2023 Provider Notifications

Connections is your link to important provider news, updates, and resources. We hope your practice finds this edition informative.

This is an overview of changes to the 2024 pediatric preventive dental pay-for-performance (P4P) program. The goal of this program is to have earlier intervention into the disease prevention process and to increase inclusion of patients who have previously not been active in receiving quality oral health services.

The manufacturers of Flovent and Levemir plan to discontinue all brand-name formulations of these products, and biosimilar formulations of adalimumab (Humira) get preferred status on the 2024 statewide PDL.

As we prepare for the 2024 EVV go-live, HHAeXchange is hosting training webinars for Home Health Care Services providers.

The Pennsylvania Department of Human Services will implement changes to the statewide preferred drug list on January 8, 2024.

As a reminder, it is critical that we receive your practice data updates/changes in a timely manner.

AmeriHealth Caritas Pennsylvania providers who believe their patients would benefit from an automatic blood pressure monitor (A4670) should give them a prescription that can be taken to any participating network pharmacy.

Review this bulletin for updates including tobacco use and cessation counseling recommendations, topical fluoride treatment payments, and other important changes affecting providers.

Your strong recommendation is a critical factor in whether your patients get vaccinated. In preparation for the onset of the 2023 – 2024 flu season, we ask that you encourage your patients to get their flu shot.

On August 31, 2023, AmeriHealth Caritas Pennsylvania replaced APR-DRG version 37 with versions 38 and 39 for all inpatient acute care encounters with a discharge date on or after October 1, 2020.

AmeriHealth Caritas Pennsylvania will follow the Pennsylvania Department of Human Services (DHS) guidelines and will terminate procedure codes S9123 and S9124 and replace with procedure codes T1002 and T1003 effective January 1, 2024.

We would like to remind you that effective July 10, 2023, preferred direct-acting antivirals in the Hepatitis C Agents class on the Pennsylvania Statewide Preferred Drug List (PA PDL) no longer require prior authorization when prescribed within quantity limits.

Effective for dates of service on and after October 1, 2023, eligible providers should utilize the newly created CMS POS 27 (Outreach Site/Street).

Effective November 27, 2023, two additional codes will require plan prior authorization.

Effective November 20, 2023, some products will be removed from the AmeriHealth Caritas Pennsylvania formulary, and others will have new or updated quantity limits.

AmeriHealth Caritas Pennsylvania will require in-home visits to be recorded in the EVV system.

The updated Department of Human Services (DHS) Sterilization Consent Form (MA 31) is available on the provider websites.

AmeriHealth Caritas Pennsylvania is pleased to announce added functionality for network providers to submit electronic attachments (275 transactions) to support a medical claim via Change Healthcare, effective August 1, 2023.  

AmeriHealth Caritas Pennsylvania would like to notify you about procedure code updates that will go into effect on October 1, 2023. These include code terminations and replacement codes for reporting pediatric shift care services.  

Effective September 1, 2023, AmeriHealth Caritas Pennsylvania will no longer cover the cost of prescription eyeglasses or prescription contact lenses for members 21 years of age or older, with certain exceptions.

AmeriHealth Caritas Pennsylvania is pleased to announce the availability of the second edition of our provider newsletter, Connections.

To assist Providers with the Cures Act requirement, AmeriHealth Caritas PA will continue its relationship with HHAeXchange and will be going live, with a soft launch, on August 14, 2023.

We have launched two new tools in the NaviNet provider portal that will allow providers to view upcoming Medical Assistance eligibility redetermination dates.

AmeriHealth Caritas Pennsylvania is pleased to announce that the 2023 medical provider claims filing guide is now available on our website.

A new streamlined report to easily identify members in your practice that have open care gaps is now available in NaviNet.

Recall notice: Akorn Operating Company, LLC (Akorn) has voluntarily recalled several products from the market due to the company shutdown.

AmeriHealth Caritas Pennsylvania is pleased to announce that the updated 2023 Dental Provider Supplement is available.

Effective August 1, 2023, AmeriHealth Caritas Pennsylvania is upgrading its claims editing process to SNIP Level 4 to meet industry compliance standards.

AmeriHealth Caritas Pennsylvania will follow the billing guidelines issued by the PA Department of Human Services (DHS) Medical Assistance bulletin 17-23-01 regarding the requirement to submit the ADA claim form – version 2019.

On April 6, 2023, the U.S. Food and Drug Administration announced its final decision to withdraw approval of Makena (hydroxyprogesterone caproate injection) and its generics.

AmeriHealth Caritas Pennsylvania is pleased to announce the availability of the 2023 Provider Manual.

Reminder for hospital providers to accurately complete fields in NaviNet when submitting inpatient delivery notifications or inpatient maternity authorizations.

Effective July 3, 2023, prior authorization is no longer required for monitored anesthesia care (MAC) for gastrointestinal (GI) endoscopy services.

Please see process change details for requesting transplant authorizations and transplant care coordination updates.

Whole-person care is a holistic and patient-centered approach that may lead to better health outcomes and higher patient satisfaction.

As indicated in the provider manual, please adhere to this incontinence supply prior authorization policy.

Effective March 31, 2023, Change Healthcare will be updating all electronic claims user guide links throughout its provider systems and communication materials.

A newly activated feature allows providers to bypass the InterQual review process when completing prior authorization submissions.

Highlights include: Medical Assistance renewals are coming — important information to share with your patients regarding their health care coverage; Inpatient claims and Medicare Part B billing recommendations; Members’ and Participants’ rights and responsibilities; and more.

Please review these details regarding the process for submitting dental benefit limit exception (BLE) requests.

Effective May 1, 2023, members currently receiving more than the quantity limit for certain products will require prior authorization. This change does not apply to members for whom it is not medically advisable to change therapy.

Effective January 2023, Labcorp is another choice for your AmeriHealth Caritas Pennsylvania patients requiring outpatient lab tests or processing of lab specimens.