NIA can accept multiple requests during one phone call. PHCS Request to Update Procedure Code (s) on an Existing Authorization. AARP United Healthcare (Medicare Supplement) Aetna (except Aetna Better Health/Aetna Medicaid) AmeriHealth AmeriHealth Administrators AmeriHealth Davis Vision Claim Form. 0000002892 00000 n Our members are at the center of everything we do. ET 1-800-424-4791 Anytime www.radmd.com The practice is 100 percent physician-owned, and our radiologists are board certified which means we make the patient-doctor relationship our top priority. Dental: Skygen USA TM. Click below to learn more about radiology, and some of the services we offer. Find out why AmeriHealth New Jersey is your perfect partner in health insurance. BEECH STREET (Multiplan) Failure to obtain prior authorization for any of the services or drugs AIM uses these guidelines during the precertification process to determine medical necessity for facility-based sleep testing. 15 0 obj <> endobj 0000017465 00000 n rights reserved. Please call 1-800-275-2583 if you have any questions about this 0000000016 00000 n All results are subject to change in accordance with plan policies and procedures and the Provider Manual (PDF). H\n0 H ,uA9omwg_q/5tiUi[o9cvYy7M+~,ftY#>M?q1ic7y*{b?~fonen;Wcx5;hCVE!&"!3BNlCVWq\K%[dC=TP:::::60E,Y,Xdq\qU Please turn on JavaScript and try again. All services billed with the following revenue codes: Prior authorization lookup tool Interested in becoming a provider in our network? NaviNet is a registered trademark of For more information visit amerihealthnj.com. AHNJ Enrollment/Change Request Form (01412) 2007-05. 0000009954 00000 n Precertification is required for outpatient nonemergent diagnostic imaging services and certain high-technology radiology services for our managed care members. 0000013636 00000 n Association. 1-732-452-6050 Adult medical day care: 1-888-240-4717 The following always require prior authorization: Elective services provided by or arranged at nonparticipating facilities. You can also go to amerihealthnj.com/html/providers/policies.html to learn more about precertification requirements for all products. Is this injury related? Submit a medication prior authorization request to the PerformRx Prior Authorization team by fax at 1-855-825-2717. See how AmeriHealth New Jersey actually rewards members for healthy behaviors. Please review Medical Policy #11.02.27: Percutaneous Coronary Intervention, Coronary Angiography, and Arterial Ultrasound for the specific AmeriHealth policies and a link to Clinical Appropriateness Guidelines that AIM uses during the precertification process, as well as a listing of procedure codes requiring precertification on our xref Please enable scripts and reload this page. 0000005382 00000 n Coverage of the COVID-19 Vaccination for AmeriHealth Members (Retroactively effective to October 12, 2022, issued November 2, 2022) This communication provides notice regarding information and procedure codes related to the coverage of SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) vaccines and administration of the vaccines . MAGNACARE PPO (excluding No-Fault) Please review Medical Policy #00.01.66: Musculoskeletal Services for the specific AmeriHealth policies and a link to Clinical Appropriateness Guidelines that AIM uses during the precertification process, as well as a listing of procedure codes requiring precertification on our If you still have questions after reviewing the FAQ, please send an email to 0000018283 00000 n Medical Policy. Musculoskeletal Utilization Management Program: Frequently asked questions (FAQ). Ordering physicians PCPs or specialists are required to obtain precertification for the following outpatient nonemergent diagnostic services: Reviews for the above services will be performed by AIM according to Medical Necessity criteria. Adobe PDF Reader is required to view clinical worksheets documents. %PDF-1.3 % Only participating providers in an Independence Blue Cross, Independence Administrators, AmeriHealth, or AmeriHealth Administrators network can obtain access to the PEAR portal. 0000006936 00000 n AmeriHealth Created Date: 9/28/2005 7:24:27 AM . This includes visits with: Including nutrition counseling; urgent care; video-only visits for physical and occupational therapy; and audio or video for speech therapy, Waiving cost-sharing for in-network, inpatient acute care treatment for COVID-19, Waiving prior authorization for all inpatient admissions, Coverage of consumer-grade pulse oximeters at no cost, Waiving prior authorization requirements for post-acute care admissions. Cardiac or pulmonary rehabilitation. QUALCARE 2007-01. 