Click "Submit". Forgot Member Username Decide on what kind of signature to create. AmeriHealth Administrators . Opens a new window. If you have questions about this tool or a service or to request a prior authorization, call 1-888-913-0350. AmeriHealth New Jersey Wire Claim Form Combined Broker of Record/Employer Authorization Form Copay Reimbursement Form Dependent to 31 application Disabled Dependent Form Employer Authorization Form for Access to Employer Portal Guardian Critical Illness and Accident Insurance 25 - 100 Guardian Critical Illness and Accident Insurance 101 - 500 How to submit a request for pharmacy prior authorizations. Box 7576 Please refer back to the main Pharmacy page for more information about the Standard and Select Drug Program formularies. If you have questions about the preauthorization process, call 1-800-275-2583. Prior authorization is not a guarantee of payment for the service authorized. AmeriHealth Administrators uses various policies and criteria, including AmeriHealth medical policy and InterQual , for utilization review determinations. By phone. ;G, 1237420 - 2021_01 updates to precert lists Tier 3_Standard_AHNJ.indd, 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