amerihealth april update · debuts • providing phi to employer groups acting as claims...

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IINNSSIIDDEE TTHHIISS IISSSSUUEE:: AAPPRRIILL 22000055

ANNOUNCEMENTS• New Transactions with AmeriHealth: Your Quick Reference to Billing, Referrals, and E-Connectivity

Debuts • Providing PHI to Employer Groups Acting as Claims Fiduciaries• Continued Success in Addressing Fraud and Abuse

PHARMACY ANNOUNCEMENTS• AdvancePCS Changes Name to “Caremark®”• Important Information About Prescription Drug Coverage: Prior Authorization for

Tarceva® (erlotinib)

FOR MEMBER’S HEALTH• Supporting Our Members, Your Patients: ConnectionsSM Health Management Programs

CLASS ACTION SETTLEMENT UPDATE• Enhancements to Policy, Payment, Disclosure, and Appeals Processes for Class Action Settlement Providers• Announcements

POLICY• Credentialing Compliance Hotline and Web Page

BILLING UPDATE (PLEASE NOTE CRITICAL EFFECTIVE DATES) RED PAGES 5-9• Field 19 Requirement: Paper or Electronic Referrals Must be on File for Claims to Process . . . . . . . . . . . . . . . . . 5• Claims with More Than One Unit of Time for Speech-Pathology Codes Will Reject . . . . . . . . . . . . . . . . . . . . . . 5• 10-Digit Provider ID Number Required for Field 32 for CMS 1500 Forms, Effective July 1, 2005 . . . . . . . . . . . 5• End Date of HIPAA Transactions and Code Sets (TCS) Contingency Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6• New Diagnostic Imaging Services Improve Radiology Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6• Providers Required to Use NaviNetSM or Telephonic Interactive Voice Response (IVR) System to Obtain Member

Eligibility Information, Effective August 1, 2005 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7• Beginning August 1, 2005: AmeriHealth New Jersey Transitioning to All-Electronic Encounter and

Referral Submission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7• ID Cards with New 13-Position Member Identification Number Now Being Issued . . . . . . . . . . . . . . . . . . . . . . . 7• Policy Update: Removal of Impacted Cerumen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

BILLING REMINDERS• Use the Standard CMS 1500 Form When Submitting Paper Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8• Pricing Procedure for Unlisted or Not Otherwise Classified (NOC) Services Fully Implemented . . . . . . . . . . . . . . 9• Performing Provider ID, Group Provider ID, and Tax ID Number Required in Order to Ensure Clean Claims . . . . 9

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Providing PHI to Employer Groups Acting as Claims FiduciariesSelf-insured group health plans (“Plans”) are usually sponsored by employers or health and welfare funds (“PlanSponsors”) and often have a large number of enrollees. PlanSponsors who elect to retain “claim fiduciary” status andresponsibility have final control over benefit determinationsand other issues that Plan enrollees raise in member appealsunder the self-insured Plan. Typically the Plan Sponsor delegates responsibility for the administration of the Plan,which may include responsibility for appeals and otherclaim fiduciary matters, to its Plan Administrator. The PlanAdministrator then performs these administrative and fiduciary duties on behalf of the Plan.

AmeriHealth wants you to know that when a Plan Sponsorelects to be the named claim fiduciary for one of its self-insured Plans:

• The Plan Administrator (or its designee) may sometimescontact a network provider for Protected HealthInformation (PHI) regarding member appeals. Becausethe Plan is a HIPAA-Covered Entity, when the PlanAdministrator performs administrative functions on behalfof the Plan, the Plan Administrator (and/or its designee)

is authorized to obtain PHI for purposes of the Plan’s treatment, payment, and/or health care operations(“TPO”). Network providers should rely on their owninternal resources and established protocols for handlingthese requests for PHI.

• Providers can call Provider Services to determine if apatient is enrolled in a self-insured Plan whose PlanSponsor has chosen to retain claim fiduciary liability.Please be prepared to give Provider Services the name ofthe patient involved and other specific reference information. (This is necessary because a single PlanSponsor may have both self-insured and fully insuredPlans with AmeriHealth.)

By continuing to educate our network providers on thisissue, we hope to improve service to members of self-insured Plans that have elected to retain claim fiduciaryresponsibility. (Please note that AmeriHealth will continueto be fully involved in processing member appeals for self-insured Plans that designate AmeriHealth as the Plan’snamed claim fiduciary, as well as for fully insured Plans.)

AmeriHealth will be introducing a periodic supplement toour Provider Manual: Transactions with AmeriHealth: YourQuick Reference to Billing, Referrals, and E-Connectivity. Thisnew publication will keep you and your office staff up-to-date on doing business with AmeriHealth, informingyou of billing and referral requirements and processingchanges. Transactions includes information on submittingclean claims to speed up processing and payment, and proper code and modifier use for accurate disbursement.Transactions also contains information regarding the settlement between AmeriHealth and providers.Additionally, Transactions contains important informationabout switching to electronic transaction channels, includingclearinghouse options for electronic claim submission andNaviNetSM, our secure provider portal which secures andaccelerates processing and payment.

Transactions should be filed in your AmeriHealth ProviderManual behind the red Billing tab. This publication willreplace the existing “Guide to Billing” and Billing table of contents.

Store all of your publications in your Provider Manual inorder to provide your staff with a toolkit of information thatis administrative, policy-related, and clinical.

New Transactions with AmeriHealth: Your Quick Referenceto Billing, Referrals, and E-Connectivity Debuts

Look to:• Partners in Health monthly Update for timely

policy and procedure announcements.• Clinical Update for quarterly clinical information

from a doctor-to-doctor perspective.• Coding Guidelines and Policy Update for quarterly

medical policy and a resource for claim paymentpolicy.

• Provider Manual for a comprehensive repository ofinformation your office needs for working withAmeriHealth.


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Insurance fraud and abuse are major factors in the risingcost of health care in the U.S. today—costing consumers asmuch as $1 out of every $7 spent on health care.AmeriHealth is doing its part in addressing this problem byidentifying, investigating, and reporting suspicious cases ofabusive practices to law enforcement authorities.

Unfortunately, a few providers taint the profession: The vastmajority of providers render appropriate care and billaccordingly. The Corporate and Financial InvestigationsDepartment (CFID) utilizes sophisticated software datamining tools to analyze all claims submitted by medicalproviders, facilities, and pharmacies and compare themagainst member enrollment data and overall provider information. Any trends, patterns, or aberrant billing practices are targeted for in-depth audits or investigations.