1The Families First Coronavirus Response Act (FFCRA) and Coronavirus Aid, Relief, and Economic Security (CARES) Act mandate that member cost sharing (deductible, co-pays and coinsurance) is waived both in and out-of-network for the testing and diagnosis of COVID-19 through the public health emergency. To request prior authorization contact AmeriHealth Caritas North Carolina's radiology benefits vendor (NIA) via their provider web-portal at radmd.com or by calling 1-800-424-4953 Monday through Friday 8:00 a.m. - 8:00 p.m. (EST).. For specialty vendors, please verify prior authorization requirements with the following contracted vendors: Vision: Avesis. AmeriHealth Select Drug Program Q \& A. 3Unless the benefit design provides otherwise, or out-of-network visits are permitted by AmeriHealth New Jersey due to network adequacy or access. Cardiac and pulmonary rehabilitation services. Post-Acute Facility Admission Guide. Drugs administered by physician or outpatient hospitals on the Louisiana Medicaid Fee Schedule will be reimbursed. Chiropractic services after the 24th visit if the member is under the age of 18. VETERANS CHOICE (prior authorization required for all services) Please refer to the Clinical Services Utilization Management or the Specialty Programs sections of the This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of AmeriHealth, AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey. Prior Authorization is required for services exceeding 24 visits per discipline within a calendar year. Note: All chiropractic and acupuncture services require authorization through the Living Beyond Pain program. The extended dates show AmeriHealth New Jersey's commitment to ensuring that its members receive the care they need during the COVID-19 pandemic. If you have questions about this tool or a service or to request a prior authorization, call 1-888-913-0350. Hunterdon Radiological Associates provides state-of-the-art advanced medical imaging. Chiropractic manipulative treatment for members over age of 18 (only codes 98940, 98941 and 98943). 0000008508 00000 n & spectral, Transthoracic echo complete w/o HUMANA (if QualCare PPO Network New Jersey Only is on member ID card) Title: AmeriHealth New Jersey services that require precertification Author: AmeriHealth New Jersey Created Date: 5/21/2015 3:35:56 PM Click the link below to learn more about our team. Use SHIFT+ENTER to open the menu (new window). The results of this tool are not a guarantee of coverage or authorization. 0000001467 00000 n Prior authorization for these radiological exams is obtained from National Imaging Associates (NIA) or by calling 1-800-424-5657. Box 21545 | Eagan, MN 55121 . HORIZON BCBS OF NJ (including Medicare Advantage, Medicare Advantage NJ Direct 10 and15-PPO) Is study part of a standard post-chemo/radiation protocol in a patient with a prior cancer diagnosis? RadMD is available 24 hours per day, seven days per week, except when maintenance is performed once every other week after business hours. The registration form requires an officer or owner of the provider . PEAR Practice Management (PEAR PM) - provides access to transactions such as eligibility & benefits checks, authorization submission & search, referral submission and search, claim submission, search & investigation; . w/cont EKG, Resting transthoracic 0000004184 00000 n 0000001117 00000 n <<937498CE07FF2D45BB953072380F38A3>]/Prev 438121>> P.O. You may be trying to access this site from a secured browser on the server. AmeriHealth New Jerseys COVID-19 initiatives currently in effect for fully insured groups and individual members until 90 days after the end of both the state of emergency and the public health emergency related to COVID-19: AmeriHealth New Jerseys COVID-19 initiatives currently in effect for fully insured groups and individual members until December 31, 2020: AmeriHealth New Jersey encourages members and others to visit the companys comprehensive COVID-19 websites for details on the updates, as well as the latest news and information: For more information on AmeriHealth New Jerseys response to the COVID-19 pandemic, visitamerihealthnj.com/covid-19. Precertification is required for certain surgical procedures of the spine and joint and interventional pain management procedures and is delegated to AIM for evaluation of medical necessity. Wellness programs. Insurance companies may attempt to tell you which radiology center you must go to for your exam. , 1-855-214-6777. The company regularly assesses the current environment for ways to help members, employers, and physicians. You may obtain prior authorization by calling 1-800-424-5657. If you still have questions after reviewing the FAQ, please send an email to US FAMILY HEALTH PLAN (through MedSolutions for global radiology, MRI, PET servicesperformed at Brems and Hunterdon Imaging) Yes No Date and type of Injury: _____ 6. You may be trying to access this site from a secured browser on the server. GREAT WEST CIGNA (excluding Medicare Advantage) 0000001417 00000 n Since the onset of the Affordable Care Act, we have