Policies and Guidelines

Medical Policy
Use this online searchable database to read AmeriHealth medical and claim payment policies.

Pharmacy Policy
Use this online database to read AmeriHealth pharmacy policies.

Clinical Practice Guidelines
Download guidelines outlining a generally accepted minimum standard of care — adherence may lead to improved patient outcomes.

Preapproval/Precertification for Services
Certain services require preapproval/precertification from AmeriHealth prior to being performed.

Most Cost-Effective Setting Program
Find out how AmeriHealth reviews the requested treatment settings for certain specialty drugs that are eligible for coverage under the medical benefit.

Dosage and Frequency Program
Learn how AmeriHealth reviews treatment regimens for certain specialty drugs to ensure they adhere to safe prescribing limits.

Medical Necessity Criteria
Find information regarding the InterQual guidelines for acute and home care settings as well as support for procedure and durable medical equipment decisions.