In addition, recovery of overpaid claim dollars is pursued,regardless of the reasons. During the past 24 months,approximately 200 investigations or audits were initiatedfrom leads generated from the fraud and abuse data miningsoftware tools. The CFID has received 1,512 tips pertainingto allegations of fraud, abuse, or aberrant billing practiceswith 366 of these allegations coming from members/subscribers. As a result of these allegations, 489 fraud andabuse investigations were initiated, as well as several hundred additional audits.

Evidence gathered resulted in 91 referrals to law enforcement or regulatory authorities. Of this number, 42referrals pertained to providers, of which 15 were chiropractors. The fraud schemes most often used werebilling for services not rendered and up-coding procedurecodes on claims submitted in order to receive a higher reimbursement. Grand Jury indictments and the filing ofcriminal information were brought against 38 individualsduring the past 24 months. In addition, 36 individuals pledguilty or were convicted of health care fraud violations with10 individuals receiving incarceration ranging from 12 to 53months in prison and Court Order Restitution as high as$1,080,000.

As a result of the investigations and audits performed by theCFID, over $55.7 million has been recovered within thepast two years, with an additional $11 million in overpaidclaims identified but not yet recovered.

Although the CFID will continue its efforts to ensurehealth care insurance costs are appropriate, we need yourhelp. The software data mining tools and toll-free hotlineboth provide valuable leads, but there is no substitute for ourprovider network’s own vigilance. If you are suspicious ofany health care related activity, please call our toll-freeCorporate Compliance and Fraud Hotline at (866) 282-2707, or visit www.amerihealth.com and click on AboutUs and then Business Issues.

Continued Success in Addressing Fraud and Abuse


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AdvancePCS Changes Name to “Caremark®”AmeriHealth would like to announce that its pharmacybenefit manager, AdvancePCS is changing its name toCaremark®. Caremark® is one of the largest pharmaceuticalservices companies in the U.S. and one of the nation’s leading prescription benefits managers. The combination ofCaremark® and AdvancePCS strengthens our capabilities,enabling us to enhance the products and services membersreceive.

As our pharmacy benefits manager, Caremark® will continue to administer AmeriHealth’s prescription drugbenefits, including the management of our mail order

program, the payment of claims, and the establishment andmaintenance of a pharmacy network. Please note that thename change to Caremark® will not affect members’prescription drug coverage.

Throughout 2005, materials will be updated to reflect theCaremark® name and logo. Caremark® will appear on formulary materials, ID cards, prescription labels, claimforms, and websites. Until members receive their new IDcards bearing the Caremark® logo, members can continueto use their existing ID cards.

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Effective February 17, 2005, prior authorization is nowrequired for Tarceva® (erlotinib). Members who filled a prescription for Tarceva® prior to February 17, 2005 will begrandfathered and will not require prior authorization.Tarceva® was approved in November 2004 by the U.S. Foodand Drug Administration (FDA) for the treatment ofpatients with locally advanced or metastatic non-small-celllung cancer after failure of at least one prior chemotherapyregimen. Tarceva® may also be considered for individualswith neoplastic disease with documentation of failure of allconventional therapy. Tarceva® showed no clinical benefit as

first-line therapy with the use of platinum-based chemotherapy.The recommended daily dose is one 150mgtablet taken one hour before or two hours after the ingestionof food. More information can be found in the package insertavailable at the following website:https://www.tarceva.com/tarceva/docs/PI.pdf. To obtain priorauthorization, fax a completed prior authorization form to thePharmacy Services Department at (888) 671-5285. Formsmay be obtained at www.amerihealth.com/provider_rx or bycalling (888) 671-5280, and selecting option 1. Please note:Providers registered with NaviNetSM may use this system tosubmit drug prior authorization requests.

IIMMPPOORRTTAANNTT IINNFFOORRMMAATTIIOONN AABBOOUUTT PPRREESSCCRRIIPPTTIIOONN DDRRUUGG CCOOVVEERRAAGGEE:: Prior Authorization for Tarceva® (erlotinib)

FFOORR MMEEMMBBEERR’’SS HHEEAALLTTHH

SUPPORTING OUR MEMBERS, YOUR PATIENTS: CONNECTIONSSM HEALTH MANAGEMENT PROGRAMS

HELPING YOU AND YOUR PATIENTS MANAGE FIVE CHRONIC CONDITIONS

(Asthma, CAD, CHF, COPD, and Diabetes)

CONTACT THE CONNECTIONSSM

HEALTH MANAGEMENT PROGRAMS PROVIDER SUPPORT LINE AT (866) 866-4694 TO:

• Refer a member for Health Coaching.• Ask questions or provide feedback.• Request information regarding the SMARTTM Registry.• Request ConnectionsSM posters for your office, referral

pads, or copies of the Clinical Insights.• Request patient information for the purposes of treatment

or care coordination for your patient.

A ConnectionsSM Provider Service Specialist will return your call within two business days.

PROVIDING RESOURCES FOR YOU AND YOURPATIENTS WITH END-STAGE RENAL DISEASE

CONTACT THE CONNECTIONSSM

KIDNEY PROGRAM AT (866) 303-4CKP [4257] TO:

•Refer a member on chronic outpatient dialysis to a Health Service Coordinator.

•Ask questions or provide feedback.•Request individual member information.


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Unless otherwise specified in the Current ProceduralTerminology (CPT*) descriptor, common speech-languagepathology codes represent a single evaluation or treatmentsession. Therefore, it is inappropriate to report more thanone unit of time for any of the speech therapy codes,including speech-pathology evaluation (92506), treatmentsession (92507), or group treatment session (92508).

All claims submitted incorrectly with greater than one unitof time for these codes and services will be subject to denialand/or adjustment with recoupment of overpaid claims.

* Current Procedural Terminology (CPT®) is a copyright of the AmericanMedical Association (AMA). All Rights Reserved. No fee schedules, basicunits, relative values, or related listings are included in CPT. The AMAassumes no liability for the data contained herein. Applicable FARS/DFARSrestrictions apply to government use. CPT® is a trademark of the AmericanMedical Association.

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Claims with More Than One Unit of Time for Speech-Pathology Codes Will Reject

Field 19 Requirement: Paper or Electronic Referrals Mustbe on File for Claims to ProcessEffective May 1, 2005, due to contractual requirementswith our groups, we can no longer accept referral numbersin Field 19 of a CMS 1500 claim to satisfy a member’sreferral requirement. A copy of the paper or electronic referral must be on file in addition to the information inField 19 in order for the claim to process.

