Resources

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.

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 more
Visit the Provider News Center

Faster reimbursement

Providers and facilities can choose to receive fully reconciled remittance advice and claims settlement payments quickly and electronically, powered by InstaMed, for services provided to patients who carry an AmeriHealth Administrators ID card.
Visit InstaMed

Streamline requests with iEXCHANGE

AmeriHealth Administrators' network providers can streamline inpatient and outpatient precertification requests and treatment updates using iEXCHANGE, our convenient, HIPAA-compliant online service offered through MEDecision, Inc.

Provider access
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New to iEXCHANGE?
Visit

Overview
Download

Frequently asked questions
Download

Inpatient requests
Download

Outpatient requests
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Contact the iEXCHANGE help desk or request a free webinar. Call 1-888-444-4617.

Dosage and Frequency Program

Learn how AmeriHealth Administrators reviews treatment regimens for certain specialty drugs to ensure they adhere to safe prescribing limits.

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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.

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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.

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Claim appeals and reimbursements

Need to appeal a claim or file for a reimbursement? Download these forms:

Premium formulary

The Premium Formulary differs from the standard drug formulary in that it excludes 80 medications, which all have clinical alternatives included in the Premium Formulary. The Premium Formulary is managed and maintained by a Pharmacy Benefits Management Company. AmeriHealth Administrators does not control how the Premium Formulary is comprised or administered.