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Important Information About the Upcoming Clinical Care Report

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. The Clinical Care Report is part of a larger strategy to utilize our member claims data and expand the use of health information technology to improve care.

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 Report 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, genetic testing, or for services for which AmeriHealth did not pay a claim.

How to grant or remove access to the Clinical Care Report
Beginning August 22, 2011, only the designated Security Officer(s) in each provider office will have access to the Clinical Care Report, and he or she will be able to control user access through the User Management transaction on NaviNet. Note: In order for providers to access the Clinical Care Report, a designated Security Officer must enable individual users or all users.

For detailed instructions on how the designated Security Officer(s) in each provider office can grant or remove individual or group access to the Clinical Care Report, please refer to the article in the July edition of Partners in Health Update^SM.