Quality management

Maintaining standards of care

AmeriHealth New Jersey Quality Management ProgramAmeriHealth New Jersey 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 standardsAmeriHealth New Jersey'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 & responsibilitiesAll AmeriHealth New Jersey members have clearly defined rights and responsibilities relating to care, information, conduct and other issues.

Privacy & confidentialityAmeriHealth New Jersey, our contractors, and our affiliates, protect the privacy and confidentiality of our members' personal and health information as required by law.

Utilization management decisionsUtilization Management defines AmeriHealth New Jersey's policy for the approval and denial of coverage. AmeriHealth New Jersey does not offer incentives to encourage inappropriate under or over utilization.

NCQA AccreditationNCQA is a private, non-profit organization dedicated to improving health care quality. NCQA evaluates the quality of key processes and systems health plans provide their members.

If you have any questions or concerns about the quality of care received, you can reach us by calling the number on the back of your ID card.

Medical record keeping standardsWell-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.