inside this issue · interactive voice response (ivr) system enhancements scheduled for july. july...

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July 2009 www.amerihealth.com/providers Inside this issue BILLING Upcoming audits to investigate trends in questionable billing MEDICAL New federal mental health and substance abuse parity mandate Reminder: Mandated coverage for autism spectrum disorders (PA only) OB/GYN copayment and product information for routine and nonroutine services Policy notifications posted as of June 17, 2009 WEB NEWS New search feature available on amerihealth.com PHARMACY Use direct ship for specialty injectable and specialty oral medication therapies Upcoming NDC code submission changes for institutional providers PREVENTIVE HEALTH AmeriHealth Healthy Lifestyles SM programs help members maintain a healthy weight Online immunization schedules for newborns and children now available Connections SM Health Management Programs: Supporting our members, your patients Online immunization schedules for newborns and children now available

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Page 1: Inside this issue · Interactive Voice Response (IVR) system enhancements scheduled for July. July 2009 ... mandate is effective July 1, 2009. We will begin to include ... Refer to

July 2009www.amerihealth.com/providers

Inside this issue

BILLING

Upcoming audits to investigate trends in ●questionable billing

MEDICAL

New federal mental health and substance abuse ●parity mandate

Reminder: Mandated coverage for autism ●spectrum disorders (PA only)

OB/GYN copayment and product information for ●routine and nonroutine services

Policy notifications posted as of June 17, 2009 ●

WEB NEWS

New search feature available on amerihealth.com ●

PHARMACY

Use direct ship for specialty injectable and ●specialty oral medication therapies

Upcoming NDC code submission changes for ●institutional providers

PREVENTIVE HEALTH

AmeriHealth Healthy Lifestyles ● SM programs help members maintain a healthy weight

Online immunization schedules for newborns and ●children now available

Connections ● SM Health Management Programs: Supporting our members, your patients

Online immunization schedules for newborns and children now available

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Models are used for illustrative purposes only. Some illustrations in this publication copyright 2009 www.dreamstime.com. All rights reserved.

This is not a statement of benefits. Benefits may vary based on state requirements, Benefit Program (HMO, PPO, Indemnity, etc.), and/or employer groups. Providers should call Provider Services for the member’s applicable benefit information. Members should be instructed to call the Customer Service telephone number listed on their ID card.

The third-party websites mentioned in this publication are maintained by organizations over which AmeriHealth exercises no control, and accordingly, AmeriHealth disclaims any responsibility for the content, the accuracy of the information, and/or quality of products or services provided by or advertised in these third-party sites. URLs are presented for informational purposes only. Certain services/treatments referred to in third-party sites may not be covered by all benefits plans. Members should refer to their benefits contract for complete details of the terms, limitations, and exclusions of their coverage.

NaviNet® is a registered trademark of NaviNet, Inc.

An AmeriHealth company holds a minority ownership interest in NaviNet, Inc.

CPT copyright 2008 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. No fee schedules, basic units, relative values, or related listings are included in CPT.

Weight Watchers® is a registered trademark of Weight Watchers International, Inc.

Partners in Health UpdateSM is a publication of AmeriHealth and its affiliates (AmeriHealth) created to provide valuable information to the AmeriHealth participating provider community. This publication may include notice of changes or clarifications to administrative policies and procedures which are related to the covered services you provide in accordance with your participating professional provider, hospital, or ancillary provider/ancillary facility contract with AmeriHealth. This publication is the primary method for communicating such general changes. Suggestions are welcome.

Contact Information:

Provider CommunicationsAmeriHealth1901 Market Street 35th FloorPhiladelphia, PA 19103

[email protected]

John Shermer Managing Editor

Charleen BaseliceProduction Coordinator

For articles specific to your area of interest, look for the appropriate icon:

Professional

Facility

Ancillary

AmeriHealth HMO, Inc. in New Jersey has an accreditation status of Excellent from the National Committee for Quality Assurance (NCQA).

