To promote better coordination of health care for our members and physicians, we will soon introduce the Clinical Care Report. Unless a member chooses to opt out, this tool will be accessible through the NaviNet web portal and offers participating physicians a snapshot view of care that their patients have received based on AmeriHealth-paid medical and prescription drug claims as explained below.

The Clinical Care Report is intended for viewing by the following participating health care providers:

• a member’s personal or primary care physician;
• physicians who have treated a member in the past year;
• a new physician with whom a member has an upcoming scheduled appointment;
• a physician who is addressing a current emergency medical need.

Information available in the Clinical Care Report

The information populated in our members’ Clinical Care Reports is derived from member claims data and includes:

• disease conditions reported in the past two years;
• visits to the emergency room in the past year;
• hospital admissions in the past four years;
• outpatient procedures in the past two years;
• specialists seen in the past two years;
• prescriptions filled in the past six months;
• alerts by condition (i.e., gaps in care), if any;
• lab tests with results (when available);
• diagnostic imaging in the past two years;
• immunizations in the past four years.

This report is not a complete medical record of all services, tests, or products that a member may have received. It does not include data for sensitive health conditions, such as mental/behavioral health, substance abuse, HIV/AIDS, sexually transmitted diseases, or genetic testing, or for services for which AmeriHealth did not pay a claim.