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As previously communicated, effective January 1, 2015, precertification will be required for non-emergent outpatient radiation therapy for all commercial AmeriHealth HMO members in Pennsylvania. AmeriHealth is working with CareCore National, LLC (CareCore) to manage precertification requests for non-emergent outpatient, non-emergent radiation therapy services. Precertification is not required when radiation therapy is rendered in the inpatient hospital setting.
To initiate precertification for non-emergent outpatient radiation therapy, a new option will be added to the NaviNet® web portal within the Authorizations transaction that will link to CareCore's provider portal.
You can also access their provider portal directly by going to www.carecorenational.com. Once on CareCore's portal, you will be required to create a login and password. This login will be used every time you request precertification through CareCore. If you already have access to CareCore's portal, please use your current login information.
For precertification requests for dates of service on or after January 1, 2015, you can call CareCore directly at 1-866-686-2649 or submit the request via NaviNet starting December 16, 2014.
In April 2015, precertification requests for non-emergent outpatient radiation therapy will also be reviewed for medical necessity. A medical policy will be forthcoming that will include a list of all the codes requiring precertification through CareCore as well as a link to the guidelines that will be used to determine medical necessity.
Precertification for other radiology services
Precertification requests for all high technology diagnostic imaging services (e.g., CT, MRI, PET) will continue to be handled through the current process with AIM Specialty Health®.
For more information
Look for more information about this change in future editions of Partners in Health UpdateSM. Network radiation therapy centers will receive a letter describing the new precertification process through CareCore in greater detail.
Note: This precertification requirement does not apply to members ages 19 and younger or AmeriHealth New Jersey commercial HMO and PPO or Medicare Advantage HMO members.
CareCore tutorial webinars available
CareCore will host the following tutorial webinars about how to use their portal:
- December 10, 2014, 10 a.m. to 11 a.m.
- December 12, 2014, 10 a.m. to 11 a.m.
- December 12, 2014, 1 p.m. to 2 p.m.
If you are interested in participating, please
email your contact information and preferred session date and time.
AIM is contracted with AmeriHealth to perform precertification for select services for most managed care members.
NaviNet® is a registered trademark of NaviNet, Inc.
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