AmeriHealth HMO, Inc. in Delaware and AmeriHealth HMO, Inc. in Pennsylvania have an accreditation status of Commendable from the National Committee for Quality Assurance (NCQA).

This just in...

Reminder...Have you made any changes to your key practice information, such as your mailing address, phone number, or other contact information? If so, please be sure to notify us.

We value your help in keeping our files current. Accurate files allow us to continue to provide you with important information on billing, claims, changes or additions to policies, and announcements of administrative processes.

If you have had any recent changes, please submit them to us through the NaviNet® web portal, or by using the Provider Change Form available on www.amerihealth.com/providerforms.

You may also report changes to your Network Coordinator or Hospital/Ancillary Services Coordinator, or call Customer Service at 1-800-275-2583, prompt 2 for Provider Services.

Keep your information up to date

We will soon implement enhancements to the IVR system for authorization services to improve your calling experience. When calling for authorization-related services, please have your NPI or corporate provider ID number and the last four digits of your tax ID number ready.

Interactive Voice Response (IVR) system enhancements scheduled for July

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July 2009 | Partners in Health UpdateSM 3 www.amerihealth.com/providers

In addition to our Corporate and Financial Investigations Department’s (CFID) role in combating fraudulent practices against us, the CFID is also responsible for conducting audits of claims submitted by facility, professional, and ancillary service providers. Using sophisticated data-mining software tools, the CFID analyzes claims and compares them to member enrollment data and overall provider information. Any trends, patterns, or aberrant billing practices are selected for an in-depth audit or investigation.

Upcoming audits to investigate trends in questionable billingBased on recent trends that have been identified in the data, the CFID would like to alert providers to some questionable billing practices that will be the focus of upcoming audits. The CFID audit team, which consists of registered nurses, medical coders, and claims experts, will be conducting audits that focus on facility, professional, and ancillary claims.

Facility provider audits will include: ● DRG validation audits to ensure that submitted claims –are coded properly and remitted appropriately; outpatient fee schedule coding audits to ensure –that CPT®/HCPCS codes are properly submitted to reflect the services rendered and that remittance is consistent with policies and contracts; outpatient observation audits to ensure that services –rendered accurately match services billed; outpatient critical-care audits to assure accurate –coding of outpatient critical-care ER visits.

Professional provider audits will include: ● inpatient and outpatient evaluation and management –(E&M) services audits to ensure that appropriate levels are billed and paid, including consultation codes and the use of modifiers 24 and 25 with E&M claim submissions; office site-of-service audits to ensure that services –receiving a site-of-service differential were rendered and billed in the office where the service took place;

audits of E&M codes billed with modifier 25 on the –same days as preventive medicine codes to ensure that the documentation that supports the E&M service was for a significant and separately identifiable service from the preventive medicine service; consultation E&M code audits to ensure that the – documentation satisfies the requirements for a consultation, which include the request for an opinion or advice, the consultant’s opinion and services performed or ordered, and a written report back to the requesting physician; single- versus multiple-unit audits to ensure that the – correct units are billed as defined for CPT codes; audits of high-dollar medications that are –administered in a physician’s office to assure the accuracy of claims billed; duplicate billing audits to ensure that duplicate claims –are denied appropriately; anesthesia base code and add-on code audits to –ensure that units are billed correctly.

Ancillary provider audits will include: ● audits of high-dollar medications administered in the –home setting to assure the accuracy of claims billed; durable medical equipment audits to ensure that –claims accurately reflect services rendered; medication compounding audits to ensure that –necessary and appropriate compounding and billing are done only when commercially prepared mixtures are unavailable.

Health care fraud is a violation of state and federal law. An easy-to-use process exists for reporting any suspected fraud, waste, or abuse. If you are suspicious of any health care-related activity, please visit www.amerihealth.com/antifraud or call our toll-free Corporate Compliance and Fraud Hotline at 1-866-282-2707. These tips can lead to audits, fraud investigations, or both, which can result in monetary recoveries that help keep health care costs down.