Specialists can verify that a referral is on file in one of several ways:

1) By logging on to NaviNetSM, using the “Referral Inquiry”function, and reviewing the online referral form;

2) By obtaining a faxed copy of the NaviNetSM generatedreferral; or

3) By obtaining a hard copy of the referral from the member at the time of the visit.

If you are not using NaviNetSM to submit electronic referrals today, we encourage you to discover the benefitsthat NaviNetSM has to offer and make the move toward apaperless office. For more information, contact theeBusiness Provider Inquiry Line at (856) 638-2701 in NewJersey and (302) 661-6111 in Delaware, or complete ourOnline Inquiry Form atwww.amerihealth.com/providers/navinet.

If you have any questions, please contact Provider Servicesor your Network Coordinator.

10-Digit Provider ID Number Required in Field 32 for CMS 1500 Forms Effective July 1, 2005 For claims received on and after July 1, 2005, providers willbe required to report the hospital’s or Ambulatory SurgicalCenter (ASC)’s 10-digit provider identification number infield 32 of the CMS 1500 form when performing diagnostic radiology or laboratory services in the outpatientsetting of a hospital or ASC. Currently, providers report thehospital or ASC’s name, address, city/state/zip code, and theMedicare number in field 32 of the CMS 1500 form toidentify where services were rendered.

The 10-digit provider identification number is assigned byAmeriHealth to hospitals and ASCs. Enclosed is aHospital Listing with the associated 10-digit provideridentification number.

Please contact Provider Services or your NetworkCoordinator if you have questions regarding this change.

Listed below are instructions for reporting the 10-digitprovider identification number in the HIPAA format. If you oryour vendor has questions about the electronic format,please contact the eBusiness Help Desk at (215) 241-2305 or via e-mailat [email protected].

HIPAA 837P

Loop ID Segment2310D REF02

CMS 1500Field 32 Is reserved for the 10-digit provider ID

number of the facility where the service was rendered, if other thanhome or office, effective July 1, 2005.

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Effective May 26, 2005, AmeriHealth will no longer acceptelectronic transactions submitted in 837-3051 or NationalStandard Format (NSF). Effective in the third quarter of2005, electronic claims submitted to AmeriHealth willreceive a quicker priority processing over paper claims.

Providers and trading partners were required to convert toHIPAA-compliant 837 Institutional and Professionalclaims transactions by October 16, 2003, as mandated bythe Health Insurance Portability and Accountability Act of1996 (HIPAA). Since the original notification of thisrequirement in April 2003, an extended contingency planhas allowed providers additional time for successful testingand conversion to HIPAA-compliant 837P claims transactions. However, as previously announced, the extended contingency plan would not continue indefinitely,with the end date based on guidance from the Centers forMedicare and Medicaid Services and other sources.

Adoption of the HIPAA-complaint 837 4010A claim format within the industry has reached a level that deemsfurther contingency plans unnecessary.

In addition, please note that on September 1, 2004,AmeriHealth incorporated the HIPAA-compliant 837Ptransactions into the existing Claims Pre-ProcessingSystem. Benefits to providers include increased accuracy ofclaim processing and payment, avoiding payment delays dueto missing or inaccurate data, and error reports that, whenappropriate, provide data needed for error correction. Formore details, refer to the Electronic Billing Update (August2004).

We thank those providers, who have successfully metHIPAA-compliant requirements for their efforts. Providerswho have not yet converted or begun testing for HIPAA-compliant formats should continue to work aggressivelytoward full compliance to ensure continuity of electronicclaims submission and payment. Please refer to the important information in the sidebar below, “HIPAA-Compliance Testing and Conversion Instructions.”

End Date of HIPAA Transactions and Code Sets (TCS)Contingency Plan

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For assistance with testing and conversion to the HIPAA-compliant claims transaction 837, please contact theNaviMedix®, Inc. HIPAA Conversion Team at (866) 877-6284.You may also contact the AmeriHealth eBusiness Help Desk at(215) 241-2305 or e-mail at [email protected].

For providers who submit electronic claims through Highmark®:If you have not yet converted to the HIPAA-compliant 837claims transaction, before being able to test for conversion youmust complete a new enrollment application athttps://www.highmark.com/health/professionals/edi-services/edi_signup.html.

Many clearinghouse vendors are also available to assist youwith testing to ensure that your electronic claim submissions areseamless. These include, but are not limited to, Datastream, PerSe, Quadramed, SSI, NDC, Seimens (HDX), Web MD (Envoy),and McKesson.

HIPAA COMPLIANCE TESTING AND CONVERSION INSTRUCTIONS

New Diagnostic Imaging Services Improve RadiologyTesting for AmeriHealth (Delaware only)AmeriHealth will be implementing a new RadiologyQuality Initiative (RQI) for outpatient diagnostic imagingservices for Delaware members of AmeriHealth. This program is intended to improve the overall clinical appropriateness of radiology testing. The RQI process isbased upon evidence-based guidelines from major medical organizations and medical literature.

This RQI program is scheduled to begin in August. Whenimplemented, ordering physicians for AmeriHealth(Delaware only) members must contact AmeriHealth toobtain a pre-authorization number for certain diagnosticservices, such as CT/CTA, MRI, MRA, NuclearCardiology, PET, and PET/CT fusion when performed inan office, outpatient hospital (excluding emergent and inpatient services), or free-standing imaging center.

AmeriHealth will implement these changes to the qualitymanagement of outpatient diagnostic imaging services forDelaware members of AmeriHealth HMO, AmeriHealthPPO, AmeriHealth Point-of-Service, and AmeriHealthFlex Copay Series HMO, PPO, and POS products.

Note for HMO/POS members: Ordering physicians/PCPs willbe required to issue a referral for all radiology services, includingthose that require pre-authorization. Radiology sites must stillconfirm the pre-authorization number prior to performingservices.

Please note: AmeriHealth implemented a similar radiologyprogram for New Jersey members of AmeriHealth inFebruary 2004.

Please look for more information on this important initiative in next month’s Partners in Health Update.

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BBEEGGIINNNNIINNGG AAUUGGUUSSTT 11,, 22000055:: AmeriHealth New Jersey Transitioning to All-ElectronicEncounter and Referral Submission Beginning August 1, 2005, AmeriHealth (New Jerseyonly) will be transitioning to an all-electronic format forreferrals and encounters. At that time, providers will berequired to submit referrals and encounters usingNaviNetSM or via enhancements to our Interactive VoiceResponse (IVR) system. (Please see the IVR article abovefor additional information.)

