Our Quality Management Program regularly reviews the care and service our members receive and promotes clinical, network, and service quality through its activities.
To ensure our members receive quality care, our Quality Management Program has standard of care requirements related to:
As a participating provider, you have agreed to cooperate with, participate in, and abide by the AmeriHealth Quality Management Program. Please review the standards of care with your staff.
Our member safety and wellness initiatives promote efficient utilization of services, facilitate coordination of care, promote adherence to the plan of care, and help to improve outcomes.
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Complex case management. Members with complex medical conditions may be eligible for case management. You can refer members online or by calling 1-800-313-8628.
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Drug Utilization Review. Targeted reports are generated annually related to prescribing and care coordination practices. Reports are sent via mail to your practice, if applicable.
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Occurrence investigation. Our clinical staff, with Medical Director oversight, review all reported occurrences for quality issues. Medical records may be requested for a detailed analysis and, if necessary, a corrective action plan from the facility or provider.
Providers can learn more about our Quality Management Program, goals, and activities:
- AmeriHealth New Jersey providers can visit the
website, read the Quality Management section of the
Provider or
Hospital manual, or call Customer Service at 1-888-YOUR-AH1 (1-888-968-7241).
- AmeriHealth Pennsylvania providers can visit the
website, read the Quality Management section of the
Provider manual, or call Customer Service at 1-800-275-2583.