Upcoming audits to investigate trends in questionable billing

Billing

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New federal mental health and substance abuse parity mandateAn upcoming Mental Health Parity and Addiction Equity Act for mental health and substance abuse benefits may affect your patients. A summary of the mandate is below to help prepare you for questions that your patients may have.

Mental Health Parity and Addiction Equity ActThe Mental Health Parity and Addiction Equity Act, which is part of the Emergency Economic Stabilization Act of 2008 that President George W. Bush signed late last year, applies to members who are covered by group health plans with 51 or more employees. It requires that mental health and substance abuse benefits, if they are provided, be in parity with (or equal to) medical and surgical benefits.

As a result of the mandate, members may experience some benefits changes, including the removal of limits on inpatient days and outpatient visits as well as differences in cost-sharing (e.g., deductibles, copayments, coinsurance, and out-of-pocket expenses) for mental health and substance abuse services. Please note that current medical management (e.g., precertification) will not be affected by the mandate. Members will be notified about how the mandate may affect them before any benefits changes take place.

The mandate will go into effect for new and renewing groups on or after October 15, 2009, and it applies to all commercial managed care (HMO, POS, Direct POS [PA only], and PPO) plans.

If you have questions about the Mental Health Parity and Addiction Equity Act, please contact Customer Service at 1-800-275-2583, prompt 2 for Provider Services. If your patients have questions, please refer them to Customer Service.

Products

Reminder: Mandated coverage for autism spectrum disorders (PA only)

Medical

On July 3, 2008, the Commonwealth of Pennsylvania passed a law that requires health insurers to cover the diagnosis and treatment of autism spectrum disorders (ASD) for members under 21 who are in commercial groups with 51 or more employees. ASD includes autistic disorder, Asperger’s Syndrome, Rett Syndrome, childhood disintegration disorder, and pervasive development disorder. Coverage for ASD in accordance with this mandate is effective July 1, 2009. We will begin to include coverage for eligible new members who begin coverage on or after July 1, 2009. We will also apply this coverage over the next year to eligible existing members on their contract anniversary date. Benefits will be provided for services set forth in a treatment plan, which we may request and review for approval.

For more detailed information about ASD coverage for eligible Pennsylvania group members, refer to the June issue of Partners in Health Update. You can also refer to Policy #07.03.07c: Evaluation and Management of Autistic Spectrum Disorders (ASD), which is now available on our website at www.amerihealth.com/medpolicy.

July 2009 | Partners in Health UpdateSM 4 www.amerihealth.com/providers

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July 2009 | Partners in Health UpdateSM 5 www.amerihealth.com/providers

When a member visits your office for GYN services, you should collect the appropriate copayment. To verify the correct copayment, please refer to the member’s ID card, refer to the product/copayment table below, or verify eligibility through the NaviNet® web portal.

In most circumstances for routine annual GYN visits, only a routine GYN copayment should be collected. However, in cases where both routine annual screening and specific problem-focused evaluation and management (E&M) are delivered during the same visit, both routine and nonroutine copayments may apply. You may bill separately for the problem-focused E&M visit only if the services you rendered beyond the preventive visit separately meet CPT® criteria for the E&M code.

Refer to the product/copayment tables below when rendering OB/GYN services to your patients, and share this information with the person who handles billing for your office. An updated Provider Manual for Participating Professional Providers that includes these changes will be available later this year.

If you have any questions, contact your Network Coordinator or Hospital/Ancillary Services Coordinator.

Note: Documentation in the medical record must support the services billed.

