distinct, or independent non-E&M services on the same dayPosted: 7/2/2015
- •
  View up-to-date medical and claim payment policy activity on the Medical Policy Portal Posted: 7/2/2015
- •
  Obtaining precertification for non-emergent radiation therapy services through NaviNet^®Posted: 7/2/2015
- •
  Upcoming changes to the enforcement of medical and claim payment policy for AmeriHealth New Jersey membersPosted: 6/1/2015
- •
  Medical and claim payment policy activity posted from April 25 – May 22, 2015 Posted: 6/1/2015
- •
  Gender reassignment surgery claims for Medicare Advantage membersPosted: 6/1/2015
- •
  New medical policy criteria for commercial members in treatment for osteoarthritis of the kneePosted: 6/1/2015
- •
  Updated InterQual^® guidelines for 2015Posted: 6/1/2015
- •
  CareCore's radiation therapy criteria now in effectPosted: 5/1/2015
- •
  Medical and claim payment policy activity posted from March 24 – April 24, 2015 Posted: 5/1/2015
- •
  Changes to the Direct Ship Injectables Program Posted: 5/1/2015
- •
  NaviNet^® to provide direct access link to CareCore's provider portalPosted: 4/1/2015
- •
  Medical and claim payment policy activity posted from February 21 – March 23, 2015 Posted: 4/1/2015
- •
  Medical and claim payment policy activity posted from January 24 – February 20, 2015Posted: 3/2/2015
- •
  Clarification: Injectable hyaluronate acid products being removed from the Direct Ship Injectables ProgramPosted: 3/2/2015
- •
  Non-emergent outpatient radiation therapy to be reviewed for medical necessityPosted: 3/2/2015
- •
  New changes to our ePASS^® incentive opportunity for professional providers Posted: 1/30/2015
- •
  Medical and claim payment policy activity posted from December 20, 2014 – January 23, 2015Posted: 1/30/2015
- •
  Precertification and compliance monitoring for PAP machines and suppliesPosted: 1/30/2015
Medi
2014 Updates
- •
  Medicare Advantage HMO policies now in effect Posted: 12/30/2014
- •
  New codes for digital breast tomosynthesisPosted: 12/30/2014
- •
  Changes to the experimental/investigational services policies effective January 1, 2015Posted: 12/30/2014
- •
  Download the latest precertification requirement list Posted: 12/30/2014
- •
  Medical and claim payment policy activity posted from November 21 – December 19, 2014 Posted: 12/30/2014
- •
  Injectable hyaluronate acid products being removed from the AmeriHealth Direct Ship Injectables ProgramPosted: 12/30/2014
- •
  Reminder: Precertification requirements for DME providers now in effect Posted: 12/30/2014
- •
  Precertification requirement for non-emergent outpatient radiation therapy now in effect Posted: 12/30/2014
- •
  Upcoming policy on transcutaneous electrical nerve stimulators and associated suppliesPosted: 12/1/2014
- •
  Presumptive and definitive drug testingPosted: 12/1/2014
- •
  Medical and claim payment policy activity posted October 25 – November 20, 2014Posted: 12/1/2014
- •
  Reminder: Upcoming changes to precertification requirements for medical benefit drugsPosted: 12/1/2014
- •
  Reminder: Precertification requirements for DME providers go into effect January 1, 2015Posted: 12/1/2014
- •
  Reminder: Precertification requirement for non-emergent outpatient radiation therapy starts January 1, 2015Posted: 12/1/2014
- •
  Medical and claim payment policy activity posted from September 26 – October 24, 2014 Posted: 10/31/2014
- •
  Upcoming change to Multiple Procedure Payment Reduction guidelines for certain diagnostic services Posted: 10/1/2014
- •
  New Medicare Advantage HMO policy notifications now availablePosted: 10/1/2014
- •
  Recent changes to our ePASS^® incentive opportunity for professional providers Posted: 10/1/2014
- •
  Reminder: Receiving infliximab (Remicade^®) in cost-effective settingsPosted: 10/1/2014
- •
  Upcoming changes to medical policies on spinal injectionsPosted: 10/1/2014
- •
  Upcoming changes to precertification requirementsPosted: 10/1/2014
- •
  Medical and claim payment policy activity posted from August 23 – September 25, 2014 Posted: 10/1/2014
- •
  New coverage criteria for repository corticotropin (H.P. Acthar^® Gel Injection) Posted: 10/1/2014
- •
