Provider Notifications

June 15, 2022
Clarification: continued stay coverage, review, and billing reminders (PDF)
A claim can be submitted once authorization is approved with no need to hold the claim for the NFCE determination.
June 9, 2022
Changes to Pennsylvania’s HealthChoices physical health plans (PDF)
Effective September 1, 2022, the Pennsylvania Department of Human Services is changing which physical health managed care organizations are available for Medical Assistance consumers.
June 1, 2022
Change to adult immunization/immune globulin fee schedule (PDF)
Effective August 1, 2022, the AmeriHealth Caritas Pennsylvania adult immunizations/immune globulin fee schedule will be updated.
May 18, 2022
Take the annual mandatory fraud, waste, and abuse training (PDF)
All network providers must complete and attest to completion of mandatory FWA training on an annual basis, as required by our contract with the Pennsylvania Department of Human Services (DHS).
May 11, 2022
Continued stay coverage, review, and billing reminders (PDF)
Coverage policy reminder for nursing facilities.
May 11, 2022
June 2022 formulary changes (PDF)
Some products will be removed from the AmeriHealth Caritas Pennsylvania drug formulary on June 15, 2022. Members currently receiving those products will require a new prescription for an alternative product before that date.
May 11, 2022
2022 medical provider claims filing instructions now available (PDF)
AmeriHealth Caritas Pennsylvania is pleased to announce the availability of the 2022 medical provider claims filing instructions.
April 5, 2022
New solution for online prior authorizations (PDF)
Effective June 3, 2022, a new system is being implemented for providers to submit prior authorization requests for medical and behavioral health services.
March 30, 2022
Update to home accessibility durable medical equipment (DME) coverage and billing (PDF)
AmeriHealth Caritas Pennsylvania will follow the Department of Human Services (DHS) guidelines released in Medical Assistance Bulletin (MAB) 25-21-01 regarding the coverage of home accessibility durable medical equipment and procedure for obtaining an 1150 administrative waiver in the fee-for-service delivery system.
March 23, 2022
Update to Modifier 25 policy (PDF)
Effective April 1, 2022, AmeriHealth Caritas Pennsylvania is revising the reduced payment policy for certain Evaluation and Management (E/M) procedure codes billed with Common Procedure Terminology (CPT) modifier 25 when services occur within the minor procedure Global Surgery time frames as defined by the Centers for Medicare & Medicaid Services (CMS).
March 21, 2022
March issue of our provider newsletter, Connections, now online (PDF)
Highlights include a new Medical Assistance bulletin (MAB) announcing newly created Current Procedural Terminology (CPT) codes for the administration of SARS-CoV-2 vaccines, claims filing instructions, and more.
March 21, 2022
Our 2022 Quality Enhancement program manual is now available (PDF)
The 2022 Quality Enhancement Program (QEP) manual is now available for our primary care providers.
March 9, 2022
Introduction of a new procedure code (T1019) for Electronic Visit verification (EVV) reporting for Personal Care Services (PCS) (PDF)
AmeriHealth Caritas Pennsylvania will follow the Pennsylvania Department of Human Services (DHS) guidelines and will implement the new procedure code T1019 for reporting EVV PCS services for 15-minute units.
February 1, 2022
NaviNet upgrades for Condition Optimization Program (formerly Intensive Case Management Program) (PDF)
Effective April 1, 2022, AmeriHealth Caritas Pennsylvania is upgrading the NaviNet portal to enhance the Retrospective and Prospective Outreach Programs.
January 10, 2022
CPT codes for pediatric Pfizer, Inc. SARS-CoV-2 vaccine (PDF)
AmeriHealth Caritas Pennsylvania will follow the guidelines issued in MAB 01-21-51 addressing CPT codes for the administration of pediatric SARS-CoV-2 Pfizer, Inc. vaccine. Additionally, we are also following guidelines issued in MAB 01-21-55, outlining CPT codes for the administration of booster doses of the SARS-CoV-2 vaccines.
January 3, 2022
Update: formulary changes (PDF)
Some products will be removed from the AmeriHealth Caritas Pennsylvania drug formulary. Members currently receiving these products will require a new prescription for an alternative product before February 1, 2022.

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