Network participation and credentialing
Professional providers include but are not limited to the following specialties: physicians, radiologists, CRNP, physical therapists, registered dieticians, etc.
Most licensed practitioners are board-certified physicians. If a physician is not board certified, the required number of educational years deemed sufficient per the Accreditation Council for Graduate Medical Education (ACGME) guidelines would need to be primarily source verified. There are some instances where a practitioner is not board certified, and the educational institution per their policy requires a payment for the verification of a completed program. As needed for cases where education requires a charge, AmeriHealth will place the responsibility on the practitioner for the required verification from the institution to be sent directly to the Credentialing Operations processor.
Important credentialing notes
It typically takes 90-120 days to complete the credentialing process once AmeriHealth has received all requested documentation. Due to the influx of behavioral health providers interested in joining our network, our credentialing process is taking longer than usual.
While we remind you to please respond promptly to all inquiries for documentation, we do apologize for the delay and appreciate your patience.
- Any professional provider interested in participating in our network must complete the Practitioner Participation Form.
- 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.
Behavioral health providers
Effective January 1, 2023, AmeriHealth insourced its behavioral health network and is now directly contracting with behavioral health providers.
Although AmeriHealth does work with Magellan Healthcare, Inc. (Magellan) to help provide behavioral health services to our members, that contract ends effective December 31, 2023. To remain an in-network behavioral health provider at AmeriHealth, you must sign an AmeriHealth Provider Agreement prior to December 31, 2023.
Note: If you have not yet signed an AmeriHealth Professional Provider Agreement but are currently participating with Magellan, you will remain in-network through December 31, 2023.
Effective January 1, 2024, however, you will be considered out-of-network for our members.
If you are a behavioral health provider interested in joining our network and would like to receive an enhanced reimbursement under the terms of the AmeriHealth agreement, please follow the process outlined below:
- If you do NOT currently participate in the Magellan network: The first step is to complete the Practitioner Participation Form.
- If you DO currently participate in the Magellan network but have NOT signed an AmeriHealth Professional Provider Agreement:
Please email us at firstname.lastname@example.org and provide the following information:
- Tax identification number
- Group NPIs
- Group Name
- List of providers including their individual NPI and specialty
- Contact person including email address
- Contract signatory and email address
- If you DO currently participate in the Magellan network and have signed an AmeriHealth Professional Provider Agreement: You do NOT need to do anything. Your current credentials will remain in effect through 2023.
However, please note:
- If you are scheduled to be re-credentialed in 2023, Magellan (on behalf of AmeriHealth) will perform recredentialing and pass the results to AmeriHealth. Please be sure to respond to all recredentialing requests to ensure continuous participation. If you are a participating practice, please make sure that your practitioner roster is up to date.
- If you are scheduled to be recredentialed in 2024 or beyond, AmeriHealth will manage this process. Please note that you will need to provide credentialing documentation required for initial credentialing, so please respond to all requests in a timely manner.
Behavioral health practitioners joining existing contracted groups:
- Up through October 1, 2023: If you have a new practitioner joining a Contracted Group contracted with Magellan, or contracted with both Magellan and AmeriHealth, please submit all credentialing material to Magellan.
- If you have a new practitioner joining an AmeriHealth contracted group that does not contract with Magellan, initiate the credentialing process at AmeriHealth by completing the Practitioner Participation Form.
As AmeriHealth transitions to a directly contracted behavioral health network, behavioral health providers contracted with Magellan will continue to be considered in network only through December 31, 2023. If you have any questions related to your Magellan agreement, you can contact Magellan Provider Services Line at 1-800-788-4005 for assistance.
Magellan Healthcare, Inc., an independent company, manages mental health and substance abuse benefits for most AmeriHealth members.
Reimbursement terms effective January 1, 2023:
If you currently participate in the Magellan network but have not signed an AmeriHealth Professional Provider Agreement, you will be considered as participating in the AmeriHealth network through December 31, 2023. Effective January 1, 2024, however, you will be considered out-of-network for our members.
- You will be reimbursed in accordance with the terms and conditions specified in the Magellan Professional Provider Agreement
- While you will maintain your in-network participation status to provide services to AmeriHealth members, you will not be eligible for the AmeriHealth terms and conditions (including provider appeal rights and the enhanced AmeriHealth reimbursement) until you sign an AmeriHealth Professional Agreement.
- Please refer to the steps above to complete the contracting/credentialing process.
To confirm if you are a credentialed provider, search for your name on the AmeriHealth (PA) or AmeriHealth (NJ) Find a Doctor tool.
- If your name is listed but you need to submit provider demographic changes, please use the online Provider Change Request form: NJ Provider Change Request or PA Provider Change Request.
- If your name is not listed, it means that your credentialing application is still being processed. For a status update on your application, please contact the Provider Partnership Associate (PPA) who covers the county in which your practice is located (see table below).
Due to the influx of behavioral health providers interested in joining our network, our credentialing process is taking longer than our usual 90-to-120 day process. While we remind you to please respond promptly to all inquiries for documentation, we do apologize for the delay and appreciate your patience.
- If it has been more than 90 days since you submitted all required credentialing documentation and you wish to check the status of your application, please contact your PPA, found on the table below:
|Provider Partnership Associate (PPA)||State||County|
||NJ||Atlantic, Burlington, Cape May, Gloucester, Middlesex, Monmouth, Salem, Somerset, and Union|
||NJ & DE||Kent, New Castle, Sussex, Bergen, Camden, Cumberland, Essex, Hudson, Hunterdon, Mercer, Morris, Ocean, Passaic, Sussex, and Warren|
||PA||Lancaster and Lehigh|
Accreditation requirements 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 email@example.com. Be sure to include your name, contact number, and provider ID number in your email.
*All information obtained during the credentialing process is confidential and will not be shared with third parties. Submission of the credentialing application and required supporting documentation does not guarantee inclusion in AmeriHealth network(s).
The National Committee for Quality Assurance (NCQA) is the most widely recognized accreditation program in the U.S.