As previously communicated in a Partners in Health Update^SM article, as of June 1, 2019, AmeriHealth requires precertification for all non-emergent transfers from one inpatient acute-care setting to another inpatient acute-care setting and for non-emergent land and air ambulance transports for AmeriHealth Pennsylvania members.

Requesting precertification

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

• Facilities need to call the AmeriHealth Utilization Management team to request precertification when a non-emergent inpatient transfer request is initiated by the facility, regardless of the way the member will be transported.
• The receiving facility should obtain the precertification authorization from the transferring facility before the non-emergent inpatient transfer occurs.
• Facilities are not able to initiate non-emergent inpatient transfer requests through the NaviNet^® web portal at this time. 

• Ambulance providers should verify that the transferring facility has obtained precertification for all non-emergent ambulance transport requests through the Authorizations transaction on NaviNet. If an authorization is not found, please contact the requesting transferring facility.
• For any other elective ambulance transport requests 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 the AmeriHealth Utilization Management team. Providers are not able to initiate non-emergent air ambulance requests through NaviNet at this time.

Failure to obtain or verify precertification when required may result in a reduction in payment or non-payment for services rendered. 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 Utilization Management team at 1-800-275-2583.

This requirement is reflected in our updated Preapproval/Precertification List, which is available on our website.

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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