• Provider News Center

• Policies and Guidelines

• Medical Policy
• Pharmacy Policy
• Clinical Practice Guidelines
• Preapproval/ Precertification Requirements and Member Cost-Sharing
• Medical Necessity Criteria

• Claims and Billing

• Interactive Tools and Resources

• Pharmacy Information

• Resources for Patient Management

• Contact Information

Clinical Practice Guidelines

The goal of our plan-approved Clinical Practice Guidelines* is to enhance the improvement of patient outcomes by providing you with the resources that support clinical practice consistent with nationally recognized standards of care.

Clinical Practice Guidelines are considered the accepted minimum standard of care. Individual clinical decisions should be tailored to specific patient medical and psychosocial needs.

Details of the Clinical Practice Guidelines

The Clinical Practice Guideline grid** will provide you with condition-based information, the guideline reference, and the link to the organization providing the guideline. Information is rapidly evolving in this field and may lead to changes in recommendations. As changes occur, please update your practice accordingly.

For a copy of the Clinical Practice Guidelines, you can access the PDF below or you can call 1-800-858-4728 to receive a hard copy by mail.

Download the AmeriHealth Clinical Practice Guidelines.

Download the AmeriHealth Perinatal Guidelines.

In addition, we offer Member Wellness guidelines for children  Member Wellness Guidelines (Children), adults 18-64  Member Wellness Guidelines (18-64), and seniors 65 and older  Member Wellness Guidelines (65+) that provide members with an outline of evidenced-based wellness recommendations for the average-risk person. These recommendations are not a statement of benefits and some of these services may require cost sharing. Members are encouraged to review these recommendations with their health care provider to determine which screenings would be appropriate based on specific patient medical and psychosocial needs.

To request a copy of these guidelines by mail, please complete the online Office Administration/Patient Education Resources Order Form.

Connections^SM Health Management Program

The Connections Health Management Program is developed from evidence-based, nationally accepted sources. The programs are designed to help health care practitioners and their patients manage chronic conditions and to help patients make more informed decisions about certain significant medical conditions.

If you have any questions or concerns, please contact Provider Services.

* These guidelines are not a statement of benefits. Benefits may vary based on state requirements, product line (HMO, PPO, etc.), contract, and/or employer group. Individual member coverage will need to be verified with AmeriHealth. For any additional questions, please contact Provider Services.

** Each guideline is based on nationally recognized standards and is reviewed by all of our Regional Clinical Quality Committees (which include input from network providers) and specialty advisory committees or consultants as required. These guidelines are then formally approved by the AmeriHealth Corporate Managed Care Quality Improvement Committee (MCQIC).

Please be advised that the websites contained in this document are maintained by organizations that AmeriHealth does not control. The websites are to be used as a reference for informational purposes only. AmeriHealth is not responsible for the content or for validating the content, nor is it responsible for any changes or updates made. Once you link to a website not maintained by AmeriHealth, you are subject to the terms and conditions of that website, including but not limited to its privacy policy. This information has been provided for general educational purposes for professional medical personnel only. It is not intended to be relied upon for treatment of an individual patient without a physician's independent professional review.