Provider notifications

December 21, 2018
December 2018 Provider Post (PDF)
Optimize care coordination by asking your patients to complete a HIPAA authorization form; December 2018 edition of Connections provider newsletter now available.
December 12, 2018
New Credentialing Requirement for Facilities: Ownership and Control Disclosure Form (PDF)
Facilities must submit an ownership and control disclosure form during the initial Medical Assistance (MA) credentialing and revalidation process.
November 30, 2018
Update: Drug Formulary Changes (PDF)
Effective January 7, 2019, the following will be removed from the AmeriHealth Caritas Pennsylvania drug formulary.
November 19, 2018
Important Claims Filing Reminder (PDF)
For claims submitted on a CMS-1500 claim form where the PLACE OF SERVICE (POS) is a facility, the NPI of the facility is a required field unless the facility is an atypical provider without an NPI.
November 16, 2018
November 2018 Provider Post (PDF)
New addition: Influenza vaccination care gap; Keys to Your Care maternity program and Keys to Your Care healthy baby program.
October 17, 2018
October 2018 Provider Post (PDF)
Important notice about electronic funds transfer; billing for flu vaccines; National Drug Code (NDC) reminder.
September 25, 2018
Important Clarification of Dual Medicare/Medicaid Claims Submission (PDF)
On June 6, 2018, we notified our provider network of changes to claims submissions for dual Medicare and Medicaid members.
September 24, 2018
Important Notice Regarding Electronic Funds Transfer (EFT) (PDF)
In 2019, AmeriHealth Caritas Pennsylvania will begin efforts to go paperless. All network providers still receiving paper checks are encouraged to transition to electronic funds transfer and electronic remittance advice.
September 18, 2018
September 2018 Provider Post (PDF)
Instructional videos now available for expanded NaviNet functionalities; sign up to receive electronic funds transfer (EFT); neoplasm disease — current versus personal history.
September 6, 2018
Formulary Change (PDF)
Effective immediately, the following will be removed from the AmeriHealth Caritas Pennsylvania drug formulary.
August 21, 2018
August 16, 2018
August 2018 Provider Post (PDF)
Hepatitis C SVR–12 care gap alert added to NaviNet; Coming soon: improvements to intensive case management (ICM) program activities in NaviNet; Valsartan and valsartan HCTZ recall
August 1, 2018
Opioid Prescription Update (PDF)
Update to our prior authorization requirements for opioid prescriptions
July 23, 2018
July 2018 Provider Post (PDF)
Now available in NaviNet: HEDIS care gap information; reporting CPT Category II codes
June 6, 2018
June 2018 Provider Post (PDF)
Save time and shorten your reimbursement cycle; use claims modifiers 25 and 59 appropriately
May 18, 2018
May 2018 Provider Post (PDF)
New status for hepatitis A and B vaccination series care gaps in NaviNet; new care gap alerts added to align with EPSDT specifications; release of 2018 recommended immunization schedule for children and adolescents
April 25, 2018
April 2018 Provider Post (PDF)
APR-DRG transition from version 34 to version 35; rural access to MAT in Pennsylvania; report suspected fraud, waste, or abuse to us
April 4, 2018
Opioid Prescription Update (PDF)
Expansion of our application of maximum morphine milligram equivalent and maximum day supply limits safety edits for opioid medications
March 16, 2018
March 2018 Provider Post (PDF)
Updated EPSDT Periodicity Schedule and Coding Matrix; clarification of rejected and corrected claim rules; claims filing instructions now available online; formulary change: Roche blood glucose meter
January 30, 2018
New NaviNet Electronic Claim Inquiry Enhancement (PDF)
Beginning January 30, 2018, ancillary, facility, and professional providers will have the ability to submit an electronic Claim Inquiry request directly through NaviNet for claims that have been finalized
January 23, 2018
January 2018 Provider Post (PDF)
Using your CLIA ID when filing claims; anxiety disorders e-learning training module; signing up for e-services; fraud, waste, and abuse mandatory provider training now online
January 2, 2018
Using Your CLIA ID When Filing Claims (PDF)
Providers that perform laboratory testing are required to indicate their CLIA ID number when submitting claims