As a reminder, 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

The method for requesting precertification differs depending upon the type of service and who requests it.

• 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 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.

• 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.

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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