Home Administrative Billing & Reimbursement Health and Wellness Medical PEAR portal Pharmacy Products Quality Management

Urgent care centers and retail health clinics are alternatives to the ER when physicians are unavailable (PA only)

May 31, 2013

We would like to remind you of the urgent care benefit available for most AmeriHealth members. This benefit allows members to receive services for urgent medical issues that do not require the advanced medical services of the emergency room/department (ER) when the physician is unavailable. Generally, urgent care is categorized as medically necessary treatment for a sudden illness or accidental injury that requires prompt medical attention, but is not life-threatening and is not an emergency medical condition, when a member's primary care physician is unavailable. Urgent care is available to members in the following places: Urgent care centers. Urgent care centers are staffed by board-certified physicians who can provide medically necessary treatment for a sudden illness or injury that is not life-threatening. Retail health clinics. Retail health clinics are staffed by certified family nurse practitioners trained to diagnose, treat, and write prescriptions for (when clinically appropriate) common illnesses and medical conditions. Local supervising physicians are on call during clinic hours of operation to provide guidance and direction when necessary. Approved urgent care providers can be found by using our []Provider Finder tool[]. These approved providers may treat members without a referral or authorization. You may want to print out a list of the approved urgent care centers and retail health clinics in your area to keep on hand and share with the staff who handle after-hours calls. This list may be instrumental in cases when a member requires urgent medical attention, but your office is closed and ER care is not necessary. Please note that not all members are eligible for the urgent care benefit. As always, continue to check the NaviNet[®] web portal for member eligibility and cost-sharing amounts. If you have any questions about the urgent care or retail health clinic network, please call Customer Service at []1-800-275-2583[]. [

NaviNet® is a registered trademark of NaviNet, Inc.

]

This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of AmeriHealth, AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey.
© 2023 AmeriHealth Site Map        Anti-Fraud        Privacy Policy        Legal        Disclaimer