Have you registered for the PEAR portal?
Our transition to the Provider Engagement, Analytics & Reporting (PEAR) portal is almost complete! The PEAR portal offers participating providers a single point of entry to multiple digital tools, including PEAR Practice Management, PEAR Comprehensive Visit, and PEAR Analytics & Reporting. Access to the NaviNet® web portal will end on or before July 1 for our plans, so make sure you’re prepared! You can check your organization’s decommission date via the Go-Live Lookup Tool.
Providers and facilities can choose to receive fully reconciled remittance advice and claims settlement payments quickly and electronically, powered by InstaMed, for services provided to patients who carry an AmeriHealth Administrators ID card.
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
Dosage and Frequency Program
Learn how AmeriHealth Administrators reviews treatment regimens for certain specialty drugs to ensure they adhere to safe prescribing limits.
Most Cost-Effective Setting Program
Find out how AmeriHealth Administrators reviews the requested treatment settings for certain specialty drugs that are eligible for coverage under the medical benefit.
Direct Ship Drug Program
AmeriHealth Administrators offers a Direct Ship Drug Program to our in-network physicians. Under this program, physicians can order certain specialty drugs that are given in the office and are eligible for coverage under the plan member’s medical benefit when medical necessity criteria are met.
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.
Claim Appeals and Reimbursements
Need to appeal a claim or file for a reimbursement? Download these forms.
Provider Claim Appeals Form
Implant Reimbursement Request Form
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).
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. 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.