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Choosing the Most Appropriate Site of ServiceAs a reminder, as part of our utilization review program, AmeriHealth evaluates the appropriateness of the setting (e.g., office, inpatient, outpatient) for Covered Services requested by a member’s health care provider that may be provided in alternate settings or sites. When a Covered Service can be administered in various settings, providers should request preapproval, as required by the applicable Benefit Program, to provide the Covered Services in the most appropriate and cost-effective setting for the member’s current medical needs and condition including any required monitoring. AmeriHealth review for preapproval will be based on the clinical documentation from the requesting health care provider supporting the requested setting. If you have any questions about this information, please contact your Network Coordinator or Hospital/Ancillary Services Coordinator. |