​​Our Quality Management Program promotes quality care and service

July 20, 2022

​As a participating provider, you have agreed to comply with the AmeriHealth Quality Management Program to support optimal health outcomes and satisfaction with care for our members. Please review our standards of care with your staff related to:

​AmeriHealth New Jersey
​AmeriHealth Pennsylvania
Provider access and availability
Provider access and availability
Member rights and responsibilities
Member rights and responsibilities
Privacy and confidentiality
Privacy and confidentiality
Medical record keeping
Medical record keeping
Utilization review
Utilization review

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.

  • Complex case management. Members with complex medical conditions may be eligible for case management. You can refer members by completing an online form for AmeriHealth New Jersey or AmeriHealth Pennsylvania; or by calling 1-800-313-8628.
  • 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.
  • 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.

Learn more about our Quality Management Program:

  • 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.