  Important news about the annual Synagis^® (palivizumab) distribution programPosted: 10/1/2014
- •
  New precertification requirements for DME providers Posted: 10/1/2014
- •
  Upcoming changes to precertification requirements for outpatient radiation therapyPosted: 10/1/2014
- •
  Medicare Advantage HMO policies and clinical relationship logic to undergo changes Posted: 8/28/2014
- •
  Choosing a safe, cost-effective setting for injectable and infusion therapy drugs Posted: 8/28/2014
- •
  Medical and claim payment policy activity posted from July 26 – August 22, 2014 Posted: 8/28/2014
- •
  Annual Synagis^® (palivizumab) distribution program approaches Posted: 8/28/2014
- •
  Medical and claim payment policy activity posted from June 25 – July 25, 2014 Posted: 7/31/2014
- •
  Additional changes to our ePASS^® incentive opportunity for professional providersPosted: 7/31/2014
- •
  Reminder: Upcoming changes to Medicare Advantage HMO policies and clinical relationship logicPosted: 7/31/2014
- •
  Cost-effective treatment options for infliximab (Remicade^®)Posted: 7/1/2014
- •
  Referring members for genetic testingPosted: 7/1/2014
- •
  Upcoming changes to Medicare Advantage policies and clinical relationship logicPosted: 7/1/2014
- •
  Revision to draft Medical Policy #02.01.01c: Home Health Care ServicesPosted: 7/1/2014
- •
  Medical and claim payment policy activity posted from May 26 – June 24, 2014Posted: 7/1/2014
- •
  Medical and claim payment policy activity posted from April 26 – May 25, 2014Posted: 5/30/2014
- •
  Policy updates regarding face-to-face encounter requirementsPosted: 5/1/2014
- •
  Changes to our ePASS^® incentive opportunity for professional providersPosted: 5/1/2014
- •
  Medical and claim payment policy activity posted from March 26 – April 25, 2014Posted: 5/1/2014
- •
  Changes to our precertification process for outpatient echocardiography services now in effectPosted: 5/1/2014
- •
  Medical policy changes for rheumatoid arthritis drugs for commercial membersPosted: 3/31/2014
- •
  Medical and claim payment policy activity posted from February 26 – March 25, 2014Posted: 3/31/2014
- •
  Documentation requirements for DME servicesPosted: 2/28/2014
- •
  Medical and claim payment policy activity posted from January 26 – February 25, 2014Posted: 2/28/2014
- •
  Additional information now available for medical and claim payment policiesPosted: 2/26/2014
- •
  Specialists needed to assist in developing medical policiesPosted: 1/31/2014
- •
  Medical and claim payment policy activity posted as of January 25, 2014Posted: 1/31/2014
- •
  Upcoming changes to our precertification process for outpatient echocardiography servicesPosted: 1/31/2014
- •
  Policy notifications posted as of December 30, 2013Posted: 1/9/2014
- •
  Download the latest precertification requirement listPosted: 1/9/2014
- •
  Updated policy for interstitial continuous glucose monitoring systemsPosted: 1/9/2014
Medi
2013 Updates
- •
  Coverage for certain surgical proceduresPosted: 12/2/2013
- •
  Policy notifications posted as of November 25, 2013Posted: 12/2/2013
- •
  Reminder: Updates to precertification requirements effective January 1, 2014Posted: 12/2/2013
- •
  Coverage for injectable drugs that reduce the risk of preterm birthPosted: 12/2/2013
- •
  Changes to sleep study precertification requirements for Medicare Advantage HMO membersPosted: 12/2/2013
- •
  Policy notifications posted as of October 30, 2013Posted: 11/1/2013
- •
  BriovaRx^TM selected as exclusive specialty pharmacy provider for prescription drug benefitPosted: 11/1/2013
- •
  Policy notifications posted as of September 27, 2013Posted: 10/2/2013
- •
  New policy on reimbursement for radiology services (NJ only)Posted: 10/2/2013
- •
  Updates to precertification requirements effective January 1, 2014Posted: 10/2/2013
- •
  Changes to medical policy for self-injectable drugsPosted: 10/2/2013
- •
  Annual Synagis^® (palivizumab) distribution programPosted: 10/2/2013
- •
  Provide Medicare Advantage HMO members notice of noncovered/excluded services and member payment responsibilityPosted: 8/29/2013
- •
  Policy notifications posted as of August 29, 2013Posted: 8/29/2013
