​​AmeriHealth HMO, Inc. and AmeriHealth Insurance Company of New Jersey (collectively, AmeriHealth) would like to remind providers that Urgent Care Centers (UCCs) must be accredited to participate in our network. This policy applies to both free-standing UCCs and hospital-based/owned UCCs.

Accreditation confirms that a UCC has the necessary standards, providers, and equipment to provide quality care. To participate in the AmeriHealth network, a UCC must be accredited by one of the following organizations:

• Joint Commission (JC)
• DNV
• National Urgent Care Center Accreditation (NUCCA)
• Accreditation Association for Ambulatory Health Care (AAAHC)
• Center for Improvement in Healthcare Quality (CIHQ)
• Urgent Care Association of America (UCAOA)

Licensing is not required for UCCs in Pennsylvania or New Jersey. In Delaware, UCCs are required to be licensed as a Freestanding Emergency Center.

Each UCC must employ a medical director who is a participating provider credentialed by AmeriHealth. The UCC medical director is responsible for overseeing care provided by medical personnel employed or contracted by the UCC, reviewing medical records and all abnormal lab or other radiology values, communicating with PCPs, overseeing the UCC's Quality Management program, and ensuring licensure and credentialing of all UCC facility professional staff is maintained during the term of their agreement.

A UCC can only be contracted for specialty care if they have employed staff in that specialty. A pediatric UCC must have specialists with appropriate pediatric training (Pediatrics, Emergency Medicine, Family Medicine) available at all times. An UCC that only treats orthopedic injuries must be staffed by an orthopedic specialist/orthopedic surgeon.

For questions or more information, please email qualitymanagement@amerihealth.com. For questions about contracting, please contact your contract manager.

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