Provider Notifications

September 7, 2021
Expansion of providers for the administration of SARS-CoV-2 vaccines and monoclonal antibody therapy (PDF)
AmeriHealth Caritas Pennsylvania will follow the guidelines recently released by the Pennsylvania Department of Human Services (DHS) Medical Assistance (MA) Bulletin (MAB) 01-21-08 regarding expanding the scope of MA enrolled providers who may bill for administration of the novel coronavirus (SARS-CoV-2) vaccines and monoclonal antibody therapy.
August 30, 2021
Administration and payment of SARS-CoV-2 vaccines for homebound members (PDF)
AmeriHealth Caritas Pennsylvania will follow the guidelines recently released by the Pennsylvania Department of Human Services (DHS) regarding the administration and payment of the SARS-CoV-2 vaccine for homebound members.
August 25, 2021
Ground ambulance billing reminders (PDF)
AmeriHealth Caritas Pennsylvania follows Pennsylvania Medical Assistance guidelines for ambulance mileage reimbursement for all ambulance providers.
August 1, 2021
Change in reimbursement for normal, low and high calibration solution/chips (PDF)
Effective October 1, 2021, AmeriHealth Caritas Pennsylvania will change the reimbursement for HCPCS code A4256.
July 27, 2021
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 September 13, 2021.
July 20, 2021
Timely filing deadlines reminder (PDF)
As outlined in the AmeriHealth Caritas Pennsylvania Claims Filing Guide, not following claims submission deadlines will result in a denied claim.
July 15, 2021
July issue of our provider newsletter, Connections, now online (PDF)
AmeriHealth Caritas Pennsylvania is pleased to announce the availability of the second edition of our provider newsletter, Connections.
July 1, 2021
New Condition Optimization Prospective Outreach Program starts on September 1, 2021 (PDF)
We are introducing this program to streamline the submission of information to AmeriHealth Caritas Pennsylvania.
June 29, 2021
ONAF forms no longer accepted via fax starting July 1, 2021 (PDF)
As announced on May 1, 2021, effective July 1, 2021 AmeriHealth Caritas Pennsylvania will only accept ONAF forms that are submitted through the Optum website.
June 24, 2021
New program encourages PCPs to proactively schedule routine office visits (PDF)
Anticipated in the third quarter 2021, AmeriHealth Caritas Pennsylvania is launching a “Prospective Outreach Program” to encourage PCPs to proactively reach out and schedule routine office visits for patients who might be due for routine care.
June 17, 2021
Member ID card primary care provider (PCP) information change (PDF)
Beginning in June 2021, the PCP information is being removed from the AmeriHealth Caritas Pennsylvania member ID cards.
June 17, 2021
Jiva application upgrade — additional free webinar demonstrations offered (PDF)
Additional webinar offerings to help familiarize your practice with the upgraded version of Jiva are available.
June 16, 2021
Critical reminder: Balance billing members is prohibited (PDF)
AmeriHealth Caritas Pennsylvania strongly reminds providers that all payments made to providers under the MA program plus any copayment required to be paid by a recipient shall constitute full reimbursement to the provider for covered services rendered. Further, a provider who seeks or accepts supplementary payment of another kind from DHS, the recipient or another person for a compensable service or item is required to return the supplementary payment.
June 1, 2021
Home and Portable Oxygen Therapy Policy (PDF)
Effective August 1, 2021, prior authorization is required for all home oxygen rentals, regardless of monthly cost.
June 1, 2021
Prior authorization requirements reinstated for certain services (PDF)
Effective for dates of services on and after August 1, 2021, AmeriHealth Caritas Pennsylvania will follow the guidelines outlined by the Department of Human Services (DHS) recently released Medical Assistance Bulletin (MAB 99-21-03).
June 1, 2021
Prior authorization requirements: therapeutic duplication and safety edits (PDF)
Effective July 1, 2021, prescriptions written for a drug that has the same or highly similar mechanism of action as another drug will be subject to therapeutic duplication requirements and/or safety edits per the PA PDL prior authorization guidelines.
May 27, 2021
Additional HCPCS medication codes requiring prior authorization (PDF)
Review a list of HCPCS codes undergoing updates to align medical claim configuration with drug formulary and prior authorization reference resources.
May 17, 2021
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.
May 12, 2021
Providers can now run NaviNet reports at the Tax ID Number (TIN) level (PDF)
We have enhanced NaviNet to give providers the capability to run certain reports on a “RollUp” basis. Instead of having to run a report for each of the Provider ID numbers that may exist for your group, you can now run ONE report with data consolidated for the practice at the TIN level.
May 3, 2021
COVID-19 vaccine reimbursement April update (PDF)
AmeriHealth Caritas Pennsylvania will follow the updated guidelines issued on April 19, 2021 by the Department of Human Services (DHS) Medical Assistance Bulletin (MAB) (01-21-03) outlining and updating the reimbursement for the administration of the novel coronavirus (SARS-CoV-2) vaccines.
May 1, 2021
Reimbursement guidelines for sexually transmitted infection tests (PDF)
Effective July 1, 2021, when three single tests used to detect sexually transmitted infections are billed together by the same provider on the same date of service, AmeriHealth Caritas Pennsylvania will reimburse providers with the rate for a more comprehensive code.
May 1, 2021
ONAF form no longer accepted via fax (PDF)
In a continued effort to share information via sustainable means, effective July 1, 2021, AmeriHealth Caritas Pennsylvania will only accept ONAF forms that are submitted through the Optum website.
March 25, 2021
Our March issue of Connections is now available online (PDF)
AmeriHealth Caritas Pennsylvania is pleased to announce the availability of the first 2021 edition of our provider newsletter, Connections.
February 15, 2021
Revised Category II CPT Codes (PDF)
On April 15, 2021, to align with HEDIS® regulations, the CPT II codes outlined in the attached grid will be payable to the included specialty types.
February 10, 2021
Updated CPT Codes for the Administration of SARS-CoV-2 Vaccines (PDF)
AmeriHealth Caritas Pennsylvania will follow the DHS guidelines issued on January 26, 2021, in Medical Assistance Bulletin 01-20-62.
January 27, 2021
Alfred I. duPont Hospital for Children reminder (PDF)
As of October 1, 2020, the Alfred I. duPont Hospital for Children and its affiliated providers are no longer in the AmeriHealth Caritas Pennsylvania network.
January 25, 2021
Capitation to Quest Diagnostics discontinued (PDF)
Effective February 1, 2021, your AmeriHealth Caritas Pennsylvania patients will no longer be required to receive outpatient laboratory tests or processing of lab specimens from Quest Diagnostics network of laboratories.
January 20, 2021
Discontinuation of dental referral fax forms (PDF)
To decrease your office’s administrative burden, effective immediately AmeriHealth Caritas Pennsylvania will discontinue the need to submit a dental referral fax form for reporting purposes.
January 13, 2021
Prior Authorization Lookup tool now available (PDF)
AmeriHealth Caritas Pennsylvania is excited to introduce the new Prior Authorization Lookup tool. This user-friendly resource allows users to enter a Current Procedural Terminology (CPT) code or a Healthcare Common Procedure Coding System (HCPCS) code to verify authorization requirements in real time before delivery of service.
January 7, 2021
CPT Codes for the Administration of SARS-CoV-2 Vaccines (PDF)
AmeriHealth Caritas Pennsylvania will follow the DHS guidelines issued on December 24, 2020, in Medical Assistance Bulletin 01-20-59.

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