Amerigroup. An Anthem Company.

New Jersey Providers

Prior Authorization requirements

To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate.

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Behavioral health

Services billed with the following revenue codes always require prior authorization:

0240–0249 All-inclusive ancillary psychiatric
0901, 0905–0907, 0913, 0917 Behavioral health treatment services
0944–0945 Other therapeutic services
0961 Psychiatric professional fees


Services billed with the following revenue codes always require prior authorization:

0632 Pharmacy multiple sources

Medicare or long-term services and supports


Precertification is not required for physician Evaluation and Management services for members enrolled in the Amerivantage Balance (HMO) plan.

Long-term services and supports

All services require precertification:

  • Personal care assistants: Call 1-732-452-6050 and select option 1 or fax requests to 1-888-240-4716
  • Adult medical day care: Fax all requests to 1-888-240-4717

Personal care assistants:


Adult medical day care:


The following always require prior authorization:

Elective services provided by or arranged at nonparticipating facilities.

All services billed with the following revenue codes:

0023 Home health prospective payment system
0570-0572, 0579 Home health aide
0944–0945 Other therapeutic services
3101-3109 Adult day and foster care

Related information

Provider tools & resources

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We look forward to working with you to provide quality services to our members.