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Quality Management

Information on maintaining standards of care

AmeriHealth Quality Management Program
AmeriHealth is dedicated to maintaining the highest standard of care, service, and performance within our company, for our members, and the communities we serve. Our Quality Management Program ensures that we maintain this high standard at all times.

Access & Availability Standards
AmeriHealth’s Access and Availability Standards ensure our managed care networks are adequate to meet the needs of our members. These standards apply to specialty, location, cultural diversity, and accessibility to primary care, urgent, and emergency care.

Member Rights and Responsibilities
All AmeriHealth members have clearly defined rights and responsibilities relating to care, information, conduct, and other issues.

Privacy & Confidentiality
AmeriHealth, our contractors, and our affiliates, protect the privacy and confidentiality of our members’ personal and health information as required by law.

Utilization Management Decisions
Utilization Management defines AmeriHealths policy for the approval and denial of coverage. AmeriHealth does not offer incentives to encourage inappropriate under or over utilization.

Medical Record Keeping Standards
Well-maintained medical records are critical for facilitating communication, continuity, coordination, and an effective plan of care. Accordingly, standards have been established to ensure that medical records are maintained in a manner that is current, detailed, and organized.