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)
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Office/Company Information
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  Street address 2:
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*Third-party billing agency: No Yes
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Choose provider type as applicable and select the specialty from the drop-down box
  Professional Ancillary
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Ancillary/Facility
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Sign up for the following communications (Check all that apply)
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