AmeriHealth continues to implement various utilization management programs through third-party vendors to ensure members receive high-quality care that is appropriate, safe, and cost-effective. These programs, which are based on established evidence-based guidelines and industry standards, reflect our commitment to being good stewards of our members’ health care dollars.
These programs expand our existing list of utilization management programs. However, self-funded groups can elect not to include these utilization management programs as part of their group health plan.
Identifying AmeriHealth members who are in a self-funded group that has elected not to participate in our utilization management programs
Because some self-funded groups may elect not to participate in our utilization management programs,
it is important to submit
all authorization requests for services included in our utilization management programs directly to our designated vendors:
- AIM Specialty Health® (AIM)
- CareCore National, LLC d/b/a eviCore healthcare (eviCore), a specialty benefit management company
If an AmeriHealth member is part of a self-funded group that has elected not to include utilization management programs in their group health plan, the authorization request will be returned with a message indicating that an authorization is not required for the service.
All other AmeriHealth members still require authorization for these services.
More information
If you have questions related to services in our utilization programs that require authorization, visit our dedicated web pages for
AIM and
eviCore. If you have additional questions after reviewing these materials, please call Customer Service at
1-888-YOUR-AH1![]( "Call: 1-888-YOUR-AH1")
for AmeriHealth New Jersey and
1-800-275-2583![]( "Call: 1-800-275-2583")
for AmeriHealth Pennsylvania.