For the most up-to-date list of services and specialty drugs that require
precertification, download the latest versions of the Preapproval/Precertification List for AmeriHealth New
Jersey and the Preapproval/Precertification List for AmeriHealth
Pennsylvania.
As a reminder, significant changes go into effect January 1, 2015, for the
following three categories:
- Non-emergent outpatient radiation therapy.
Precertification through CareCore National, LLC is required for non-emergent
outpatient radiation therapy for all commercial AmeriHealth Pennsylvania HMO
and POS members. Note: This precertification requirement does not
apply to AmeriHealth New Jersey commercial HMO and PPO or Medicare Advantage
HMO members.
- Durable medical equipment (DME).
DME providers are required to obtain precertification for all APAP, BPAP, and
CPAP machines and replacement supplies (e.g., tubing, water chambers, face
masks) for all commercial and Medicare Advantage HMO and PPO members.
- Medical benefit drugs. Precertification approval has been
added for BeleodaqTM, EntyvioTM, Keytruda®
, Opdivo®, Ruconest®, and SylvantTM.
Precertification is no longer required for Aredia®,
Arzerra®, Boniva® injection,
Ceredase®, Eloxatin®, Nulojix®,
Orthovisc®, Synvisc®, and
Synvisc-One®.
If you have any questions, please contact Cheryl McGurk, Manager of
Precertification, at 215-241-4542.