UPDATES TO BEHAVIORAL HEALTH, SECTION 8 ARE IN PROGRESS
AmeriHealth insourced its behavioral health network in 2023 and is now directly contracting with behavioral health providers. Effective January 1, 2024, if you have not yet signed an AmeriHealth Professional Provider Agreement, you will be considered out-of-network for our members.
The Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers (Hospital Manual) is part of a Hospital, Ancillary Facility, or Ancillary Provider Agreement (Agreement) with AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey, and its affiliates (collectively referred to as "AmeriHealth New Jersey").
The manual was developed to assist participating hospitals, ancillary facilities, and ancillary providers in conducting business with AmeriHealth New Jersey in accordance with the Agreement.
The Hospital Manual is an easy-to-use reference tool, color-coded, and hyperlinked to provide easy access to the information that providers need most. It is updated regularly to provide pertinent information regarding our policies, procedures, and functions.
Hospital Manual (NJ)
-
Introduction (June 2021)
-
General Information (May 2023)
-
Administrative Procedures (December 2021)
-
Fraud, Waste, and Abuse (October 2021)
-
Medical Policy & Claim Payment Policy (June 2021)
-
Clinical Services – Utilization Management (May 2023)
-
Quality Management (February 2024)
-
Behavioral Health (October 2021)
-
Billing & Reimbursement for Hospital Services (July 2023)
-
Billing & Reimbursement for Ancillary Services (May 2023)
-
Disclaimer Information (June 2021)