Effective for dates of service on or after June 1, 2012, we will implement important changes to the list of services and drugs that require precertification for most commercial AmeriHealth New Jersey members (Comprehensive Major Medical [CMM] members are excluded).*

The following precertification requirements will be added for these members in all settings:

• cardiac radiology (stress echocardiography, resting transthoracic echocardiography, and transesophageal echocardiography);
• potentially cosmetic procedures (please refer to the complete list below);
• pain management procedures (paravertebral facet joint injections, transforaminal epidural injections, epidural injections);
• additional medical infusion/injectable drugs (please refer to the complete list of additions listed below);
• cataract surgery;
• cochlear implant surgery;
• hyperbaric oxygen;
• uvulopalatopharyngoplasty (UPPP or UP3).

The following precertification requirements will be removed for these members in all settings:

• sleep studies
• cardiac rehabilitation
• pulmonary rehabilitation

It is very important that providers use the NaviNet® web portal to verify member-specific requirements or refer to the most current precertification requirement lists on our website. Failure to obtain precertification for any of the services or drugs that require it may result in a reduction in payment or nonpayment for the services not precertified.

Please call 1-800-275-2583 if you have any questions about these upcoming changes.

*This change is pending approval from the New Jersey Department of Banking and Insurance for Small Employer Health (SEH) members.
^†This drug is pending approval from the U.S. Food and Drug Administration.