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.
- All providers in New Jersey interested in participating must complete the Practitioner Participation Form.*
- To begin the credentialing process in Pennsylvania, please visit the Professional provider credentialing process page.
Important credentialing notes
- 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 has insourced a behavioral health network and is directly contracting with behavioral health providers. However, AmeriHealth is continuing to work with Magellan Healthcare, Inc. (Magellan) through 2023 to provide a behavioral health network to its members.
If you have not yet signed an AmeriHealth Professional Provider Agreement but are currently participating with Magellan, you will be considered in-network for our members and will continue to be reimbursed according to Magellan’s reimbursement terms. If you would like to receive an enhanced reimbursement under the terms of the AmeriHealth agreement, please follow the process outlined below.
If you are a behavioral health provider interested in joining our network:
- If you do NOT currently participate in the Magellan network: The first step is to complete the Practitioner Participation Form.
- If you currently participate in the Magellan network but have NOT signed an AmeriHealth Professional Provider Agreement: To obtain a contract, you must submit an application through credentialing. This enables us to verify your credentials with Magellan and then issue you a contract.
- If you 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 on January 1, 2023. 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.
Behavioral health practitioners joining existing contracted groups:
- 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.
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.
- You then 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.
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 firstname.lastname@example.org. 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.