To prepare for this transition, providers without electronicconnectivity should contact the eBusiness Provider InquiryLine at (856) 638-2701 in New Jersey to get connected toNaviNetSM.

Providers Required to Use NaviNetSM or TelephonicInteractive Voice Response (IVR) System to Obtain Member Eligibility Information, Effective August 1, 2005Effective August 1,2005,participating providers will be requiredto use either the telephonic Interactive Voice Response (IVR) system or NaviNetSM for all member eligibility inquiries.

Providers can currently use the IVR system,our speech-enabledautomated phone service, to retrieve member eligibility information for HMO and PPO patients.The IVR system canbe accessed 24-hours-a-day,7-days-a-week at (866) 681-7370.Requested information can also be faxed to your office throughthe IVR system.

In addition,providers using NaviNetSM have access to membereligibility information as well as many other resources, includingencounter and referral submission and referral and benefitsinquiries.NaviNetSM is only available to participating providers.To get started using NaviNetSM,please contact the eBusinessProvider Inquiry Line at (856) 638-2701 in New Jersey or (302)661-6111 in Delaware or complete an Online Inquiry Form atwww.amerihealth.com/providers/navinet.

ID Cards with New 13-Position Member IdentificationNumber Now Being IssuedAs previously communicated, various states have enactedlaws to limit the use of a member’s Social Security Number(SSN) on ID cards and other materials. As a result of thislegislative trend, and to better protect member identity andprivacy, AmeriHealth has developed a non-SSN-basedidentifier to be used on external communications to members, including member identification cards. In lateApril, AmeriHealth will issue new ID cards featuring thenew Member ID Number to AmeriHealth members. Atthis time, your office may begin to see members carrying IDcards with the new Member ID Number.

Please use the new Member ID Number when processingmember information. The new ID Number will consist of a3-position alpha/numeric prefix, an 8-position ID number,along with a 2-position suffix which defines a member ofthe family unit.

Please look for ongoing information in future editions ofmonthly Partners in Health Update. Please call ProviderServices or your Network Coordinator with questions.

AmeriHealth NJ Sample ID Cards:

HMO: PPO:

AmeriHealth DE Sample ID Cards:

HMO: PPO:

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AmeriHealth currently utilizes optical character recognition(OCR) technology in processing claims; therefore, for thoseclaims that are paper-billed, please remember to use thestandard red CMS 1500 form to ensure accurate and timelyprocessing. Please follow the instructions below to facilitateautomated processing.

1. Please type clearly in specified areas only. Change ribbonsoften or use a laser printer. Do not use red ink.

2. Do not use bold, italic, or other non-standard fonts.3. Make sure the claim forms are complete and accurate.

Extraneous writing on the form such as “This is a secondsubmission” will cause delays.

4. Do not use carbon copy forms because of the red transformation in the carbon.

5. Non-standard forms such as black and white or laser-printed forms will cause processing delays.

AmeriHealth strongly encourages use of electronic claimsubmission for more accurate and timely payment. Pleasenote: Effective in the third quarter of 2005, electronicclaims submitted to AmeriHealth will receive priority processing over paper claims. If you have any questions, please contact Provider Services or your Network Coordinator.

Use the Standard CMS 1500 Form When Submitting Paper Claims

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Impacted cerumen removal is a procedure to extract hardened or accumulated cerumen from the external auditory canal by mechanical means, such as irrigation ordebridement. This service is included in capitation for thoseproviders paid on a capitation basis.

However, in fee-for-service scenarios, the removal ofimpacted cerumen is covered and eligible for separate reimbursement if billed alone or in conjunction with anevaluation and management (E/M) service. Usage of Modifier -25 is effective for all claims with a date of serviceon or after September 3, 2004.

Reimbursement of both the E/M service and the procedureis contingent upon the provider reporting Modifier -25.Modifier -25 is used to identify a significant, separatelyidentifiable evaluation and management (E/M) service bythe same physician on the day of a procedure.

Documentation to substantiate the use of the modifiershould be included in the patient’s medical record and available for review if requested.

The following codes should be used to report the removalof impacted cerumen:

• 69210: Removal of impacted cerumen (separate procedure), one or both ears.

• G0268: Removal of impacted cerumen (one or both ears)by physician on same date of service as audiologic functiontesting.

* Claim Payment Policy Note: These policies, in whole or in part, are part ofthe class action settlement with providers. Please note that providers whoopted out of the class action settlement may not be entitled to certain claimpayment policy changes. Therefore, any payments made pursuant to such policy changes to providers who opted out of the class action settlement aresubject to retroactive adjustments. The inclusion of a code/modifier in thispolicy does not imply reimbursement. Eligibility, Benefits, Limitations,Exclusions, Precertification/Referral Requirements, Provider Contracts, andPolicy still apply.

Policy Update: Removal of Impacted Cerumen*


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The pricing and processing procedure for unlisted or nototherwise classified (NOC) covered services was fullyimplemented on February 1, 2005, for all products coveredunder your provider agreement.

All unlisted/NOC codes must be submitted with theappropriate narrative description of the actual services rendered on the CMS 1500 claim form in order to beprocessed. For claims that are electronically submitted,please refer to your HIPAA 837 Companion Guide. Youcan connect to the Guide at our website,www.amerihealth.com/edi.

For paper-submitted claims, additional information regarding the narrative description of the specific servicesprovided should be submitted in block 24D, directly underthe NOC/unlisted procedure code on the CMS 1500claim form. If a description is not provided, the entireclaim will be rejected with a message to resubmit with anarrative description.

For electronically submitted 837P claims, the NOCdescriptions should be populated in the 2400 loop andNTE segment using the Additional Information Qualifier“ADD.”

The following describes the standard process followed byAmeriHealth for processing and pricing unlisted/NOCservices:

1. AmeriHealth maintains a database of historical pricingdecisions for similar services previously reviewed andpriced by AmeriHealth. If available, an appropriate fee inthis database may be used to price the current claim.

2. If the database does not have pricing for the currentclaim, then the claim is reviewed by AmeriHealth for apricing decision. AmeriHealth may request that theprovider submit additional information to facilitate pricing the claim. The additional information requestedmay include (but is not limited to) an operative report, aletter of medical necessity, an office note, and/or an actual manufacturer’s invoice. Providers should only submit additional information if specifically requested todo so by AmeriHealth. When recommended for payment and processing, claims are priced using ourstandard pricing methodology, which is designed to takeinto account new procedures, and are processed in accordance with applicable claim payment policies andbenefit contract exclusions and limitations.

