Effective October 1, 2017, Amerigroup Community Care will require prior authorizations for evaluations of outpatient therapy services rendered in a hospital outpatient or other facility outpatient setting. This applies to New Jersey Medicaid/NJ FamilyCare and Amerivantage (Medicare Advantage) members.
You must obtain precertification from Amerigroup via our therapy vendor, Therapy Network of New Jersey (TNNJ), prior to referring a member for an evaluation for therapy services in a hospital outpatient or other facility outpatient setting.
This initiative applies to providers in New Jersey and covers outpatient therapy services including Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST).
If a hospital outpatient or other facility setting is not necessary, you can refer the member to an in- network therapy provider in an office setting — precertification isn’t required. Any claims submitted for PT, OT or ST services rendered in a hospital outpatient or other facility setting for dates of service of October 1, 2017, or later without precertification will be denied.
If you are helping a member obtain medically necessary PT, OT and/or ST services, refer him or her to a participating therapy provider. To find a participating therapy provider in your area, see our provider directory at providers.amerigroup.com or contact TNNJ at 1-855-825-7818, option 2.
If you have questions regarding this communication or received it in error, please contact your local Provider Relations representative or call our Provider Services team:
Issued October 2013
by Amerigroup Community Care