Amerihealth Administrators Provider Resources

AmeriHeatlh Administrators will delegate precertification for certain services to EviCore on  July 1, 2022. The ordering provider is responsible for submitting precertification requests for the applicable services. Failure to adhere to the precertification process may result in a bill to your patient.

This policy does not apply to groups who are not a part of the Enhanced Utilization Program. It is important for providers to verify member eligibility and benefits, and to refer to the most current precertification requirement lists on our website at https://www.ahatpa.com/

Providers should seek precertification from EviCore for:

• certain genetic/genomic tests (i.e., nucleic acid testing) and certain molecular analyses
• radiation therapy

Certain genetic/genomic tests and molecular analyses

Precertification for certain genetic/genomic tests (i.e., nucleic acid testing) is required and is delegated to EviCore for evaluation of medical necessity.

When a request for genetic/genomic testing is received, laboratories must ensure a precertification is on file before rendering services. If precertification is not on file for the member, it is the laboratory's responsibility to submit a request to EviCore.

Radiation therapy

Precertification for nonemergent outpatient radiation therapy services is required and is delegated to EviCore for evaluation of medical necessity. Precertification is not required when radiation therapy is rendered in the inpatient hospital setting.