3. Providers who disagree with a specific unlisted/NOCservice pricing determination should follow the normalappeals process described in the Provider Manual.

Providers are reminded to always use the most appropriatecodes when submitting claims. Claims submitted as NOCcodes when a valid CPT or HCPCS code exists may bedenied.

This new procedure has been successfully implemented. Ifyou have any questions, please contact Provider Services oryour Network Coordinator.

Pricing Procedure for Unlisted or Not Otherwise Classified(NOC) Services Fully Implemented

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As previously communicated in our Partners in Healthmonthly Update, claims may reject as non-clean claims ifthey do not contain the following:

• Performing provider ID number (PIN #)• Group provider ID number*• Federal tax ID number• Billing address

• Member’s ID number (including applicable prefix andsuffix)

• Member’s name

For questions or additional information, please contactProvider Services or your Network Coordinator.

* Please be sure the group provider ID number is associated with the GroupFederal Tax ID number on file at AmeriHealth. Providers may access thisinformation via NaviNetSM by using the Provider Change Form transaction to view current information on file at AmeriHealth.

Performing Provider ID, Group Provider ID, and Tax IDNumber Required in Order to Ensure Clean Claims B

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Announcements

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Enhancements to Policy, Payment, Disclosure, andAppeals Processes for Class Action Settlement ProvidersThe court-approved class action settlement between AmeriHealth and providers, who agreed to the terms of the classaction settlement (“Settlement Providers”), includes the following enhancements:

• Improving disclosure to Settlement Providers, including standard fee schedules, changes to schedules, and medical andpayment policies that may affect payment/reimbursement of services which will be made available online viaNaviNetSM, our secure provider portal.

• Changing claims processing for Settlement Providers on the following: selected modifiers (-RT, -LT, -25, -50, -51, -59,-62, -66, -80, -81, -82,); multiple surgical procedures; radiologic guidance during a procedure; and certain CPT* code-level designations (Modifier -51 exempt, Separate Procedure, and Add-on codes).

• Introducing a new, two-level, formal claims appeal process for Settlement Providers.

Certain of these enhancements are currently available. Others will be available during the course of this year and will beannounced as they become available.

CLAIM PAYMENT POLICY NOTEThese policies, in whole or in part, are part of the class action settlement with providers. Please note that providers whoopted out of the class action settlement may not be entitled to certain claim payment policy changes. Therefore, any payments made pursuant to such policy changes to providers who opted out of the class action settlement are subject toretroactive adjustments. The inclusion of a code/modifier in this policy does not imply reimbursement. Eligibility, Benefits,Limitations, Exclusions, Precertification/Referral Requirements, Provider Contracts, and Policy still apply.

Modifier -25 [Significant Separately IdentifiableEvaluation and Management (E/M) by the SamePhysician on the Same Day of the Procedure orOther Service]

Modifier -25 (as defined by the American MedicalAssociation [AMA]; CPT) is used to denote a significant,separately identifiable Evaluation and Management (E/M)service by the same physician on the same day of the procedure or other service. On the day of a minor surgicalprocedure (zero- or 10-day global period), the physicianmay need to indicate that the patient’s condition required asignificant, separately identifiable E/M service above andbeyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. The E/M procedure may beprompted by the symptom or condition for which the

procedure and/or service was provided. As such, differentdiagnoses are not required for reporting the E/M serviceson the same date.

The physician should maintain supportive documentationin the patient’s medical records indicating that a separateand distinct medical condition was treated on the same daythat a procedure was performed. This distinction may bereported by adding Modifier -25 to the appropriate level ofE/M service.

It is not appropriate to report Modifier -25 in the followingcircumstances because either a more appropriate modifierexists to report the service or use of Modifier -25 asdescribed above is not applicable to the reported service:

• Appended to an E/M service that resulted in the decisionto perform major surgery (90-day global period).

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• When a physician performs ventilation management inaddition to an E/M service.

• When an E/M service is performed on a different daythan the procedure.

• Appended to a surgical procedure code since this modifieris used to explain the special circumstance of providing theE/M service on the same day as a procedure.

• When the patient’s trip to the office was strictly for theminor procedure since reimbursement for the procedureincludes the related pre-service work.

Modifiers -RT [Right Side] and -LT [Left Side]

Modifiers -RT and -LT (as defined by the Centers forMedicare and Medicaid Services [CMS] HealthcareCommon Procedure Coding System [HCPCS]) are used todenote the side of the body (right or left) where a service isperformed when that service has the potential to be performed on one or both sides.

The Modifiers -RT and -LT are appropriately appended toCPT or HCPCS codes that identify procedures which canbe performed on paired organs, e.g., arms, ears, eyes, nostrils,kidneys, lungs, and ovaries.

It is not appropriate to append Modifiers -RT and -LT to aprocedure that is identified in its narrative description as abilateral service.

Modifier -51 [Multiple Procedures]

Modifier -51 (as defined by the AMA CPT) is used to

denote when multiple procedures—other than evaluation

and management services—are performed at the same ses-sion by the same provider for the same patient. The primary procedure or service may be reported as listed and the additional procedure(s) or service(s) may be identified byappending Modifier -51.

It is appropriate to report Modifier -51 to identify the secondary procedure or when multiple procedures are performed during a single operative session regardless ofwhether the procedures were through the same incision orperformed at a different anatomical site.

It is not appropriate to report Modifier -51 in the followingcircumstances:

• When a procedure code is designated by CPT as an“add-on” code. Add-on codes are always performed inaddition to the primary procedure and cannot be performed alone.

• When a procedure code is designated by CPT as Modifier-51 exempt.

• When a procedure is considered a component or incidental to a primary procedure. Any intra-operativeservices, incidental surgeries, or components of major surgeries are not separately billable.

