Ancillary Provider Credentialing and Demographic UpdatesAny ancillary provider interested in participating in our networks must complete the credentialing application below. Upon completion of the Ancillary Provider Credentialing Form, take the following steps:
What to ExpectWithin three (3) days of receiving your credentialing application form, we will send an email confirmation to you and forward the application to our Credentialing Committee. When your credentialing application form has been approved by the Credentialing Committee, we will send you a provider agreement. Please note that your provider participation is not effective until a mutually executed provider agreement is in place. Acceptance of your application and the subsequent execution of a contract may result in you being listed as a network provider in one or more of our provider directories. AmeriHealth does not guarantee a minimum volume of services to any network provider. Closed NetworksThe following ancillary provider network has limitations to participation: Durable medical equipmentThe Durable Medical Equipment network is closed to new providers in the Philadelphia five-county region and its contiguous counties (i.e., the counties that surround the AmeriHealth service area) except when the provider offers exclusive, medically necessary testing that cannot be obtained elsewhere. There is no waiting list for durable medical equipment providers. LaboratoryThe clinical laboratory network is closed to new providers in the Philadelphia five-county region and its contiguous counties (i.e., the counties that surround the Independence service area) except when the provider offers exclusive, medically necessary testing that cannot be obtained elsewhere. There is no waiting list for clinical laboratory providers. Provider Demographic UpdatesIf you have a change to your demographic information, please complete the Provider Demographic Change Form. Updates can be made to the following information:
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