Intensive Case Management: Health Education and Management Program

AmeriHealth Caritas Pennsylvania is pleased to provide information about the member health education and management program: Intensive Case Management. This proactive medical care coordination program focuses on AmeriHealth Caritas members with specific health risks.

Provider Case Management and Care Coordination Rights and Responsibilities

Providers who are treating members/consumers that participate in the Case Management/Care Coordination program have the right to:

  • Obtain information about AmeriHealth Caritas including its programs and services, its staff and its staff qualifications
  • Be informed of how AmeriHealth Caritas coordinates its interventions and plan of care for individual members
  • Know how to contact the case manager who is responsible for managing the case, and communicating with the practitioner's patients
  • Be supported by AmeriHealth Caritas and work collaboratively in decision making with members/consumers regarding their health care
  • Receive courteous and respectful treatment from AmeriHealth Caritas staff, and communicate complaints to AmeriHealth Caritas

Providers are responsible to participate in the program through:

  • Providing relevant clinical information, as requested
  • Taking action to follow-up on reported information
  • Participating in the member/consumer plan of care

Based upon the illness and the severity of illness of your members, you may be asked to refer AmeriHealth Caritas patients to us for participation in one or more of the Intensive Case Management programs. These programs are intended to be a collaborative arrangement between our Case Managers and your existing treatment plans for the involved members and will in no way impede your autonomy to provide care to members enrolled in the following programs:

Pediatric Preventive Care

This program provides the following services for members under two years of age:

  • Outreach calls for age appropriate EPSDT services
  • Outreach calls by case managers to members with children under age one who have no history of immunizations
  • Annual birthday card reminders for all EPSDT services
  • Identification of children with elevated lead levels to ensure ongoing care is received
  • Coordination of specialty care referrals and services for children with serious medical needs

All other EPSDT members (age 2-20) are eligible for all other EPSDT related services, including annual birthday card reminders for all EPSDT services due.  For more information, please contact our Pediatric Preventive Care Liaison at 1-800-521-6007.

Bright Start® Program (Pregnancy Management)

This pregnancy management program is called Bright Start and separates pregnant AmeriHealth Caritas members into low- and high-intensity risk categories with the following goals:

  • Low Risk Pregnancy Management. Members will receive pregnancy-related educational materials encouraging good prenatal care.
  • High Risk Pregnancy Management. Pregnant members identified at risk for preterm labor and/or other pregnancy complications will be assigned a nurse case manager to provide ongoing supervision and education about pregnancy. A letter will be sent to the member's physician to notify him/her of the member's enrollment in the program with a summary of the initial assessment.

All pregnant AmeriHealth Caritas members have access to a 24-hour toll free Nurse Call Line at 866-566-1513. For more information or to refer members to our pregnancy management program please call 1-800-521-6007.

Special Needs Case Management

This program addresses the needs of members who self-identify or who have special medical requirements or risk factors that are identified through physicians, case managers, etc. Special Needs Case Management is not disease specific.

For more information or to refer members to our Special Needs Case Management program, please call 1-800-684-5503.

Intensive Case Management

Intensive Case Management is a voluntary program focused on prevention, education, lifestyle choices and adherence to your treatment plan. It is designed to support your plan of care for patients with the following diseases:

Members will receive educational materials and, if identified as high risk, will be assigned to a Care Manager for one-on-one education and follow-up.

The Intensive Case Management program is also designed for AmeriHealth Caritas members with multiple chronic illnesses who require complex case management for coordination of all aspects of care and services. Members will be assigned to a care manager that will assist in coordinating all aspects of care such as ensuring access to appointments and resolving transportation, pharmacy and equipment issues. The care manager will make scheduled telephone calls to ensure the member is following the plan of care.

AmeriHealth Caritas is enthusiastic about the positive health outcomes that result from this focus on prevention, education and adherence to treatment plans. With your identification of members and consequent referrals to the programs listed above that we can assure AmeriHealth Caritas members are receiving appropriate levels of care.

For more information on any of these programs or to refer a member, please call 1-877-693-8271, option #2.

All AmeriHealth Caritas members have access to a 24-hour toll-free registered nurse call line for medical questions, when you are not available. The 24/7 Nurse Call Line is 1-866-566-1513.

Providers