- •
  Annual Synagis^® (palivizumab) distribution programPosted: 8/29/2013
- •
  Changes to sleep study precertification requirements now in effectPosted: 8/29/2013
- •
  Coverage of Influenza Vaccine for 2013-2014 Posted: 8/13/2013
- •
  Policy notifications posted as of July 31, 2013Posted: 8/1/2013
- •
  Upcoming changes to the enforcement of medical and claim payment policy for AmeriHealth Pennsylvania membersPosted: 8/1/2013
- •
  Policy notifications posted as of June 28, 2013Posted: 7/1/2013
- •
  Reminder: An incentive opportunity for professional providers (NJ only)Posted: 7/1/2013
- •
  ClaimCheck^® upgrade and edit clarificationPosted: 7/1/2013
- •
  Updated policy for intraoperative neurophysiological monitoringPosted: 7/1/2013
- •
  Transitional care management servicesPosted: 6/7/2013
- •
  ACEI/ARB therapy benefits for hypertensive patients who have diabetesPosted: 5/31/2013
- •
  An incentive opportunity for professional providers (NJ Only)Posted: 5/31/2013
- •
  Policy notifications as of May 29, 2013Posted: 5/31/2013
- •
  Change to anesthesia claims policyPosted: 5/31/2013
- •
  Choosing a safe, cost-effective setting for injectable and infusion therapy drugsPosted: 5/31/2013
- •
  Updated InterQual^® guidelines for 2013Posted: 5/31/2013
- •
  Upcoming changes to our medical policy on sleep disorder testingPosted: 5/31/2013
- •
  Updated policy for artificial intervertebral disc insertionPosted: 5/1/2013
- •
  No member cost-sharing for breast pumpsPosted: 5/1/2013
- •
  In-home assessments of high-risk membersPosted: 5/1/2013
- •
  Policy notifications posted as of April 26, 2013Posted: 5/1/2013
- •
  Changes to preferred products to treat osteoarthritis of the kneePosted: 5/1/2013
- •
  Policy notifications posted as of March 28, 2013Posted: 3/28/2013
- •
  ICD-10 codes now available in medical and claim payment policiesPosted: 3/28/2013
- •
  Policy notifications posted as of February 28, 2013Posted: 3/1/2013
- •
  Upcoming changes to our home oxygen therapy policyPosted: 3/1/2013
- •
  Policy notifications posted as of January 29, 2013Posted: 2/1/2013
Medi
2012 Updates
- •
  New policy for athletic pubalgia effective March 5, 2013Posted: 12/28/2012
- •
  Mandated coverage for orally administered anticancer medications prescribed to AmeriHealth New Jersey membersPosted: 12/28/2012
- •
  New prior authorization requirements for AmeriHealth 65^® NJ HMO and AmeriHealth 65^® Preferred HMO members now in effectPosted: 12/28/2012
- •
  Policy notifications posted as of December 21, 2012Posted: 12/28/2012
- •
  Reminder: Coverage change for Plan B One-Step^® (Levonorgestrel, Next Choice^®)Posted: 11/30/2012
- •
  Health care reform: Expansion of 100 percent coverage for women’s preventive health servicesPosted: 11/30/2012
- •
  Policy notifications posted as of November 30, 2012Posted: 11/30/2012
- •
  Updated policy for Never Events and Preventable Adverse EventsPosted: 11/30/2012
- •
  Reminder: New prior authorization requirements for AmeriHealth 65^® NJ HMO and AmeriHealth 65^® Preferred HMO members effective January 1, 2013Posted: 11/30/2012
- •
  Policy reminder regarding utilization review decisionsPosted: 11/1/2012
- •
  Policy notifications posted as of October 26, 2012Posted: 11/1/2012
- •
  Vaccination coverage for Medicare Advantage HMO membersPosted: 11/1/2012
- •
  Mandated coverage for autism spectrum disordersPosted: 11/1/2012
- •
  Policy notifications posted as of September 21, 2012Posted: 9/28/2012
- •
  Coverage change for Plan B One Step^® (Levonorgestrel, Next Choice^®)Posted: 9/28/2012
- •
  New prior authorization requirements for AmeriHealth 65^® NJ HMO and AmeriHealth 65^® Preferred HMO members effective January 1, 2013Posted: 9/28/2012
- •
  Annual Synagis^® (palivizumab) distribution programPosted: 9/28/2012
- •
  Policy notifications posted as of August 31, 2012Posted: 8/31/2012
- •
  Annual Synagis^® (palivizumab) distribution programPosted: 8/31/2012
- •
  Updated AIM clinical guidelinesPosted: 8/31/2012
- •
  Coverage of Influenza Vaccine for 2012-2013Posted: 8/13/2012
- •
  Upcoming changes to the AIM Clinical GuidelinesPosted: 8/3/2012
- •
