AmeriHealth is dedicated to maintaining the highest standard of care and
service for our members, providers, and the communities we serve. Information
about our Quality Management Program is accessible on the
AmeriHealth New Jersey
website and the AmeriHealth Pennsylvania
website. These websites include a description of the AmeriHealth Quality
Management Program, including program goals, objectives, and activities to
improve clinical, network, and service quality.
- Access and availability standards. AmeriHealth standards
ensure that our managed care networks are adequate to meet the needs of our
members with respect to location and appointment accessibility for primary and
specialty care as well as urgent and emergency care, in accordance with
applicable regulatory requirements.
- Member rights and responsibilities. All AmeriHealth
members have defined rights and responsibilities.
- Privacy and confidentiality. AmeriHealth, our contractors,
and our affiliates are required to protect the privacy and confidentiality of
our members? personal and health information in accordance with state and
federal regulatory requirements.
- Utilization review. It is the policy of AmeriHealth that
all utilization review decisions are based on the appropriateness of health
care services and supplies, in accordance with AmeriHealth?s definition of
medical necessity and the benefits available under the member?s coverage.
- Medical record-keeping standards. Well-maintained medical
records are critical to facilitate communication, continuity, coordination, and
an effective plan of care. Accordingly, AmeriHealth standards require that
medical records are maintained in a manner that is current, detailed, and
organized as required by applicable regulatory requirements.
Please review these above-listed standards with your staff to ensure that
your office maintains the required access, documentation, and quality care
expected of our network providers.
Information about our Quality Management Program and these standards can
also be found in the Provider Manual for Participating Professional
Providers (Provider Manual) and the Hospital Manual for Participating
Hospitals, Ancillary Facilities, and Ancillary Providers (Hospital
Manual), which are available through the NaviNet® web
portal. Paper copies of the Provider Manual and Hospital
Manual can be ordered by submitting an
online request or by calling the Provider Supply Line at
1-800-858-4728.
For more information about our Quality Management Program and our progress
in meeting program goals, please visit the appropriate website, as listed
above, or contact Customer Service at 1-888-YOUR-AH1 (1-888-968-7241)
for AmeriHealth New Jersey or at
1-800-275-2583
for AmeriHealth Pennsylvania. Members may request the same
information by calling Customer Service.
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