Letters will be sent later this month to some offices to advise that they may be selected to participate in an upcoming medical record review required by the National Committee for Quality Assurance (NCQA). During the first half of 2017, AmeriHealth will review the medical records of some of our members regarding services received. AmeriHealth is required to undertake this review to comply with regulatory and accreditation requirements.

Once participants have been determined, AmeriHealth will contact each office to schedule an appointment for a nurse who is trained in analyzing medical records to perform an on-site review. We will review the records in accordance with the quality standards set by NCQA in its performance measurement tool known as the Healthcare Effectiveness Data Information Set (HEDIS^®).

Note: According to your Agreement with AmeriHealth, if your office is selected for this review, participation is mandatory.

If you have any questions regarding this upcoming NCQA-required medical record review, please contact the Quality and Risk Management Department at 215-241-2678.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.