AmeriHealth Pennsylvania

HMO products

(In-network/Referred services)

HMO products

(Referred services)

OB/GYN and midwife Product Copay type Product Copay type

Routine GYN visits AmeriHealth HMO Flex AmeriHealth POS Flex

AmeriHealth Direct POS FlexPrimary care

AmeriHealth HMO Non-FlexAmeriHealth POS Non-Flex

Specialist

Nonroutine GYN visit; 1st obstetrical visit

AmeriHealth HMO Flex AmeriHealth POS Flex

AmeriHealth Direct POS FlexPrimary care

AmeriHealth HMO Non-FlexAmeriHealth POS Non-Flex

Specialist

AmeriHealth Delaware

HMO products

(Referred services)

PPO products

(In-network services)

OB/GYN and midwife Product Copay type Product Copay type

Routine GYN visits

AmeriHealth HMO FlexAmeriHealth POS Flex

Primary care AmeriHealth PPO Flex Primary care

AmeriHealth HMO Non-FlexAmeriHealth POS Non-Flex

Specialist AmeriHealth PPO Non-Flex None

Nonroutine GYN visit; 1st obstetrical visit

AmeriHealth HMO FlexAmeriHealth POS Flex

Primary care AmeriHealth PPO Flex Primary care

AmeriHealth HMO Non-FlexAmeriHealth POS Non-Flex

Specialist AmeriHealth PPO Non-Flex Primary care

OB/GYN copayment and product information for routine and nonroutine services

Medical

continued on page 6

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July 2009 | Partners in Health UpdateSM 6 www.amerihealth.com/providers

AmeriHealth New Jersey

HMO products(In-network services)

PPO products(In-network services)

OB/GYN and midwife Product Copay type Product Copay type

Routine GYN visits

AmeriHealth HMOAmeriHealth POS

Specialist AmeriHealth PPO None

AmeriHealth HMOAmeriHealth POS Plus

Primary Care

AmeriHealth 65® ValueNone - pap test

$10 - pelvic exam$40 - Specialist

AmeriHealth 65 Preferred None - pap test$25 - pelvic exam$40 - Specialist

AmeriHealth 65 Plus

Nonroutine GYN visit; 1st obstetrical visit

AmeriHealth HMOAmeriHealth POS

Specialist AmeriHealth PPO Primary care

AmeriHealth HMOAmeriHealth POS Plus

Primary Care

AmeriHealth 65 Value Specialist

AmeriHealth 65 Preferred Specialist

AmeriHealth 65 Plus Specialist

This is not a statement of benefits. Benefits may vary based on state requirements, Benefits Program (HMO, PPO, Indemnity, etc.), and/or employer groups. Providers should call Provider Services for the member’s applicable benefits information. Members should be instructed to call the Customer Service telephone number listed on their ID card.

OB/GYN copayment and product information for routine and nonroutine services (continued)

Medical

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July 2009 | Partners in Health UpdateSM 7 www.amerihealth.com/providers

Policy notifications posted as of June 17, 2009All policies are posted prior to their effective date. Below is a listing of the policy notifications that we have posted to our website as of June 17, 2009.

Policy effective date

Notification titleNotification issue date

July 1, 2009 08.00.66c Bevacizumab (Avastin®) June 1, 2009

July 1, 2009 08.00.26i Botulinum Toxin Type A and Type B June 1, 2009

July 1, 200907.03.07c Evaluation and Management of Autism Spectrum

Disorders (ASD)June 1, 2009

July 10, 200911.08.17b Debridement of Mycotic and Symptomatic Non-Mycotic

Hypertrophic NailsJune 10, 2009

July 14, 2009 11.16.03d Lung Volume Reduction Surgery April 15, 2009

July 27, 2009 11.06.04f Uterine Artery Embolization for the Treatment of Fibroids April 28, 2009

July 28, 200911.17.06g Minimally Invasive Treatments for Urinary Outlet

Obstruction due to Benign Prostatic Hyperplasia (BPH)April 29, 2009

July 28, 2009 05.00.56d Hospital Beds and Accessories May 26, 2009

July 29, 2009 08.09.11d Medicare Part B vs. Part D Crossover Drugs May 29, 2009

August 26, 2009 11.08.20e Wound Care: Bioengineered Skin Substitutes May 28, 2009

On May 11, we launched a new design for our Medical Policy Portal homepage. The updated design makes important policy information more accessible for users. From the homepage, you now can directly access the medical and claim payment policies, news and announcements, policy notifications, and recently released pages of the Medical Policy Portal.

