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Updated Precertification Requirement Lists Now Available

As previously communicated, we will implement important changes to the list of services and drugs that require precertification for Pennsylvania and Delaware members effective for dates of service on or after September 1, 2011.* Updated precertification requirement lists are available at www.amerihealth.com/providers/preapproval.

As we proceed through this transition, it is very important for providers to continue to refer to the most current precertification requirements lists or to use the NaviNet^® web portal to verify member-specific requirements. 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.

For the complete list of changes to precertification requirements, refer to the June edition of Partners in Health Update. If you have any questions, please call 1-800-275-2583.

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