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AmeriHealth Quality Management Program

The AmeriHealth Quality Management (QM) program provides a formal process to systematically monitor and objectively evaluate the company’s quality, efficiency, and effectiveness.

Program Activities

  • Provide tools and information to assist network providers in developing and maintaining a standard of care.
  • Manage partnership with network providers.
  • Monitor and evaluate care.
  • Suggest improvement to medical policies.
  • Oversee credentialing.
  • Oversee various processes for hearing grievances and appeals.
  • Collect member suggestions for quality initiatives.
  • Monitor aspects of care based on the demographics of members served (i.e., age, gender, and health status).
  • Investigate and track potential quality of care concerns through the recredentialing, grievance and appeal, and peer review processes.

Member Safety

We use plan-wide activities that increase member safety initiatives and reduce medical/medication errors. These activities include communicating information through mailings and newsletters.

Quality Improvement

Information about our Quality Improvement program is available to members and providers. Upon request, we'll provide a description of our program and a report on progress.

Additional information can be found on our Provider News Center.

Quality Management Program Information