For providers
The future of health care is constantly changing, and you need easy access to timely, accurate information which allows you to focus on what's most important — your patients’ health.
Resources
Have you registered for the PEAR portal?
The Provider Engagement, Analytics & Reporting (PEAR) portal offers participating providers a single point of entry to multiple digital tools, including PEAR Practice Management, PEAR Comprehensive Visit, and PEAR Analytics and Reporting.
Learn moreVisit the Provider News Center
Faster reimbursement
Providers and facilities can register for and maintain electronic funds transfer (EFT) capability to receive fully reconciled remittance advice and claims settlement payments electronically for services provided to AmeriHealth Administrators plan members. This process is now supported through PNC ECHO, which offers comparable functionality to what was previously available through InstaMed.
Visit the EFT Resources page to learn more
Dosage and Frequency Program
Learn how AmeriHealth Administrators reviews treatment regimens for certain specialty drugs to ensure they adhere to safe prescribing limits.
Learn more
Most Cost-Effective Setting Program
Find out how AmeriHealth Administrators reviews the requested treatment settings for certain specialty drugs that are eligible for coverage under the medical benefit.
Learn more
Direct Ship Drug Program
AmeriHealth Administrators offers a Direct Ship Drug Program to our in-network physicians. Under this program, physicians can order certain specialty drugs that are given in the office and are eligible for coverage under the plan member's medical benefit when medical necessity criteria are met.
Learn moreElectronic Data Interchange (EDI)
Submit claims and obtain important documents online through our Electronic Data Interchange (EDI) services. Submission by EDI can increase accuracy of claims processing and the speed of claim payments.
Smart Data Solutions (SDS) provides the Stream Clearinghouse to handle EDI transactions on behalf of AmeriHealth Administrators.
Visit the Trading Partner Information Center for an overview of the registration process and to review the Trading Partner Registration Guide. You can also access commonly used resources and instructions to make changes to your Trading Partner account.
For changes to your Electronic Remittance Advice (ERA), please submit your request to both:
- SDS. Visit the Make Changes section of the Trading Partner Information Center.
- PNC Healthcare. Submit an EFT and ERA Enrollment Form to ensure your EFT transactions are appropriately handled for all our vendor platforms.
If you have questions related to conducting EDI business with AmeriHealth Administrators via the Stream Clearinghouse, please contact the SDS support team Monday - Friday, 8 a.m. - 5 p.m. ET at stream.support@sdata.us or 1-855-297-4436.
Claim appeals and reimbursements
Need to appeal a claim or file for a reimbursement? Download these forms:
Peer-to-peer Requests
The peer-to-peer process streamlines workflows, improves cost-efficiencies, and complies with accreditation requirements. To participate in the peer-to-peer process, please complete the Peer-to-Peer Request form.
Prescription drug information
Learn more about the various drug formularies offered to AmeriHealth Administrators members and access prior authorization forms.
Learn more about in-network pharmacies.
Health Coaches
Health Coaches offer condition management to all eligible members. Health Coaches help members work effectively with their physicians to make "shared decisions" that are right for them.
The best way to refer a patient for health coaching is to complete the physician referral form. Providers can also call 1-800-952-3404 to make a patient referral. Eligible members can speak with a Health Coach 24 hours a day, 7 days a week, by calling 1-800-952-3404.