• When two or more physicians each perform distinctly different, unrelated procedures on the same patient, on thesame day.

www.amerihealth.com

Announcements (continued)

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PROVIDER INFORMATION andTOOLS WEB PAGEwww.amerihealth.com/providersPROVIDER MEDICAL POLICY WEB PAGEwww.amerihealth.com/medpolicy

PROVIDER ELECTRONIC DATAINTERCHANGE SERVICESWEB PAGEwww.amerihealth.com/edi

CORPORATE AND FINANCIALINVESTIGATIONS DEPARTMENTAnti-Fraud and Corporate Compliance Hotline(866) 282-2707www.amerihealth.com/anti-fraud

CREDENTIALING COMPLIANCEHOTLINE (866) 282-2707www.amerihealth.com/credentials

PROVIDER PHARMACY WEBPAGEwww.amerihealth.com/provider_rx

PROVIDER SERVICES Policies/Procedures/Claims

HMO(800) 821-9412 NJ(800) 888-8211 DE

PPO(800) 595-3627 NJ(800) 888-8211 DE

PHARMACY SERVICES Prescription Drug Authorization(888) 671-5280

Toll-Free Fax(888) 671-5285

Direct Ship Injectable(267) 402-1711(888) 671-5280

Fax(215) 761-9165

Blood Glucose Meter Hotline(888) 494-8213 (option 2)

PROVIDER SUPPLY LINE(800) 858-4728

HEALTH RESOURCE CENTERAmeriHealth Healthy LifestylesSM

(800) 275-2583

Precertification(800) 227-3116CARE MANAGEMENT AND COORDINATION HMO Commercial(800) 373-4455 DE(800) 227-3116 NJ

PPO(800) 373-4455

Case Management(800) 373-4455 DE(800) 313-8628 NJ

Baby FootSteps®

(800) 598-BABY [2229]

CONNECTIONSSM HEALTH MANAGEMENT PROGRAMS PROVIDER SUPPORT LINE(866) 866-4694

CONNECTIONSSM KIDNEY PROGRAM(866) 303-4CKP [4257]

The AmeriHealth Partners in Healthmonthly Update is a publication of theProvider Communications department forthe exchange of information and ideas among the AmeriHealth Providercommunity. Suggestions are welcome.

Contact Information:

Laura LeGowerManaging Editor

Elizabeth DeragoProduction Coordinator

Provider CommunicationsAmeriHealth1901 Market Street, 35th FloorPhiladelphia, PA 19103

Visit our website at www.amerihealth.com

IMPORTANT RESOURCES

AmeriHealth products are offered by QCC Insurance Company d/b/a AmeriHealth Insurance Company, AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey.

The third-party Web sites mentioned in this publication are maintained by organizations over which AmeriHealth exercises no control, and accordingly, AmeriHealth disclaims any responsibility for the content, the accuracy of the information, and/or quali-ty of products or services provided by or advertised in these third-party sites. URLs presented for informational purposes only. Certain services/treatments referred to in third-party sites may not be covered by all benefit plans. Members should refer totheir benefit contract for complete details of the terms, limitations, and exclusions of their coverage.

Current Procedural Terminology (CPT®) is a copyright of the American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictionsapply to government use. CPT® is a trademark of the American Medical Association

Investors in NaviMedix®, Inc. include an affiliate of AmeriHealth, which has a minority ownership interest in NaviMedix®, Inc.

009189 2003-0269 12/03

View our online provider directories at www.amerihealth.com.

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Credentialing Compliance Hotline and Web Page Our corporate credentialing policy requires that our membersreceive in-network health care services only from fully credentialed, participating practitioners. As noted in yourProfessional Provider Agreement, non-credentialed practitioners maynot see our members on an in-network basis.

Therefore, we need your assistance in identifying credentialingnoncompliance.

If you suspect any violations of our practitioner credentialing policies, please proceed with one of the following options:

Call the confidential Credentialing Corporate Compliance Hotline toll-free at (866) 282-2707.

Submit an online Credentialing Noncompliance Referral Form available at: www.amerihealth.com/credentials.

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Hospital Listing & Associated 10-Digit Provider Identification Number

Hospital 10-Digit Provider Identification Number

Abington Memorial Hospital 0001126000Albert Einstein Medical Center 0001017000Brandywine Hospital 0001750000Bryn Mawr Rehabilitation Hospital 0001063000Central Montgomery Medical Center 0001113000Chester County Hospital 0001110000Chestnut Hill Hospital 0002200000Chestnut Hill Rehabilitation Hospital 0002202000Children’s Hospital of Pennsylvania 0001006000Children’s Seashore House 0001166000Crozer Chester Medical Center 0001103000Delaware County Memorial Hospital 0001104000Doylestown Hospital 0001111000Easton Hospital 0001752000Fox Chase Cancer Center 0001001000Frankford Hospital 0001010000Graduate Hospital 0002309000Grand View Hospital 0001129000Hahnemann University Hospital 0002304000Health South Reading Rehabilitation Hospital 0001121000Heart of Lancaster Regional Medical Ctr. 0004691000Holy Redeemer Hospital & Medical Center 0001127000Hospital of the University of Pennsylvania 0001043000Jeanes Hospital 0001015000Jennersville Regional Hospital 0001751000Kensington Hospital 0001003000Kindred Hospital - Delaware County 0001241000Kindred Hospital - Philadelphia 0004596000Lancaster General Hospital 0002000000Lancaster Regional Medical Center 0005046000Lehigh Valley Hospital Center 0002018000Lehigh Valley Hospital - Muhlenberg 0001755000Lower Bucks Hospital 0001124000Magee Rehabilitation Hospital 0001076000Main Line Hospitals - Byrn Mawr 0001101000Main Line Hospitals - Lankenau 0001019000Main Line Hospitals - Paoli Memorial 0001107000Mercy Fitzgerald Hospital 0001105000Mercy Hospital of Philadelphia 0001023000Methodist Hospital 0001021000Montgomery Hospital 0001106000Moss Rehabilitation Hospital 0001081000Nazareth Hospital 0001029000

PA Providers

AmeriHealth HMO, Inc. • AmeriHealth Insurance Company of New Jersey • QCC Insurance Company d/b/a AmeriHealth Insurance Company

Northeastern Hospital 0001017000North Philadelphia Health Systems 0001026000Pennsylvania Hospital 0001050000Phoenixville Hospital 0001395000Pottstown Memorial Medical Center 0001054000Presbyterian Medical Center 0001031000Reading Hospital 0002030000Riddle Memorial Hospital 0001149000Roxborough Memorial Hospital 0001757000Sacred Heart Hospital 0004690000St. Christopher’s Hospital for Children 0002311000St. Joseph Medical Center, Reading 0004929000St. Luke’s Hospital, Bethlehem 0002029000St. Luke’s Quakertown Hospital 0001118000St. Mary Medical Center 0001153000Temple University Children’s Hospital 0001700000Temple University Hospital 0004570000Thomas Jefferson University Hospital 0001016000Thomas Jefferson University Hospital - Ford Road 0001078000Valley Forge Medical Center Hospital 0001120000Warminster Hospital 0002300000Wills Eye Hospital 0001044000


