AmeriHealth will issue a new medical policy to communicate the coverage
criteria for precertification of pediatric intensive day feeding programs.
Medical Policy #10.00.03: Pediatric Intensive Day Feeding Program was posted as
a Notification on December 28, 2018 and will go into effect January 28,
2019.
Policy details
Pediatric intensive day feeding programs for treatment of a feeding disorder
are offered in an outpatient setting. These programs are provided when the
individual requires the intensity of acute inpatient rehabilitation but does
not require 24-hour-a-day medical and nursing supervision provided in that
setting. Treatment of a feeding disorder occurs during each weekday; the
individual returns home each evening and for the entire weekend.
Treatment of a feeding disorder in a pediatric intensive day feeding program
involves multiple therapeutic services overseen by a physician who is part of a
multidisciplinary professional team. The team may be comprised of a combination
of behavioral therapist, occupational therapist, physician, registered
dietitian, and speech language pathologist/therapist. A component of pediatric
intensive day feeding programs may include other medical services such as
psychological therapy, nursing, and case management.
Feeding disorder treatment in an outpatient pediatric intensive day feeding
program is considered medically necessary and, therefore is covered when the
criteria outlined in the medical policy are met.
To obtain precertification, providers should call
1-888-YOUR-AH1 for AmeriHealth New Jersey and
1-800-275-2583 for AmeriHealth Pennsylvania and select
Authorizations from the menu. Initial authorizations for pediatric
intensive day feeding cannot be submitted through the
NaviNet® web portal at this time.
More information
To view the Notification for this policy, visit our Medical Policy
Portal select Accept and Go to Medical Policy Online, and then
select Active Notifications.
If you have additional questions, please contact Provider Services at
1-888-YOUR-AH1 for AmeriHealth New Jersey and
1-800-275-2583 for AmeriHealth Pennsylvania.
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