Take an active role with our new consumer driven plans.

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.

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.