2019 Provider notifications
December 19, 2019
December 2019 issue of Connections is now available (PDF)
Highlights include: Important changes coming January 1, 2020, to the preferred drug list; pharmacy information; submission of all claims data even when no payment is due; holiday and after-hours codes; Medicaid enrollment reminders; and the Let Us Know program.
November 12, 2019
Preferred Drug List update (PDF)
Effective January 1, 2020, the Pennsylvania Department of Human Services (DHS) will implement a statewide preferred drug list (PDL).
August 16, 2019
August 2019 Provider Post (PDF)
2019 Provider Manual now available, HEDIS® data collection and reporting, and fighting fraud, waste, and abuse.
July 26, 2019
July 2019 Provider Post (PDF)
The July edition of Connections is now available, feedback on Connections, Medicaid enrollment reminders, Opioid Use Disorder e-learning module, and how to help fight fraud, waste, and abuse.
June 20, 2019
June 2019 Provider Post (PDF)
2019 Claims Filing Instructions, an update on the multiple surgical reduction payment policy, formulary changes, and tips to fight fraud, waste, and abuse.
June 3, 2019
Service Location Enrollment Deadline (PDF)
Providers are required to enroll each of their service locations that serves Medical Assistance (MA) patients.
May 22, 2019
Opioid Prescription Morphine Milligram Equivalent (MME) Update (PDF)
Effective July 1, 2019, the maximum morphine milligram equivalent (MME) will be lowered.
May 17, 2019
May 2019 Provider Post (PDF)
2019 recommended childhood and adolescent immunization schedule, collecting social determinants of health (SDOH) data to address members’ unmet needs, and attention deficit hyperactivity disorder (ADHD) e-learning announcement.
May 1, 2019
Breo Ellipta inhalers to be removed from formulary (PDF)
Effective June 3, 2019, Breo Ellipta® (fluticasone/vilanterol) inhalers will be removed from the AmeriHealth Caritas Pennsylvania and AmeriHealth Caritas Northeast drug formulary.
April 17, 2019
April 2019 Provider Post (PDF)
Connections survey; DME criteria requirements; Opioid programs for dental providers and more.
April 1, 2019
March 2019 Provider Post (PDF)
Prior authorization; March 2019 edition of Connections provider newsletter now available.
March 29, 2019
Prenatal Services and Third-Party Liability Requirements (PDF)
Effective April 1, 2019, if there is a third-party resource, providers are to submit claims to that resource prior to submitting a claim for prenatal services to the Plan.
March 20, 2019
All Patients Refined Diagnosis Related Groups (APR-DRG) Version 36 (PDF)
AmeriHealth Caritas Pennsylvania replaced APR-DRG version 35 with version 36.
March 5, 2019
Connections Provider Newsletter Survey (PDF)
We are reaching out to you to gather your thoughts and opinions about our triannual provider newsletter, Connections.
March 4, 2019
Short-Procedure Unit (SPU) Payment Policy (PDF)
Information for ambulatory surgery centers and hospitals about our SPU payment policy.
March 4, 2019
Lead Exposure in Lancaster County, Pennsylvania (PDF)
The Pennsylvania Department of Human Services (DHS) has brought to our attention that high levels of lead were found in the drinking water of schools in five school districts in Lancaster County.
February 28, 2019
Pharmaceuticals Requiring Prior Authorization (PDF)
Effective April 1, 2019, injectable medications requiring prior authorization through the Utilization Management department will transition to requiring prior authorization through the Plan’s Pharmacy Services department.
February 26, 2019
February 2019 Provider Post (PDF)
Billing reminders for home health providers; important facts about the Keys to Your Care® Healthy Baby Program; dental coding updates.
February 15, 2019
Specialty Pharmacy Network reminder (PDF)
As a reminder, providers may specify a dispensing pharmacy on a prior authorization form when requesting coverage of specialty medications.
January 8, 2019
January 2019 Provider Post (PDF)
Reminder: Requesting your assistance with HEDIS medical record retrieval activities; Changes to the Quality Enhancement Program (QEP) and the Maternity Quality Enhancement Program (MQEP).