We have engaged Equian, an independent company, to assist AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth) with their efforts to ensure proper reimbursement to health care providers in accordance with provider and/or health benefit plan contracts.
As our Business Associate, Equian is contracted to conduct a variety of facility audits on our behalf, including:
- Hospital Bill Auditing
- Itemized Bill Review
- Outpatient Service Auditing (APC methodology)
- Inpatient Service Auditing (DRG methodology)
An Equian representative may be in contact with your facility to review certain records pertaining to the accuracy of payments AmeriHealth made to your facility. Such records may include AmeriHealth member medical records related to the claim payments.
Disclosure of protected health information by your facility to Equian related to AmeriHealth members is permitted pursuant to 45 C.F.R.164.502 and 45 C.F.R.164.506 for purposes of payment. As this is a permitted disclosure, please respond to such requests for information from Equian, including requests for protected health information.