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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 on our website under Resources for
Patient Management. The website includes a description of the AmeriHealth
Quality Management Program, including program goals, objectives, and activities
to improve clinical, network, and service quality.
- 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.
Please review the standards listed above with your office staff to ensure that
your office maintains the required access, documentation, and quality care
expected of our network providers.
Information about our Quality Management Program and these standards can
also be found in the 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 our
website or contact Customer Service at
1-800-275-2583 for providers in Pennsylvania or 1-888-YOUR-AH1
(1-888-968-7241) for providers in New Jersey. Members may request the
same information by calling Customer Service.
NaviNet® is a registered trademark of
NaviNet, Inc.
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