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​Upcoming precertification requirement for non-emergent inpatient transfers, including ambulance transport, for AmeriHealth Pennsylvania members

May 1, 2019


Attention! An update has been made to this article. The audience was updated to reflect all category types.


Effective June 1, 2019, AmeriHealth will require precertification for all non-emergent transfers from one inpatient acute-care setting to another inpatient acute-care setting as well as for non-emergent land and air ambulance transports for AmeriHealth Pennsylvania members.

Requesting precertification

The method for requesting precertification differs depending upon the type of service and who requests it.

For non-emergent transfers from one inpatient acute-care setting to another inpatient acute-care setting
  • Facilities need to call the AmeriHealth Utilization Management team to request precertification when a non-emergent inpatient transfer request is initiated by the facility, regardless of the way the member will be transported.
  • The receiving facility should obtain the precertification authorization from the transferring facility before the non-emergent inpatient transfer occurs.
  • Facilities are not able to initiate non-emergent inpatient transfer requests through the NaviNet® web portal at this time. 
For non-emergent ambulance transportation
  • Ambulance providers should verify that the transferring facility has obtained precertification for all non-emergent ambulance transport requests through the Authorizations transaction on NaviNet. If an authorization is not found, please contact the requesting transferring facility.
  • For any other elective ambulance transport requests initiated by the ambulance provider, the precertification request must be submitted through the Authorizations transaction on NaviNet.
  • When non-emergent air ambulance requests are initiated by the ambulance provider, the precertification request must be called in to the AmeriHealth Utilization Management team. Providers are not able to initiate non-emergent air ambulance requests through NaviNet at this time.

Failure to obtain or verify precertification when required may result in a reduction in payment or non-payment for services rendered. Inpatient transfers, including ambulance transportation, performed on an emergency basis are still subject to post-payment review.

For more information

If you have any questions about this change, please call the AmeriHealth Utilization Management team at 1-800-275-2583.

This requirement will be reflected in our updated Preapproval/Precertification List, which will be available on our website.

The Billing & Reimbursement for Ancillary Services section of the Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers will be updated to reflect this requirement.

NaviNet® is a registered trademark of NantHealth.


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