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

Fax all requests for services that require prior authorization to:


Inpatient:

1-877-434-7578

Outpatient:

1-800-505-1193

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

Pharmacy

Check our Preferred Drug List

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

0632 Pharmacy multiple sources

Medicare or long-term services and supports

Medicare

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:

1-732-452-6050

Adult medical day care:

1-888-240-4717

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.