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Professional provider credentialing

Credentialing and recredentialing for Pennsylvania providers

Any professional provider in Pennsylvania interested in participating in our network must complete and return a credentialing application kit. You can simplify this process using the Council for Affordable Quality Healthcare’s (CAQH) online credentialing application: CAQH ProView®. Learn more about our credentialing criteria.

Save time

Completing the credentialing process can take hours if you fill out paper forms. This is especially true if your practice contracts with multiple health plans. The CAQH ProView online application minimizes the time it will take to complete this administrative work by eliminating the need to fill out multiple, redundant and time-consuming forms.

Save money

The CAQH ProView online application is free to providers and helps practices save money on administrative resources.

Keep your information current

Keeping practice information up-to-date isn’t just important for credentialing purposes, it’s important for health plan records and directories too. The CAQH ProView, online application makes it quick and easy for you to stay current by allowing you to update only the information that needs to change. There’s no need to resubmit information that should stay the same.

The CAQH ProView electronic credentialing application is free to providers and available on the CAQH ProView website.

Behavioral health

Behavioral health providers must be contracted with Magellan Healthcare, Inc., an independent company. Interested behavioral health providers can contact Magellan by selecting the “Join the Network” link or by contacting their Magellan Provider Services Line at 1-800-788-4005 for assistance.

Network area

Pennsylvania and Delaware

If you have a primary practice address in Pennsylvania or Delaware and would like to join our network(s), you must notify AmeriHealth by submitting a Practitioner Participation Form.

Important credentialing notes

  • Any professional provider interested in participating in our network must complete the Practitioner Participation Form and the CAQH ProView credentialing application.
  • Any credentialing application request not received through the Practitioner Participation Form will be returned with instructions to submit the request using the form.
  • The Practitioner Participation Form is only for credentialing applications.
  • Certified registered nurse practitioners (CRNP) must have a collaborative agreement with a participating physician who holds a current and unrestricted license. The training and scope of practice of the collaborating physician must be consistent with the practice of the CRNP. To see scenarios where CRNPs are only allowed to be contracted and credentialed with AmeriHealth, please read this article.

Accreditation requirement for office-based varicose vein procedures

All network offices that perform varicose vein procedures will need to obtain office-level accreditation from the Intersocietal Accreditation Commission (IAC) Vein Center. To learn more about the IAC Vein Center accreditation program, please visit the IAC website or call 1-800-838-2110. If you have additional questions, please email us at qualitymanagement@amerihealth.com. Be sure to include your name, contact number, and provider ID number in your email.

Closed networks

The following professional provider networks have limitations to participation:

Pathology

The pathology provider network is closed for new office-based pathology providers in the AmeriHealth service area (i.e., participating counties in Pennsylvania, Delaware, and Maryland) except when the pathologist meets the following condition:

  • A pathology provider is joining an existing participating hospital-based pathology group in a participating hospital in our service area (as identified above).

Note: Pathologists cannot be added to participating non-pathology practices.

Podiatry

The podiatry network is closed to new providers except when the provider meets one or more of the following conditions:

  • When the provider is located in counties outside of Chester, Montgomery, Delaware, Philadelphia, and Bucks counties
  • When the provider is joining an existing participating group
  • When a non-participating provider is purchasing the assets of a participating provider, and the participating provider is terminating their AmeriHealth agreement

Chiropractic

The chiropractic network is closed to new providers in Pennsylvania and Delaware except when the provider meets one of the following conditions:

  • When the provider is joining an existing participating group
  • When a non-participating provider is purchasing the assets of a participating provider, and the participating provider is terminating their AmeriHealth agreement