AmeriHealth is dedicated to maintaining the highest standard of care and service for our members, providers, and the communities we serve. Information about our Quality Management Program is accessible for AmeriHealth New Jersey and AmeriHealth Pennsylvania. These websites include a description of the AmeriHealth Quality Management Program, including program goals, objectives, and activities to improve clinical, network, and service quality.

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

• Access and availability standards. AmeriHealth standards ensure that our managed care networks are adequate to meet the needs of our members with respect to location and appointment accessibility for primary and specialty care as well as urgent and emergency care, 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, 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 these standards can also be found in the appropriate Provider Manual for Participating Professional Providers (Provider Manual) and the Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers (Hospital Manual), which are available through the NaviNet^® web portal. Paper copies of the Provider Manual and Hospital Manual can be ordered by submitting an online request or by calling the Provider Supply Line at 1-800-858-4728.

For more information about our Quality Management Program and our progress in meeting program goals, please visit the appropriate website, as listed above, or contact Customer Service at 1-888-YOUR-AH1 for AmeriHealth New Jersey or at 1-800-275-2583 for AmeriHealth Pennsylvania. Members may request the same information by calling Customer Service.

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