Ameriben Precertification Fax Request Form (2024)

FAQs

Does AmeriBen require prior authorization? ›

Mental health, substance abuse or behavioral health services require precertification/authorization. You must submit an electronic precertification request on our secure provider website on NaviNet® at connect.navinet.net.

For precertification of pharmacy-covered specialty drugs (notedwith*) when memberis enrolled in a commercialplan,call 1-855-240-0535 or fax applicable request forms to 1-877-269-9916.

Need Help? You can reach us at the number on the back of your medical card. If you do not have access to your card, you can reach us at our general phone number 1-800-786-7930.

AmeriBen has been in business since 1958 and began processing medical claims in 1964. We specialize in administering complex benefit plans for over 170 self-funded employer groups and fully-insured university plans totaling over one million member lives.

Prior authorization—sometimes called preauthorization or precertification—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

If your provider doesn't ask for prior authorization when required, the claim will be denied. The provider CANNOT bill you for the treatment if they did not get prior authorization.

Third Party Administration

Our collaboration with AmeriBen¹ provides expertise in claims administration and processing. Partnered with Anthem's diverse network of local health professionals, we bring collaborative expertise to your healthcare plan.

Who acquired AmeriBen? AmeriBen was acquired by Elevance Health.

Covered Services: AmeriBen Solutions insurance plans typically cover a wide range of healthcare services, including preventive care, doctor visits, hospitalization, prescription medications, substance abuse, and mental health treatments.

AmeriBen, ATTN: CoC, PO Box 7186, Boise, ID 83707.

What is the payer ID for AmeriBen? ›

Appeals requested on behalf of joint administration members need to be submitted to AmeriBen; MagnaCare or Zenith American Solutions within 180 days of receipt of the written notification of an adverse benefit determination.

This broker/brokerage has broad experience across industries, employer sizes and products with a M Score rating above 3.5 stars. This is a trusted broker who is able to provide consulting and quality service.

AmeriBen is dedicated to improving the lives of those around us. We have put together a collection of tools and information that will help you enjoy a healthy lifestyle and get the most out of your health benefit plan.

AmeriBen is the company that will administer and. process your health insurance claims. This is also called a third party administrator. After you receive services from a provider in your plan and they pre-certify (approve) necessary services, the claim is sent to AmeriBen for processing and payment.

The prior authorization process begins when a service prescribed by a patient's physician is not covered by their health insurance plan. Communication between the physician's office and the insurance company is necessary to handle the prior authorization.

What to do if prior authorization is denied. The common reasons for an insurance company to deny a PA include procedures and medications not indicated for the diagnosis, off-label use of the medications, or generics available when a brand name is requested.

Why does my health insurance company need a prior authorization? The prior authorization process gives your health insurance company a chance to review how necessary a medical treatment or medication may be in treating your condition. For example, some brand-name medications are very costly.

This means the plan does not require prior authorization or premedical review. In these cases, it is going to be up to the physician or physician practice to decide if the patient meets the payor guidelines per local coverage determination policies.