Provider Communications Email Sign-Up Form

Complete this brief form to receive the latest news and information of interest to the AmeriHealth provider community.
Note: This form should only be completed by participating providers or their intermediary (i.e., third-party billing). If you are part of an Integrated Delivery System (IDS), please contact your Administrative office(s) Network Coordinator for AmeriHealth news and information.

Email Recipients Information (*required fields)
*First name:
*Last name:
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*Email address:

Office/Company Information
*Company name:
*Street address 1:
  Street address 2:
*City:
*State: *ZIP Code:
*Third-party billing agency: No Yes
*NPI:
*Provider type:

Choose provider type as applicable and select the specialty from the drop-down box
Professional

Ancillary/Facility
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Sign up for the following communications (Check all that apply)
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  • Partners in Health UpdateSM
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  • Medical Director Emails (for participating physicians only)
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