Alfred I DuPont Institute 0001234000

Bayhealth Medical Center 0004366000

Beebe Medical Center 0004362000

Christiana Care Health Service 0004363000

Kent General Hospital 0004364000

Nanticoke Memorial Hospital 0004367000

St. Francis Hospital 0004360000

Union Hospital - Maryland 0004568000



PA Providers (continued)

Delaware Providers

Atlantic City Medical Center 0001218000Bacharach Institute for Rehabilitation 0004770000Barnert Hospital 0003874000Bayonne Hospital 0004301000Bayshore Community Hospital 0004748000Burdette Tomlin Memorial Hospital 0001213000Capital Health System - Fuld Campus 0000889000Capital Health System - Mercer Campus 0001232000Cathedral Health System - St. James Hospital 0004306000Cathedral Health System - St. Michael’s Hospital 0004308000Centrastate Medical Center 0004762000Children’s Specialized Hospital (3 sites) 0004697000Chilton Memorial Hospital 0004418000Christ Hospital 0004443000Clara Maass Medical Center (includes OP division in Hudson County) 0004482000Columbus Hospital 0004512000Community Medical Center 0001230000Cooper Hospital/University Medical Center 0001203000Deborah Heart and Lung Center 0001224000East Orange General Hospital 0004518000Englewood Hospital 0004302000Greenville Hospital 0004311000Hackensack Medical Center 0004709000Hackettstown Community Hospital 0002472000HealthSouth Rehab Hospital of NJ 0001212000HealthSouth Rehab Hospital of Tinton Falls 0004806000Holy Name Hospital 0004426000Hunterdon Medical Center 0004530000Irvington General Hospital 0004389000JFK Johnson Rehabilitation 0004804000JFK Medical Center 0004307000Jersey City Medical Center 0004312000Jersey Shore University Medical Center 0004324000Kennedy Memorial Hospitals - Cherry Hill 0001225000Kennedy Memorial Hospitals - Stratford Division 0001225000Kennedy Memorial Hospitals - Washington 0001225000Kessler Memorial Hospital 0001227000Kessler Rehabilitation Institute 0004798000Kimball Medical Center 0001231000Lourdes Medical Center of Burlington County 0001216000Marlton Rehabilitation Hospital 0001060000Meadowlands Hospital 0004391000Memorial Hospital of Salem County 0001207000Monmouth Medical Center 0004300000Morristown Memorial Hospital 0004537000Mountainside Hospital 0004538000Muhlenberg Regional Hospital 0004303000Newark Beth Israel 0004452000



New Jersey Providers

Newton Memorial Hospital 0004628000Ocean Medical Center (Brick & Point Pleasant) 0004412000Our Lady of Lourdes Hospital 0001211000Overlook Hospital 0004497000Pascack Valley Hospital 0004544000PBI Regional Medical Center 0004637000Raritan Bay Medical Center 0004310000Rehabilitation Institute at Morristown 0003833000Riverview Medical Center 0004447000Robert Wood Johnson Hospital at Hamilton 0004761000Robert Wood Johnson University Hospital 0004241000Robert Wood Johnson University Hospital at Rahway 0004737000Runnell’s Specialized Hospital 0001228000St. Barnabas Medical Center 0004414000St. Clare’s Healthcare - Denville 0004542000St. Clare’s Healthcare - Dover 0004542000St. Clare’s Healthcare - Sussex 0004542000St. Francis Medical Center 0001237000St. Francis Rehabilitation & Nursing Center 0004442000St. Joseph’s Wayne Campus 0004390000St. Joseph’s Hospital & Medical Center 0004411000St. Lawrence Rehabilitation Hospital 0004634000St. Mary Hospital 0004387000St. Mary’s Hospital 0004724000St. Peter’s University Medical Center 0004304000Shore Memorial Hospital 0001209000Shore Rehabilitation Institute 0004219000Somerset Medical Center 0004289000South Jersey Healthcare Regional Medical Center 0001245000South Jersey Healthcare - Bridgeton Health Center 0001235000South Jersey Healthcare - Vineland Health Center 0001235000South Jersey Hospital System - Elmer 0001200000South Jersey Regional Cancer Treatment Center - Millville 0001235000Southern Ocean County Hospital 0001229000Trinitas Hospital 0004309000UMDNJ - University Hospital 0004566000Underwood Memorial Hospital 0001204000Union Hospital 0004407000University Medical Center at Princeton 0001208000Valley Hospital 0004421000Virtua - Memorial Hospital of Burlington County 0001202000Virtua - West Jersey Health System - Berlin 0001205000Virtua - West Jersey Health System - Camden 0001205000Virtua - West Jersey Health System - Marlton 0001205000Virtua - West Jersey Health System - Voorhees 0001205000Warren Hospital 0004742000Weisman Children’s Rehabilitation Hospital 0001214000



New Jersey Providers (continued)

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MEMBER’S HEALTH UPDATE

www.amerihealth.com

AmeriHealth, in collaboration with the American Cancer Society (ACS), urges you to encourage your patients to bescreened for colorectal cancer. Colorectal cancer is the third most common cancer among men and women, and the ACSestimates 145,290 new cases this year alone.

The five-year survival rate for colorectal cancer is 90% when it is caught early. Routine screening may actually preventthe disease by removing polyps discovered during screening. Colorectal cancer screening rates in the U.S. continue toremain low.

Guidelines and patient education materials can make it easier for you to discuss and recommend preventive healthscreenings with all your patients. The current ACS guidelines offer several different screening options. These options arereflected in AmeriHealth’s Preventive Health Guidelines that can be accessed at www.amerihealth.com/providers.* The best screening test is the test that your patient will get. Please know that your personal recommendation greatlyinfluences your patient’s decision to seek recommended preventive health screenings.

Enclosed for your use are the following educational tools:

• Colorectal Cancer “No Excuses” brochure (English version).• Colorectal Cancer “No Excuses” brochure (Spanish version).• Colorectal Cancer Prevention Pocket Card (for physicians).

Please be advised that based on a recently published study of 2,665 patients1, AmeriHealth does not recommendfecal occult blood testing (FOBT) on stool obtained by digital rectal exam as a sole screening test. Instead, if FOBTis selected, then the multiple sample FOBT method is recommended.

If you would like additional copies of any of the above materials, please contact our Provider Supply Line at (800) 858-4728 and indicate the materials you would like sent to you, while supplies last.