  Retrospective chart review programPosted: 7/31/2012
- •
  Performing EGD and colonoscopy procedures on the same dayPosted: 7/31/2012
- •
  Policy notifications posted as of July 25, 2012Posted: 7/31/2012
- •
  New initiative promotes the use of generic drugsPosted: 7/31/2012
- •
  Choosing a safe, cost-effective setting for injectable and infusion therapy drugsPosted: 6/29/2012
- •
  Policy notifications posted as of June 22, 2012Posted: 6/29/2012
- •
  The process of requesting retrospective reviews for inpatient staysPosted: 6/29/2012
- •
  Health care reform: Expansion of 100 percent coverage for women’s preventive health servicesPosted: 6/29/2012
- •
  Policy notifications posted as of May 21, 2012Posted: 5/31/2012
- •
  Changes to approved drug dose, frequency, or regimen must be resubmitted for precertificationPosted: 5/31/2012
- •
  Upcoming precertification requirement changes for most commercial AmeriHealth New Jersey membersPosted: 5/31/2012
- •
  Updated InterQual^® guidelines for 2012Posted: 5/31/2012
- •
  Precertification no longer needed for certain mental health and substance abuse services for AmeriHealth New Jersey membersPosted: 5/1/2012
- •
  Policy notifications posted as of April 23, 2012Posted: 5/1/2012
- •
  Policy notifications posted as of March 26, 2012Posted: 3/29/2012
- •
  Assessing the needs of high-risk Medicare Advantage HMO membersPosted: 3/29/2012
- •
  Low-dose chest CT screening for individuals at high risk for lung cancerPosted: 3/29/2012
- •
  Clarification on the use of Modifier 52Posted: 3/1/2012
- •
  Policy notifications posted as of February 21, 2012Posted: 3/1/2012
- •
  Upcoming precertification requirement changes for most commercial New Jersey membersPosted: 3/1/2012
- •
  Strong bones, improved quality of life for women: Controlling osteoporosis after a fracturePosted: 3/1/2012
- •
  Policy notifications posted as of January 20, 2012Posted: 1/31/2012
Medi
2011 Updates
- •
  Policy notifications posted as of December 21, 2011Posted: 12/29/2011
- •
  Reminder: Use of modifier -25 when reporting E&M services with spinal/extraspinal manipulation codesPosted: 12/29/2011
- •
  Reminder: New precertification requirements now in effect for Medicare Advantage HMO membersPosted: 12/29/2011
- •
  Reminder: Change to anesthesia claims payment methodology calculationPosted: 12/1/2011
- •
  Policy notifications posted as of November 23, 2011Posted: 12/1/2011
- •
  Reminder: Change to anesthesia claims payment methodology calculationPosted: 12/1/2011
- •
  Precertification process change for certain infusion therapy drugsPosted: 12/1/2011
- •
  Policy notifications posted as of October 27, 2011Posted: 11/1/2011
- •
  2011–2012 Clinical Insights now availablePosted: 11/1/2011
- •
  Specialists needed to assist in developing medical policiesPosted: 11/1/2011
- •
  Policy reminder regarding utilization review decisionsPosted: 10/3/2011
- •
  Policy notifications posted as of September 23, 2011Posted: 10/3/2011
- •
  Policy on Modifier 52Posted: 10/3/2011
- •
  Precertification requirement changes for Medicare Advantage HMO membersPosted: 10/3/2011
- •
  Transitioning select infusion therapy drugs from the outpatient setting to the office or home settingPosted: 9/1/2011
- •
  New policy on inpatient hospital readmissionsPosted: 9/1/2011
- •
  Change in reimbursement for assistant-at-surgery servicesPosted: 9/1/2011
- •
  Policy notifications posted as of August 19, 2011Posted: 9/1/2011
- •
  Reminder: Use updated precertification requirements lists*Posted: 9/1/2011
- •
  Annual Synagis^® (palivizumab) distribution programPosted: 9/1/2011
- •
  Policy notifications posted as of July 20, 2011Posted: 7/28/2011
- •
  Updated procedures for requesting precertification for pain management, DME, and home health providers Posted: 7/28/2011
- •
  Annual Synagis^® (palivizumab) distribution program Posted: 7/28/2011
- •
  Precertification requirement changes and updated lists available in July*Posted: 7/1/2011
- •
  Policy notifications posted as of June 21, 2011Posted: 7/1/2011
- •
  Important information about the upcoming Clinical Care ReportPosted: 7/1/2011

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