Provider notifications

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.