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Precertification Requirement Changes and Updated Lists Now Available*

As previously communicated, we will implement important changes to the list of services and drugs that require precertification effective for dates of service on or after September 1, 2011, for Pennsylvania and Delaware members. Please refer to the June edition of Partners in Health Update for the complete list of changes to precertification requirements.

As we proceed through this transition, it is very important for providers to continue to refer to the most current precertification requirements list or to use the NaviNet^® web portal to verify member-specific requirements. The updated precertification requirement lists are now available at www.amerihealth.com/providers/preapproval. Failure to obtain precertification for any of the services or drugs that require it may result in a reduction in payment or nonpayment for the services not precertified. Please call 1-800-275-2583 if you have any questions about these upcoming changes.

Note: These new precertification requirements will apply to all commercial members for dates of service on or after September 1, 2011; Medicare Advantage HMO and PPO members will transition for dates of service on or after January 1, 2012.

*Changes will also be made for New Jersey commercial members, but the effective date has yet to be determined. More information will be available in future editions of Partners in Health Update.