Americhoice of Pennsylvania & Americhoice Medicare

 

 

Special Notes

 

Physician Service

Encounter Form Required

 

Pre-Certification

 

 

Initiating Provider

Must Be Capitated

Primary Care

No

No

 

Must Be Capitated

Gerontology

No

No

 

Must Be Capitated

Pediatrics

No

No

 

Must Be Capitated

Care Clinic

No

No

 

 

 

Specialty

 

Care Office

 

Visits

 

 

 

Physician Service

Referral Form Required

Case Reference

Pre-Certification

Phone Reference

 

Initiating Provider

 

Audiology

Yes

No

PCP

 

Cardiology

Yes

No

PCP

 

Dermatology

Yes

No

PCP

 

Ear Nose & Throat

Yes

No

PCP

 

GYN (2 visits per Year)

No

No

 

 

Neurology

Yes

No

PCP

 

Nutritional Counseling

Yes

No

PCP

 

Oncology

Yes

No

PCP

 

Ophthalmology

Yes

No

PCP

 

Orthopedics

Yes

No

PCP

 

Podiatry

Yes

No

PCP

 

Surgery

Yes

No

PCP

 

Urology

Yes

No

PCP

 

Gilda C. Chinnici, CHAM Permission Required Riv. 8-99