To access these notifications and then view the policies in their entirety, follow these instructions:

1. Visit www.amerihealth.com/medpolicy.

2. Select Accept and Go to Medical Policy Online.

3. Select Policy Notifications.

Be sure to check back often as the site is updated frequently.

Medical

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July 2009 | Partners in Health UpdateSM 8 www.amerihealth.com/providers

We recently added a new feature to our website’s search engine, making it easier for you to find information and publications relevant to your office. This new feature allows you to search for content that is specific to providers. The results of your search criteria will display only those documents — including PDFs and web pages — that have been posted within the provider section of the website.

Please note that you are not limited to the provider section of amerihealth.com — you can focus your search on any section, including News & Events, Social Mission, and For Members, by selecting the appropriate checkbox.

The results that appear are listed in order of relevance based on your keywords. However, you may find better results by selecting the sort by date option, which will list the most recent files that match your keywords.

If you have questions about this new feature, please contact your Network Coordinator or Hospital/Ancillary Services Coordinator.

Follow these steps to use the enhanced search feature:

Go to 1. www.amerihealth.com.

Locate the 2. Search field (on the top right corner of your screen), and click Go.

Select the 3. For Providers checkbox.

Enter one or more keywords in the 4. Search field (e.g., “infusion” or “billing”), and click the Search button.

New search feature available on amerihealth.com

WeB neWs

Calling all providers!Do you have suggestions on how we can improve your experience with our website?

We are in the process of redesigning the provider section of amerihealth.com and

value your input. Please email your ideas to [email protected]. Our goal is to make the site easier to navigate so you can quickly find the information you need. We appreciate and welcome your feedback.

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We coordinate with FutureScripts®, our pharmacy benefits manager, to offer the FutureScripts Direct Ship Specialty Pharmacy Program to members who have medical coverage through AmeriHealth. With this program, you can obtain specialty injectables and specialty oral medications (e.g., oral chemotherapy) for your patients.

When you use the FutureScripts Direct Ship Specialty Pharmacy Program to order speciality injectables and specialty oral medications, they facilitate shipment to your office or to your patient’s home.

Your patient can benefit from key features of this program, including:

free shipping; ● educational information and pharmacists available to answer questions about their therapies and possible side effects; ● proactive refill service, providing your patient with a phone call the week before the prescribed refill date to schedule ●the next delivery.

To complete requests as efficiently as possible, all referrals should be sent directly to the FutureScripts Direct Ship Specialty Pharmacy Program. They will coordinate the shipment and delivery of the specialty injectable or specialty oral medication therapies. You can obtain a referral form for enrollment by calling FutureScripts at 1-888-678-7012, option 3, or by visiting www.futurescripts.com.

If you have any questions about the FutureScripts Direct Ship Specialty Pharmacy Program, please call Customer Service at 1-800-275-2583, prompt 2 for Provider Services.

Use direct ship for specialty injectable and specialty oral medication therapies

For institutional providers: Scheduled for future release in 2009, we will require all claims for outpatient services containing the following pharmacy revenue codes and an unlisted and/or nonspecific (CPT® or HCPCS) code to also include a valid National Drug Code (NDC) when submitted: 250 – 259, 262, 263, 331, 332, 335, 343, 344, and 631 – 637. By requesting this detailed drug billing information, we can provide greater transparency for our members and providers.

NDC billing informationOnce these new billing requirements are effective, please submit the NDC using the 5-4-2 format when billing with hyphens (e.g., 12345-1234-12). NDC numbers without hyphens (e.g., 12345678911) will also be accepted. Please do not include spaces, decimals, or other characters in the 11-digit string, or the claim will be returned to you for correction prior to processing.

Certain claims for unlisted and nonspecific drug codes that are not accompanied by an NDC in the correct format and location will not be processed and will be returned to you for correction and resubmission after these changes have been implemented. Please note that the NDC requirement is applicable to the claim processing date and not the date of service.

