In December 2020, Congress passed legislation designed to protect patients – the Consolidated Appropriations Act (CAA) H.R.133 and No Surprises Act H.R.3630.

Effective December 27, 2020, AmeriHealth must comply with certain requirements of the Acts, including increased transparency of health care costs to enrollees.

If you entered into a provider participation contract with AmeriHealth in 2015 or later, your agreement likely already meets the Acts' requirements.

If you entered into a provider participation agreement with AmeriHealth prior to 2015, then your provider participation contract likely does not contain the following language, which is necessary for compliance:

9.4 Exceptions to Confidentiality Obligations. The obligations imposed on the Parties in this Section 9 shall not restrict or limit disclosures made by the Receiving Party that are either: (a) required by applicable laws or a governmental authority; or (b) compelled by a court order or a governmental order, provided that the Receiving Party being compelled to disclose any such information shall (i) give prompt notice after learning of the need therefore to the Disclosing Party (if allowed by applicable law), (ii) disclose only that portion of the Disclosing Party's Confidential Information that the Receiving Party's legal counsel advises is legally necessary to comply with such laws or governmental authority, and (iii) assist the Disclosing Party if it chooses to object to such disclosure.

While we work to revisit our older provider contracts, this notice serves as an amendment all our provider participation contracts to include the language above to ensure the presence of the language required for compliance.

The legislation states that we increase transparency by:

• requiring the disclosure of provider-specific costs or quality information to referring providers, the plan sponsor, and current or prospective enrollees.
• allowing electronic access of de-identified claims and encounter information for each enrollee.
• allowing that information be shared with HIPAA business associates.

Please contact Customer Service at 1-888-YOUR-AH1 (AmeriHealth New Jersey) or 1-800-275-2583 (AmeriHealth Pennsylvania) with questions.