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The document is an In Network Exception Request Form for AmeriHealth New Jersey, detailing the process for requesting exceptions based on various reasons such as provider participation changes or member enrollment issues. It includes sections for member and doctor information, treatment details, and required documentation. Additionally, it provides language assistance services and a nondiscrimination notice, ensuring compliance with civil rights laws.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is a network exception form?

A network exception request is for an out of network provider requesting an in network exception. Please indicate below as to what specialized experience, training or certification in a particular clinical area or patient population you possess that would support the need for an in network exception request.

Does AmeriHealth cover prescriptions?

We are committed to providing comprehensive prescription drug coverage. To achieve this, we include a formulary feature in your prescription drug benefit. The drugs are approved by the U.S. Food and Drug Administration (FDA).

What is exception request form?

Exception Request Process To request an exception, survey vendors are required to complete and submit an Exception Request Form online (see form below). The form is designed to capture information on the proposed alternative(s) to the standard on-site operating requirements.

What is the phone number for AmeriHealth?

General inquiries Call 1-800-492-2385 or email sales@ahatpa.com.

What is the phone number for medical Mutual RX?

For information regarding Coverage Management Programs, call 1-800-753-2851 (available Monday - Friday, 8 a.m. to 9 p.m.). For general information about Express Scripts Programs, call 1-800-211-1456 (available Monday - Friday, 8 a.m. to 8 p.m.).

What is the phone number for AmeriHealth prescription coverage?

Contact information AmeriHealth Rx PPO members: call 1-866-569-5190 (TTY/TDD: 711). Representatives are available seven days a week, from 8 a.m. to 8 p.m. Please note that on weekends and holidays from April 1 through September 30, your call may be sent to voicemail.

How do I contact AmeriHealth in New Jersey?

For the most direct service, call the number on the back of your AmeriHealth ID card. If you are a consumer member, call 1-844-937-2448. If you are enrolled in a NJ-based employer plan, call 1-888-968-7241. If you are enrolled in a PA-based employer plan, call 1-866-681-7373.

What is the phone number for PerformRx prior authorization?

For questions, please contact the health plan or PerformRx via phone: 1-866-533-5492 or email: info@performrx.com.

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