Please refer to the Claims Preprocessing Edits Claims Resolution Document at www.amerihealth.com/ediforms for information on claims submission resolution. If you have questions, please contact your Hospital/Ancillary Services Coordinator.

Note: Effective January 1, 2009, changes in NDC submissions went into effect for professional and home infusion providers. Please see the January 2009 edition of Partners in Health Update for more information about those changes and to view the complete list of unlisted and nonspecific drug codes.

Upcoming NDC code submission changes for institutional providers

July 2009 | Partners in Health UpdateSM 9 www.amerihealth.com/providers

PharMacy

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July 2009 | Partners in Health UpdateSM 10 www.amerihealth.com/providers

Obesity among Americans, both adults and children, has doubled over the past two decades. According to the Centers for Disease Control and Prevention (CDC), data from the 2003 – 2004 National Health and Nutrition Examination Survey shows that 66 percent of U.S. adults are overweight and 32 percent are obese.

Being overweight or obese is a risk factor for a variety of chronic health conditions, including hypertension, heart disease, and diabetes mellitus. Despite public health efforts to encourage Americans to attain and maintain a healthy weight, the CDC reports suggest that much work remains to be done.

One of the national health objectives for 2010 is to reduce the prevalence of obesity among adults to less than 15 percent. We continue to embrace a proactive approach regarding the health of our members. This is why we are asking providers to discuss the following overweight- and obesity-related information with our members:

potential health risks related to weight ●body mass index (BMI) ●recommendations for weight management through healthy eating ●weight management programs ●recommendations for physical activity ●fitness programs ●

AmeriHealth offers programs to helpThe AmeriHealth Healthy Lifestyles programs can help members maintain a healthier way of life by providing incentives to help keep everyone in the best of health. AmeriHealth Healthy Lifestyles programs offer discounts and reimbursements for participating in weight management, fitness, smoking cessation, and alternative health programs. Eligible members can also receive up to six nutritional counseling visits per year.

In particular, our Healthy Weight, Healthy You program is designed to provide your patients with the necessary tools to achieve and maintain their ideal weight. Whether your patients are looking for the interaction of a group support program, the one-on-one attention of a registered dietitian, or the convenience of a self-directed program, we offer a variety of approaches to fit their lifestyle. By logging into our member portal at www.amerihealthexpress.com, your patients can learn more about obesity, determine their BMI, and complete a health risk assessment, which can help identify their possible health risks and offers suggestions for improvement. Members are also eligible to receive up to $200 for attending either Weight Watchers® or an approved weight management program based at a network hospital.

Please encourage members to call the Health Resource Center at 1-800-275-2583 to verify eligibility. Members may visit www.amerihealthexpress.com for more information about all of our AmeriHealth Healthy Lifestyles wellness programs, including Healthy Weight, Healthy You.

Weight Watchers® is a registered trademark of Weight Watchers International, Inc.

AmeriHealth Healthy LifestylesSM programs help members maintain a healthy weight

Preventive health

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Online immunization schedules for newborns and children now availableTo ensure that all infants and children receive all age-appropriate immunizations, we reach out each year to expectant mothers and the parents of children 18 months and older to inform them of the importance of vaccinations.

Newborn immunizationPhysicians should register expectant mothers in our Baby FootSteps® Program. A few weeks after registering, the mother will receive a packet of information that includes a recommended childhood immunization schedule for birth through age 6, which is adapted from several nationally recognized sources. The immunization schedule also includes a section that addresses questions and concerns about pediatric vaccination.

Pediatric immunizationSince 1997, we have been sending parents immunization reminders that include a vaccination schedule for birth to age 6 as well as answers to commonly asked questions about pediatric vaccinations. We encourage parents to consult their physician for the vaccination schedule most appropriate for their child. Members who receive this reminder may call your office to ensure that their child’s vaccinations are up to date or to schedule an appointment. We appreciate your attention to this important preventive care initiative.

In past years, vaccine shortages may have led to a delay in administration of scheduled vaccines. When vaccines become available, it is important for you to contact your patients to administer any missed vaccinations.

