AmeriHealth Administrators' network providers can streamline inpatient and outpatient precertification requests and treatment updates using iEXCHANGE, our convenient, HIPAA-compliant online service offered through MEDecision, Inc.
CONTACT THE IEXCHANGE HELP DESK OR
REQUEST A FREE WEBINAR
PrecertificationProcedures and Medications Requiring Precertification
Certain procedures and prescription drugs require precertification before they are performed or administered. You can request precertification online using iEXCHANGE or call the phone number on the plan member's ID card. Required precertification must be obtained to avoid reduced payment or non-payment for the service or medication.
Electronic Data Interchange (EDI)
Submit claims and obtain important documents online through our Electronic Data Interchange (EDI) services, which can increase accuracy of claims processing and the speed of claim payments. Or visit the EDI Trading Partner Business Center, a resource for trading partners, where you can register to submit and receive transactions and access additional information about submitting transactions through Highmark (Highmark Gateway).
Provider Claim AppealsClaim Appeals Form
Need to appeal a claim? Download the Provider Claim Appeals Form.
Prescription Drug Information
AmeriHealth Administrators’ preferred pharmacy benefits manager is FutureScripts®. Before prescribing a medication, you should work with the plan member to determine if the drug is included on the formulary.
Many FutureScripts plans require prior authorization for certain medications. Send authorization requests directly to FutureScripts. Visit FutureScripts to download a request form, or call FutureScripts at 1-888-678-7013.
AmeriHealth Administrators’ Prescription Drug Program Formulary for plans that require prior authorization.
AmeriHealth Administrators’ Prescription Drug Program Formulary
The Premium Formulary differs from the standard drug formulary in that it excludes 80 medications, which all have clinical alternatives included in the Premium Formulary. The Premium Formulary is managed and maintained by FutureScripts. AmeriHealth Administrators does not control how the Premium Formulary is comprised or administered.
Medical Utilization Management
AmeriHealth Administrators uses various policies and criteria, including AmeriHealth medical policy and InterQual®, for utilization review determinations. Only AmeriHealth medical policy is used for utilization review for fully-insured plans issued or delivered in Connecticut (HTH Student plans and GeoBlue plans). You can obtain a copy of a specific policy by calling the AmeriHealth Administrators clinical service department at 1-800-952-3404.
AmeriHealth Medical Policy
Provider Contact Information
Find an AmeriHealth Administrator Network Provider.
Call the number on your patient’s ID card or log into iEXCHANGE
For behavioral health services, please call the phone number listed on the patient’s AmeriHealth Administrators ID card.