In January 2018, AmeriHealth will send letters to some provider offices to advise that they may be selected to participate in an upcoming medical record review required by the National Committee for Quality Assurance (NCQA). AmeriHealth will review the medical records of some members during the first half of 2018 regarding services received. AmeriHealth is required to undertake this review to comply with regulatory and accreditation requirements.

Once provider offices have been selected, AmeriHealth will contact each office to schedule an appointment for an on-site review from a nurse who is trained in analyzing medical records. We will review the records in accordance with the quality standards set by NCQA in its performance measurement tool known as the Healthcare Effectiveness Data Information Set (HEDIS?).

Note : According to your Provider Agreement with AmeriHealth, if your office is selected for this review, participation is mandatory.

If you have any questions regarding this upcoming NCQA-required medical record review, please contact the Quality and Risk Management Department at 215-241-2678.

HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Used with permission.