For additional cancer-related information, including information on colorectal cancer screening and communityresources, please provide patients with the ACS’s toll-free number, (800) ACS-2345, or its website: www.cancer.org.**

AmeriHealth would like to take this opportunity to remind you about the ConnectionsSM Health ManagementPrograms. These programs provide chronic condition and decision support services to AmeriHealth members. If youwould like more information about the ConnectionsSM Programs, or if you would like to refer a patient for HealthCoaching, please call the ConnectionsSM Programs Provider Support Line at (866) 866-4694.

Thank you for your assistance in promoting awareness of colorectal cancer prevention. Together we can make an impactin helping to control cancer.

* This is not a statement of benefits. Benefits may vary according to state requirements, product line (HMO, PPO, etc.) and/or employer groups. Individual HMOmember coverage may be verified through Provider Services. PPO members should call the number on the back of their identification card for benefit information.

** Please be advised that these websites are maintained by organizations that AmeriHealth does not control. The websites are to be used as a reference for informationalpurposes only. AmeriHealth is not responsible for the content or for validating the content, nor is it responsible for any changes or updates made. Once you link to awebsite not maintained by AmeriHealth, you are subject to the terms and conditions of that website, including but not limited to its privacy policy. This informationhas been provided for general educational purposes for professional medical personnel only. It is not intended to be relied upon for treatment of an individual patientwithout a physician'’ independent professional review.

1 Collins, J.F., Lieberman, D.A., Durbin, T.E., Weiss, D.G., Veterans Affairs Cooperative Study #380 Group. “Accuracy of Screening for Fecal Occult Blood on aSingle Stool Sample Obtained by Digital Rectal Examination: A Comparison with Recommended Sampling Practice.” Annals of Internal Medicine. Jan. 18, 2005.Volume 142. pp. 81-85.

IMPORTANT INFORMATION REGARDING COLORECTAL CANCER SCREENING

Allan B. Goldstein, M.D., F.A.C.P.Vice President and Regional Medical DirectorAmeriHealth, New Jersey

Alfred R. Ashford, M.D.Chief Medical SpokespersonAmerican Cancer Society

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MEMBER’S HEALTH UPDATE

www.amerihealth.com

AmeriHealth, in collaboration with the American Cancer Society (ACS) — South Atlantic Division, urges you toencourage your patients to be screened for colorectal cancer. Colorectal cancer is the third most common cancer amongmen and women, and the ACS estimates 145,290 new cases nationally and 410 cases in Delaware this year alone.

The five-year survival rate for colorectal cancer is 90% when it is caught early. Routine screening may actually preventthe disease by removing polyps discovered during screening. Colorectal cancer screening rates in the U.S. continue toremain low.

Guidelines and patient education materials can make it easier for you to discuss and recommend preventive healthscreenings with all your patients. The current ACS guidelines offer several different screening options. These options arereflected in AmeriHealth’s Preventive Health Guidelines that can be accessed at www.amerihealth.com/providers.* The best screening test is the test that your patient will get. Please know that your personal recommendation greatlyinfluences your patient’s decision to seek recommended preventive health screenings.

Enclosed for your use are the following educational tools:

• Colorectal Cancer “No Excuses” brochure (English version).• Colorectal Cancer “No Excuses” brochure (Spanish version).• Colorectal Cancer Prevention Pocket Card (for physicians).

Please be advised that based on a recently published study of 2,665 patients1, AmeriHealth does not recommendfecal occult blood testing (FOBT) on stool obtained by digital rectal exam as a sole screening test. Instead, if FOBTis selected, then the multiple sample FOBT method is recommended.

Also enclosed is a “Colorectal Cancer Screening Physicians Office Educational Materials Order Form” so that you mayorder additional copies of the tools for use in your office and to distribute to your patients. For additional cancer-relatedinformation, including information on colorectal cancer screening and community resources, please provide patients withthe ACS’s toll-free number, (800) ACS-2345, or its website: www.cancer.org.**

AmeriHealth would like to take this opportunity to remind you about the ConnectionsSM Health ManagementPrograms. These programs provide chronic condition and decision support services to AmeriHealth members. If youwould like more information about the ConnectionsSM Programs, or if you would like to refer a patient for HealthCoaching, please call the ConnectionsSM Programs Provider Support Line at (866) 866-4694.

Thank you for your assistance in promoting awareness of colorectal cancer prevention. Together we can make an impactin helping to control cancer.

* This is not a statement of benefits. Benefits may vary according to state requirements, product line (HMO, PPO, etc.) and/or employer groups. Individual HMOmember coverage may be verified through Provider Services. PPO members should call the number on the back of their identification card for benefit information.

** Please be advised that these websites are maintained by organizations that AmeriHealth does not control. The websites are to be used as a reference for informationalpurposes only. AmeriHealth is not responsible for the content or for validating the content, nor is it responsible for any changes or updates made. Once you link to awebsite not maintained by AmeriHealth, you are subject to the terms and conditions of that website, including but not limited to its privacy policy. This informationhas been provided for general educational purposes for professional medical personnel only. It is not intended to be relied upon for treatment of an individual patientwithout a physician’s independent professional review.

1 Collins, J.F., Lieberman, D.A., Durbin, T.E., Weiss, D.G., Veterans Affairs Cooperative Study #380 Group. “Accuracy of Screening for Fecal Occult Blood on aSingle Stool Sample Obtained by Digital Rectal Examination: A Comparison with Recommended Sampling Practice.” Annals of Internal Medicine. Jan. 18, 2005.Volume 142. pp. 81-85.

IMPORTANT INFORMATION REGARDING COLORECTAL CANCER SCREENING

Richard L. Snyder, M.D.Vice President Quality ManagementAmeriHealth

Allison L. GilRegional Mission Delivery DirectorAmerican Cancer SocietySouth Atlantic Division

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COLORECTAL CANCER SCREENING Physician’s Office Educational Materials

Free of Charge

If you or someone you know has cancer, the American Cancer Society (ACS) can help! Please provide patients with the ACS’s toll-free number, (800) ACS-2345, or its website,

www.cancer.org

Order Form

For Patients Quantity Colorectal Cancer “No Excuses” brochure (English version) 50 100 Colorectal Cancer “No Excuses” brochure (Spanish version) 50 100 For Physicians Quantity Colorectal Cancer Prevention Pocket Card ___________ Send to: County: _______________________________________________________________ Practice Name: _________________________________________________________ Attention: _____________________________________________________________ Address: ______________________________________________________________ Zip Code: _____________________ email address: ___________________________

Return to:

American Cancer Society South Atlantic Division, Inc.

Attention: Allison Gil 92 Read’s Way - Suite 205

New Castle, DE 19720 FAX: (302) 324-4233

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