AmeriHealth is dedicated to providing access to a network of health care providers who provide a high standard of care and service for our members. We strive to develop and maintain strong relationships with the providers in our network and the communities we serve. One of the ways we do this is through our Quality Management Program. Our websites include a description of the Quality Management Program and an outline of program goals, objectives, and activities to improve clinical, network, and service quality.

Program standards

Please review the following standards with your staff to ensure that your office maintains the required access, documentation, and quality of care expected of our network providers:

• Access and availability standards. AmeriHealth standards ensure that our managed care networks adequately meet the needs of our members. Appointment location and accessibility for primary and specialty care, as well as urgent and emergency care, must be in accordance with applicable regulatory requirements.
• Member rights and responsibilities. All AmeriHealth members have defined rights and responsibilities.
• Privacy and confidentiality. AmeriHealth, our contractors, and our affiliates are required to protect the privacy and confidentiality of our members? personal and health information in accordance with state and federal regulatory requirements.
• Utilization review. It is the policy of AmeriHealth that all utilization review decisions are based on the appropriateness of health care services and supplies. This is in accordance with the AmeriHealth definition of medical necessity and the benefits available under the member?s coverage.
• Medical record-keeping standards. Well-maintained medical records are critical to facilitate communication, continuity, coordination, and an effective plan of care. Accordingly, AmeriHealth standards require that medical records are maintained in a manner that is current, detailed, and organized as required by applicable regulatory requirements.

Information about our Quality Management Program and the standards above can also be found in the appropriate Provider Manual for Participating Professional Providers and the Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers, which are available through the NaviNet^? web portal. Paper copies of the manuals can be ordered by submitting an online request for AmeriHealth New Jersey or AmeriHealth Pennsylvania.

For more information about our Quality Management Program and our progress in meeting program goals, please visit our website for AmeriHealth New Jersey and AmeriHealth Pennsylvania or contact Customer Service at 1-888-YOUR-AH1 for AmeriHealth New Jersey or at 1-800-275-2583 for AmeriHealth Pennsylvania. Members can also request this information by calling Customer Service at the number listed on the back of their ID card.

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