Attention! An update has been made to this article. The audience was updated to reflect all category types.
As previously announced,
as of January 1, 2019, AmeriHealth New Jersey requires 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.
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 Clinical Services to request precertification when a non-emergent inpatient transfer request is initiated by the facility, regardless of the way the member will be transported.
- Facilities are not able to initiate non-emergent inpatient transfer requests through 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.
- 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 emergency basis are still 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![]( "Call: 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.
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