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Provider Supply Line Order Form

Most of the information available through this form can also be found on our website at www.amerihealth.com or on the NaviNet® web portal. If you cannot find what you’re looking on our website or do not have access to NaviNet, please continue completing the form below.

Your request will be processed and delivered within five to seven business days.

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Your Information

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Provider/Office Information

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Please select the items you wish to request.

Behavioral Health Overview Guides









Health Care Reform




Health and Wellness Material












Member Wellness Guidelines (PA):








Manuals




Newsletters











Stickers







Other materials, including forms and patient resources, are available at:

Please note that claim forms, such as the CMS-1500, are not available through the Provider Supply Line; they are available for purchase at many local office supply stores.

If you still don’t see what you are looking for, or if you need to order larger quantities, please contact the Provider Supply Line at 1-800-858-4728.

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.