Provider Notifications

September 7, 2023
August's electronic visit verification (EVV) soft launch (PDF)
AmeriHealth Caritas Pennsylvania will require in-home visits to be recorded in the EVV system.
August 22, 2023
Updated sterilization consent form is now available (PDF)
The updated Department of Human Services (DHS) Sterilization Consent Form (MA 31) is available on the provider websites.
August 8, 2023
Electronic documentation — added transaction functionality for providers (PDF)
AmeriHealth Caritas Pennsylvania is pleased to announce added functionality for network providers to submit electronic attachments (275 transactions) to support a medical claim via Change Healthcare, effective August 1, 2023.  
August 1, 2023
Code change notice for pediatric shift care (PDF)
AmeriHealth Caritas Pennsylvania would like to notify you about procedure code updates that will go into effect on October 1, 2023. These include code terminations and replacement codes for reporting pediatric shift care services.  
July 31, 2023
Adult eye care benefit changes (PDF)
Effective September 1, 2023, AmeriHealth Caritas Pennsylvania will no longer cover the cost of prescription eyeglasses or prescription contact lenses for members 21 years of age or older, with certain exceptions.
July 25, 2023
Connections summer issue (PDF)
AmeriHealth Caritas Pennsylvania is pleased to announce the availability of the second edition of our provider newsletter, Connections.
July 10, 2023
Electronic visit verification system soft launch (PDF)
To assist Providers with the Cures Act requirement, AmeriHealth Caritas PA will continue its relationship with HHAeXchange and will be going live, with a soft launch, on August 14, 2023.
June 13, 2023
NaviNet tools available to view Medical Assistance eligibility redetermination dates (PDF)
We have launched two new tools in the NaviNet provider portal that will allow providers to view upcoming Medical Assistance eligibility redetermination dates.
June 13, 2023
Medical provider claims filing instructions are now available (PDF)
AmeriHealth Caritas Pennsylvania is pleased to announce that the 2023 medical provider claims filing guide is now available on our website.
June 7, 2023
Primary care HEDIS rollup report (PDF)
A new streamlined report to easily identify members in your practice that have open care gaps is now available in NaviNet.
June 6, 2023
Akorn issues recall due to company shutdown (PDF)
Recall notice: Akorn Operating Company, LLC (Akorn) has voluntarily recalled several products from the market due to the company shutdown.
June 6, 2023
2023 Dental Provider Supplement (PDF)
AmeriHealth Caritas Pennsylvania is pleased to announce that the updated 2023 Dental Provider Supplement is available.
June 1, 2023
Strategic National Implementation Process (SNIP) Level 4 upgrade effective August 1, 2023 (PDF)
Effective August 1, 2023, AmeriHealth Caritas Pennsylvania is upgrading its claims editing process to SNIP Level 4 to meet industry compliance standards.
May 31, 2023
American Dental Association (ADA) claim form is required effective July 1, 2023 (PDF)
AmeriHealth Caritas Pennsylvania will follow the billing guidelines issued by the PA Department of Human Services (DHS) Medical Assistance bulletin 17-23-01 regarding the requirement to submit the ADA claim form – version 2019.
May 18, 2023
Makena removal notice (PDF)
On April 6, 2023, the U.S. Food and Drug Administration announced its final decision to withdraw approval of Makena (hydroxyprogesterone caproate injection) and its generics.
May 16, 2023
2023 Provider Manual (PDF)
AmeriHealth Caritas Pennsylvania is pleased to announce the availability of the 2023 Provider Manual.
May 15, 2023
Inpatient delivery notification and inpatient maternity authorizations reminder (PDF)
Reminder for hospital providers to accurately complete fields in NaviNet when submitting inpatient delivery notifications or inpatient maternity authorizations.
May 2, 2023
Anesthesia services for gastrointestinal endoscopy policy update (PDF)
Effective July 3, 2023, prior authorization is no longer required for monitored anesthesia care (MAC) for gastrointestinal (GI) endoscopy services.
April 12, 2023
Transplant care coordination process change (PDF)
Please see process change details for requesting transplant authorizations and transplant care coordination updates.
April 5, 2023
Integrated Care Plan (ICP) sharing in NaviNet (PDF)
Whole-person care is a holistic and patient-centered approach that may lead to better health outcomes and higher patient satisfaction.
April 4, 2023
Incontinence supply prior authorization policy reminder (PDF)
As indicated in the provider manual, please adhere to this incontinence supply prior authorization policy.
March 22, 2023
Change Healthcare user guide link updates (PDF)
Effective March 31, 2023, Change Healthcare will be updating all electronic claims user guide links throughout its provider systems and communication materials.
March 21, 2023
Updated training material for NaviNet medical authorizations is now available online (PDF)
A newly activated feature allows providers to bypass the InterQual review process when completing prior authorization submissions.
March 21, 2023
Spring issue of Connections now online (PDF)
Highlights include: Medical Assistance renewals are coming — important information to share with your patients regarding their health care coverage; Inpatient claims and Medicare Part B billing recommendations; Members’ and Participants’ rights and responsibilities; and more.
March 7, 2023
Dental benefit limit exception (BLE) update (PDF)
Please review these details regarding the process for submitting dental benefit limit exception (BLE) requests.
March 1, 2023
Update: formulary changes (PDF)
Effective May 1, 2023, members currently receiving more than the quantity limit for certain products will require prior authorization. This change does not apply to members for whom it is not medically advisable to change therapy.
February 7, 2023
New choice for AmeriHealth Caritas Pennsylvania outpatient laboratory services (PDF)
Effective January 2023, Labcorp is another choice for your AmeriHealth Caritas Pennsylvania patients requiring outpatient lab tests or processing of lab specimens.