How are we creating the future of health care? Together.

The future of health care is extremely complex and constantly changing. This resource is specifically designed to give health care providers easy access to timely, accurate information. Which allows you to focus on what's most important - your patients’ health.

Streamline Requests
With iExchange

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.

Provider Access

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New to iExchange?

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Overview

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Frequently Asked Questions

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Inpatient Requests

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Outpatient Requests

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CONTACT THE IEXCHANGE HELP DESK OR
REQUEST A FREE WEBINAR

1-888-444-4617

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).

HIPAA Companion Guide

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Secure Document Submission

Use our secure document submission portal to upload and submit a variety of patient documents to our Clinical Services team, or view online document statuses and history. You can also print a barcoded cover sheet for a fax submission (found within the portal).

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Provider Claim Appeals

Need to appeal a claim? Download the Provider Claim Appeals Form.

Claim Appeals Form

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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

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
Provider Finder

Find an AmeriHealth Administrator Network Provider.

Find Providers

Precertification

Call the number on your patient’s ID card or log into iEXCHANGE

Provider Services
1-800-841-5328
provrelations@ahatpa.com
Claims, benefits, & eligibility

Log into NaviNet®
Call the toll-free service phone number on your patient's ID card.
customerservice@ahatpa.com

FutureScripts®
Call 1-888-678-7013
1-888-671-5285 (fax)
NaviNet®
1-888-482-8057
iEXCHANGE®
1-888-444-4617
For behavioral health services, please call the phone number listed on the patient’s AmeriHealth Administrators ID card.

Connecting tomorrow with today

We reimagined our entire technology engine to better serve clients. This technology allows us to offer more comprehensive client services, enhanced interoperability, and improved health data management. What’s that mean to you? More options.

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Help when people need it most

If patients are facing a serious illness or medical condition, AmeriHealth Administrators’ case management program might be right for them. This free, confidential program provides support, guidance, and coordinated care for complex health concerns.

Learn more

How can we help you?
Still have questions or need additional information? We can help. 1-800-841-5328 | provrelations@ahatpa.com

Additional contacts