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HIPAA Privacy Practices and Forms

AmeriHealth Administrators is committed to protecting the privacy of our customers’ personal health information. As a Business Associate, part of that commitment is complying with the Privacy Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which requires us to take additional measures to protect personal information and to inform our customers about those measures.

General HIPAA Information

  • HIPAA Compliance
  • How to Retrieve Secure Email from AmeriHealth Administrators

HIPAA Privacy Forms

For your convenience, download and print any of the following HIPAA forms as needed:

  • PDF icon Authorization to Release Information
  • PDF icon Request for Copies of PHI
  • PDF icon Request for Confidential Communication of PHI
  • PDF icon Request for Limitations and Restrictions of PHI
  • PDF icon Amendment Request
  • PDF icon Revocation of Access
  • PDF icon Request for Accounting of Disclosures of PHI
  • PDF icon Personal Representative Request

Mail or fax the completed and signed forms to:

AmeriHealth Administrators
Attn: Privacy Office
720 Blair Mill Road
Horsham, PA 19044
Fax: 215-238-7993
Phone: 215-830-2579

HIPAA Transactions for Providers

For information about HIPAA-compliant transactions, visit the Electronic Data Interchange (EDI) Services section.

HIPAA Privacy Inquiries

If you have questions or comments regarding HIPAA Privacy, please submit an inquiry.


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