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:
*Title:
*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
  Phone number:
  Name of person completing form:

Sign up for the following communications (Check all that apply)
  • Select All
  • Partners in Health UpdateSM
  • News
  • Medical Director Emails (for participating physicians only)
  • Provider Bulletins (Note: Fee schedule information is restricted to contractual notification requirements.)
Your company's firewall and email filters may erroneously block AmeriHealth email. To help ensure that your email is not blocked, please forward the following security information to your information services (IS) or information technology (IT) contacts.
To ensure your privacy, all information will be sent via a secure connection. AmeriHealth will not disclose any personal information to outside persons or entities unless we have written consent or unless authorized by law.

Please see our Notice of Privacy Practices for more information.
NaviNet® is a registered trademark of NantHealth.