been committed to offering health plans on the Individual Marketplace, which has expanded access to coverage for New Jersey residents. Provider Contact Information. Please click on the link below for the applicable Prior Authorization form. USA MANAGED CARE PPO It is very important that providers use 44 0 obj <>stream COVENTRY PPO (including Workers Comp) To see the complete list of the non-emergent tests and procedures that will be delegated to AIM and how to submit precertification requests, please review our website. Fax #215-784-0672 . Provider Manual for Participating Profession Providers for more information on preapproval/precertification through AIM. yua.OOaVX+tDGKK8WGa.A.y%w@^e^E^8O(p45SOu. Home-based sleep study tests do not require precertification. MULTIPLAN (including Workers Comp) of service on or after January 1, 2013, providers will need to obtain prior Therapy Authorization Forms : Physical, Occupational, Chiropractic or Speech Therapy Nursing Private Duty Nursing Phone: 1-800-258-3175 Transplants. the NaviNet web portal to verify RAILROAD MEDICARE Services requiring prior authorization OXFORD FREEDOM AND LIBERTY PLANS (including Medicare Advantage) PHCS. UNITED HEALTHCARE COMMUNITY PLAN (formerly Americhoice) Medical Policy Portal. The extended dates show AmeriHealth New Jerseys commitment to ensuring that its members receive the care they need during the COVID-19 pandemic. If you have questions about the preauthorization process, call 1-800-275-2583. AMERIHEALTH (including Medicare Advantage and Independence BC) The categories of treatment (in any setting) that require prenotification include: Any surgical procedure that may be considered potentially cosmetic; Precertification is required through AIM for sleep studies and continuous positive airway pressure (CPAP) titration studies in facility-based settings. If you would like to view all eviCore core worksheets, please type in "eviCore healthcare" as your health plan. We also provide administrative services to self-funded groups. Use SHIFT+ENTER to open the menu (new window). AmeriHealth Administrators . FIRST HEALTH PPO (including Workers Comp) are listed in the table below: Transthoracic stress echo, complete Use the Prior authorization lookup tool above to see if a code requires authorization. Our radiologists are all board certified. For High Deductible Health Plans, in-network cost sharing waivers for inpatient COVID-19 treatment detailed above will remain in effect through December 31, 2020 unless prohibited by law. UNITED HEALTHCARE (including Medicare Advantage) A request form must be completed for all medications requiring prior authorization. Effective for dates of service on or after January 1, 2013, providers will need to obtain prior authorization for AmeriHealth 65 NJ HMO and AmeriHealth 65 Preferred HMO members for cardiac radiology services, which include: stress echocardiography; resting transthoracic echocardiography; transesophageal echocardiography aimumprograms@amerihealth.com. You, as the patient, have a right to choose if you would like to have your exam performed at South Jersey Radiology. Cranbury, NJ, July 1, 2020 AmeriHealth New Jersey announces that it has extended many of the benefit changes the company implemented for fully insured groups and individual members in response to the COVID-19 pandemic.. For questions about precertification, please call Customer Service at 1-888-YOUR-AH1 (1-888-968-7241). 15 30 For prior authorization after hours, on weekends, and during holidays, call Member Services at 1-833-704-1177. *AmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc. Media Contact Jill Roman Manager, Public Relations AmeriHealth New Jersey (609) 662-2454 Jill.Roman@AmeriHealth.com AmeriHealth Administrators uses various policies and criteria, including AmeriHealth medical policy and InterQual , for utilization review determinations. Named one of the Best Places to Work for the past nine years, AmeriHealth New Jersey is located in Cranbury, NJ. *AmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc. Media Contact Jill Roman Manager, Public Relations AmeriHealth New Jersey (609) 662-2454 Jill.Roman@AmeriHealth.com, AmeriHealth Insurance Company of New Jersey | AmeriHealth HMO, Inc.Anti-fraud | Privacy Policy | Legal | Carrier Data Sets, Coverage for the costs of COVID-19 testing. trailer Named one of the Best Places to Work for the past nine years, AmeriHealth New Jersey is located in Cranbury, NJ. DME providers are required to obtain preapproval/precertification for APAP, BPAP, and CPAP (PAP) machines and their replacement supplies (e.g., tubing, water chambers, face masks). If you are interested in having a registered nurse Health Coach work with your Pennsylvania patients, please complete a physician referral form or contact us at 1-800-313-8628. 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