AmeriHealth New Jersey’s commitment to members

At AmeriHealth New Jersey you’re protected by more than great coverage. We also look out for you by providing the technology, programs, and resources to help you manage your health benefits quickly and easily.

With work, family, and friends, you don’t always have the time or the resources to focus on your health. Our member portal has all your benefits and claims information in one convenient location. Once registered, you can manage your account, find a doctor or hospital, view claims and benefits, and help manage your health through our personalized tools and resources. With amerihealthexpress.com, you have quick and secure access to information you need to make smarter health care decisions, anytime and anywhere. Other features you’ll enjoy include a virtual assistant, symptom checker, ability to download a temporary member ID card, and so much more!

Learn more

Member Resources

Manage your Benefits
Find a Doctor
Choosing a Primary Care Physician (PCP)/ Preferred Provider
Find a Dental Provider
Find a Vision Provider
Davis Vision Direct Reimbursement Claim Form
Formulary Drug List
Clinical Practice Guidelines Summary
In Network Exception Request Form
Network Selection Criteria
Seasonal Flu Coverage and Benefits
Healthy Families and Kids
Transparency in Coverage and Cost-Sharing
Summary of Coverage and Cost Information for Out-of-Network Treatment
In-Network Labs
GradFin for Group members
GradFin for Individual members
How to make a payment
AblePay¹
Cancer Support Team: Thyme Care

Preapproval/precertification for services and member cost-sharing

Certain services require preapproval/precertification from AmeriHealth New Jersey prior to being performed.

Precertification Lists:

• 2023 Precertification List (as of 1/1/2023)
• 2023 Precertification List with AIM Opt Out (as of 1/1/2023)
• 2022 Precertification List (as of 7/1/2022)
• 2022 Precertification List with AIM Opt Out (as of 7/1/2022)

Tele-behavioral Health

AmeriHealth New Jersey believes your overall health includes both your physical and emotional well-being. That’s why we make it easy for you to use behavioral health services through the tele-behavioral health benefit. You can have virtual visits by phone or video chat with an in-network licensed health care professional (including psychiatrists, psychologists, and counselors). Virtual visits are convenient, flexible, and completely confidential. Cost-sharing will be waived until 90 days after the end of both New Jersey’s state of emergency and public health emergency related to COVID-19.

To get started, simply locate a tele-behavioral health provider by calling the number on the back of your ID card under Mental Health/Substance Abuse or check our Provider Finder. You can also check with your current provider to see if he or she offers virtual visit options.

Condition and Case Management

AmeriHealth New Jersey offers condition and case management support for complex and chronic conditions.²

Quality Management

See how AmeriHealth New Jersey upholds the highest standards of care

Safe Prescribing

Learn how our prescription drug benefit uses safe prescribing procedures to allow you access to the drugs you need while also keeping you safe.

Preventive Services

Like yearly check-ups, screenings, and immunizations, Preventive care helps you and your family stay healthier and can help lower your overall out-of-pocket medical costs. As a result of the Patient Protection and Affordable Care Act of 2010 (PPACA) and the Health Care and Education Reconciliation Act (HCERA) of 2010, most AmeriHealth New Jersey health plans include coverage for certain designated preventive care services with no cost-sharing. Talk to your doctor about what types of preventive care are appropriate for you. Learn more

Additionally, services may be considered preventive when mandated by state law. For more information, refer to the current version of medical policy 00.06.02, Preventive Care Services.

Medical Policy

The Medical Policy Portal contains medical and claim payment policy bulletins. Medical policy bulletins describe the Company’s coverage position on medical and behavioral health care services, including laboratory tests, diagnostic procedures, preventive interventions, and treatments (e.g. drugs/biologics, devices, medical/surgical procedures). Claim payment policy bulletins describe the Company’s coverage and reimbursement position on a specific topic; the requirements for coverage and reimbursement; the instructions for reporting specific services, a class of services, and/or codes (e.g. diagnosis, procedure, procedure code modifier); and/or a description of the claims system logic applied to procedure code combinations. Learn more.

¹AblePay Health is an independent company. This is a value added program and not a benefit under AmeriHealth New Jersey and is therefore subject to change without notice. Check your benefits for eligibility.

²AmeriHealth New Jersey members who are covered through fully-insured employer groups are automatically considered eligible for the condition management. Members covered through certain self-insured employer groups may not be eligible for the program. Members can call Customer Service at 1-888-YOUR-AH1 (1-888-968-7241) to verify their eligibility.

³MDLIVE services are available to all AmeriHealth New Jersey members, however, those enrolled in Health Saving Account (HSA) eligible plans must meet their deductible before MDLIVE services can be obtained at zero cost-share in accordance with federal IRS regulations.