Beginning January 1, 2019, AmeriHealth New Jersey will require precertification for all non-emergent transfers from one inpatient acute-care setting to another inpatient acute-care setting as well as non-emergent land and air ambulance transports. Requesting precertification For non-emergent inpatient transfers Facilities will need to call Clinical Services to request precertification when a non-emergent inpatient transfer request is initiated by the facility, regardless of the manner in which the member will be transported. Facilities are not able to initiate non-emergent inpatient transfer requests through the Authorizations transaction on the NaviNet? web portal at this time. For non-emergent ambulance transportation When non-emergent land ambulance requests are initiated by the ambulance provider, the precertification request must be submitted through the Authorizations transaction on NaviNet. However, when non-emergent air ambulance requests are initiated by the ambulance provider, the precertification request must be called in to Clinical Services. Providers are not able to initiate non- emergent air ambulance requests through NaviNet at this time. Failure to obtain precertification when required may result in a reduction in payment or non-payment for services rendered. Note: Inpatient transfers, including ambulance transportation, performed on an emergent basis are subject to post-payment review. For more information If you have any questions about this change, please call the AmeriHealth Clinical Services department at 1-888-YOUR-AH1. This requirement is reflected in the 2019 Precertification List, which is available on our website. Note: 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 once it becomes effective.

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