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April 2020
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Market Edge
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News for All Segments
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AmeriHealth New Jersey is waiving member cost‑sharing on COVID‑19 treatment and waiving certain prior authorization requirements
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As the COVID‑19 pandemic evolves, AmeriHealth New Jersey is working with local and national health officials to assess current conditions, health care for our members, and ways to help our clients and partners. To reduce barriers, so that members can get the care they need, when they need it, AmeriHealth New Jersey is waiving member cost‑sharing for in‑network, inpatient, acute care treatment for COVID‑19. This means members will have no out-of-pocket costs for COVID‑19 hospitalizations.
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AmeriHealth New Jersey will also waive cost‑sharing for Emergency Room visits when members are admitted to the hospital for COVID‑19 treatment. These changes are effective March 30, 2020 and will extend through May 31, 2020. This applies to all individual and family plans and all fully insured group business.
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Cost‑sharing will continue to be applied to all post‑acute care (e.g. skilled nursing, rehabilitation, and long‑term acute care facilities), outpatient treatment, prescription drugs, ambulance transportation to a post‑acute setting, and out-of-network care.
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Waiving certain prior authorization requirements
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We are taking measures to help physicians and health care facilities during the COVID‑19 outbreak so members can more easily access the care they need. This includes temporarily suspending prior authorization requirements for these situations at in‑network facilities:
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- Acute inpatient admissions from the emergency department for members with a COVID‑19 diagnosis.
- Transfers from acute inpatient facilities to post‑acute facilities, including long‑term acute care hospitals, rehabilitation, and skilled nursing facilities, for any diagnoses. This includes transportation from the acute inpatient facility to a subacute facility.
- Transportation between facilities.
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AmeriHealth New Jersey will work closely with provider facilities to gather clinical information and coordinate transitions of care for members. This will remain in place until April 30, 2020, at which time we will reassess based on COVID‑19 activity.
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If you have any questions, please contact your AmeriHealth New Jersey broker representative.
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