Please visit our website at www.amerihealth.com/trackingforms for more information on our immunization programs.

Preventive health

July 2009 | Partners in Health UpdateSM 11 www.amerihealth.com/providers

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July 2009 | Partners in Health UpdateSM 12 www.amerihealth.com/providers

ConnectionsSM Health Management Programs: Supporting our members, your patients

Connections Health Management Program information is available by visiting www.amerihealth.com/providerconnections.

ConnectionsSM

AccordantCareTM

Program

Call the Connections AccordantCare Program at 1-866-398-8761 to refer a member if the member has any of the following diseases:

n seizure disorders

n rheumatoid arthritis

n multiple sclerosis

n Crohn’s disease

n Parkinson’s disease

n systemic lupus erythematosus (SLE)

n myasthenia gravis

n sickle cell disease

n cystic fibrosis

n hemophilia

n scleroderma

n polymyositis

n dermatomyositis

n chronic inflammatory demyelinating polyradiculoneuropathy (CIDP)

n amyotrophic lateral sclerosis (ALS)

n Gaucher’s disease

Call the Provider Support Line at 1-866-866-4694 to refer a member for health coaching if the member has any of the following conditions:

ConnectionsSM

HealthManagementProgram

n asthma

n diabetes

n chronic obstructive pulmonary disease (COPD)

n �coronary heart disease (CHD)

n migraine

n heart failure

n hypertension

n gastroesophageal reflux disease (GERD)

n peptic ulcer disease (PUD)

Health Coaches also provide decision support for numerous health-related issues, including chronic pain, migraines, depression, and breast or prostate cancer.

Preventive health

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I m p o r t a n t R e s o u r c e s

Visit our website: www.amerihealth.com/providercommunications

American Imaging Management (AIM) Call for CT, MRI/MRA, PET, and Nuclear Cardiology (NJ only) Call for CT, MRI/MRA, PET, and Nuclear Cardiology (PA/DE only)

1-800-859-52881-800-275-2583

Care Management and Coordination Case Management 1-800-313-8628

Baby FootSteps® 1-800-598-BABY (2229)

AmeriHealth Healthy LifestylesSM Keys to Wellness (PA and DE only) 1-800-313-8628

ConnectionsSM Health Management Programs ConnectionsSM Health Management Program Provider Support Line 1-866-866-4694

ConnectionsSM AccordantCareTM Program 1-866-398-8761

Corporate and Financial Investigations Department Anti-Fraud and Corporate Compliance Hotline

1-866-282-2707www.amerihealth.com/anti-fraud

Credentialing Credentialing Hotline

215-988-6534 www.amerihealth.com/credentials

Credentialing Violation Hotline 215-988-1413

Credentialing and Re-credentialing inquiries (NJ only) 1-866-227-2186

Customer Service (Policies/Procedures/Claims) HMO and PPO

eBusiness Help Desk 215-241-2305

FutureScripts®

Prescription Drug Authorization Toll-free Fax

1-888-678-70121-888-671-5285

Direct Ship Specialty Pharmacy Program Fax

1-888-678-7012215-761-9165

Blood Glucose Meter Hotline 1-888-678-7012

FutureScripts® Secure Medicare Part D 1-888-678-7015

Formulary updates www.amerihealth65.com

Health Resource Center AmeriHealth Healthy LifestylesSM 1-800-275-2583

Precertification 1-800-275-2583

Interactive Voice Response (IVR) system 1-800-275-2583, prompt 2

NaviNet® Portal Registration www.amerihealth.com/navinet

Provider Medical Policy website www.amerihealth.com/medpolicy

Provider Pharmacy website www.amerihealth.com/provider_rx

Provider Supply Line 1-800-858-4728

1-800-275-2583, prompt 2 for Provider Services1-800-275-2583, prompt 1 for Member Services

AmeriHealth HMO, Inc. • AmeriHealth Insurance Company of New Jersey • QCC Insurance Company d/b/a AmeriHealth Insurance Company

Updated websites